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Meta-analysis: The Effectiveness of Youth Psychotherapy Interventions in Low- and Middle-Income Countries

Forfatter(e)
Venturo-Conerly, K. E. Eisenman, D. Wasil, A. R. Singla, D. R. Weisz, J. R.
År
2022
DOI
10.1016/j.jaac.2022.12.005
Tidsskrift
Journal of the American Academy of Child & Adolescent Psychiatry
Sider
16
Kategori(er)
Atferdsproblemer, antisosial atferd og atferdsforstyrrelser Depresjon og nedstemthet (inkl. både vansker og lidelse) Angst og engstelighet (inkl. både vansker og lidelse) Tvangsforstyrrelser (OCD) Traumatiske belastninger/stress (PTSD)
Tiltakstype(r)
Foreldreveiledning/-terapiKognitiv atferdsterapi, atferdsterapi og kognitiv terapi
Abstract

OBJECTIVE: Because most youth psychotherapies are developed and tested in high-income countries, relatively little is known about their effectiveness or moderators in low- and middle-income countries (LMICs). To address this gap, we conducted a meta-analysis of randomized controlled trials (RCTs) testing psychotherapies for youth with multiple psychiatric conditions in LMICs, and we tested candidate moderators.

METHOD: We searched nine international databases for RCTs of youth psychotherapies in LMICs published through January 2021. The RCTs targeted elevated symptoms of youth anxiety (including post-traumatic stress disorder [PTSD] and obsessive compulsive disorder [OCD]), depression, conduct, and attention problems. Using robust variance estimation, we estimated the pooled effect sizes (Hedges g) at post-treatment and follow-up for intervention versus control conditions.

RESULTS: Of 5,145 articles identified, 34 (with 43 treatment-control comparisons and N=4176 participants) met methodological standards and were included. The overall pooled g with winsorized outliers was 1.01 (95% CI=0.72 1.29, p<.001) at post-treatment and 0.68 (95% CI=0.29 1.07, p=.003) at follow-up. Interventions delivered by professional clinicians significantly outperformed those delivered by lay-providers (g=1.59 vs. 0.53). Interventions developed non-locally were more effective if not adapted to local contexts than if adapted locally (g=2.31 vs. 0.66), highlighting a need for further research on effective adaptations. Significant risk of bias was identified.

CONCLUSION: Overall pooled effects of youth psychotherapies in LMICs were markedly larger than those in recent comparable non-LMIC meta-analyses, which have shown small-to-medium effects for youth psychotherapies. Findings highlight the potential benefits of youth psychotherapies in LMICs as well as a need for more RCTs and improved study quality.