Abstract
Children and adolescents are a vulnerable group to develop post-traumatic stress symptoms after natural or man-made disasters. In the light of increasing numbers of refugees under the age of 18 years worldwide, there is a significant need for effective treatments. This meta-analytic review investigates specific psychosocial treatments for children and adolescents after man-made and natural disasters. In a systematic literature search using MEDLINE, EMBASE and PsycINFO, as well as hand-searching existing reviews and contacting professional associations, 36 studies were identified. Random- and mixed-effects models were applied to test for average effect sizes and moderating variables. Overall, treatments showed high effect sizes in pre-post comparisons (Hedges' g = 1.34) and medium effect sizes as compared with control conditions (Hedges' g = 0.43). Treatments investigated by at least two studies were cognitive-behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy for children (KIDNET) and classroom-based interventions, which showed similar effect sizes. However, studies were very heterogenic with regard to their outcomes. Effects were moderated by type of profession (higher level of training leading to higher effect sizes). A number of effective psychosocial treatments for child and adolescent survivors of disasters exist. CBT, EMDR, KIDNET and classroom-based interventions can be equally recommended. Although disasters require immediate reactions and improvisation, future studies with larger sample sizes and rigorous methodology are needed.
Highlights
Natural and man-made disasters, like earthquakes, hurricanes, terrorist attacks or war, often lead to psychiatric impairment in child and adolescent survivors (Wang et al 2013; Witt et al 2015)
Inclusion criteria were: studies published in English or German during the years 2002 and the last date of literature search (25 August 2016), or unpublished data of studies during this time-frame, which was provided by the investigator, all participants of one study experienced the same natural or man-made disaster which was described in the study, all participants were under the age of 18 years, at least one outcome measure on distress related to the traumatic event with means and standard deviations was reported, all participants of one group were treated with the same treatment method, which focused on posttraumatic symptoms
Across all 36 studies included in this review, n = 3541 children and adolescents were treated with a specific therapy and n = 870 served as a control group
Summary
Natural and man-made disasters, like earthquakes, hurricanes, terrorist attacks or war, often lead to psychiatric impairment in child and adolescent survivors (Wang et al 2013; Witt et al 2015). In 2014, 59.5 million people worldwide were forcibly displaced, of which 19.5 million were international refugees. Of those refugees, 51% were children and adolescents under the age of 18 years (UNHCR, 2016). Greatly varying prevalence rates between 1 and 95% were found in a review on the prevalence of psychopathology in children and adolescent survivors of natural disasters (Wang et al 2013). Longitudinal studies included in both reviews showed rather persistent psychopathology over time and higher risk for psychiatric impairment in adulthood
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