Standardized Mean Gain Research Articles

The Effects of Suicide Prevention Gatekeeper Training on Behavioral Intention and Intervention Behavior: A Systematic Review and Meta-Analysis.

To understand the current state of research, a systematic review and meta-analysis were conducted to synthesize the effects of suicide prevention gatekeeper training (GKT) on participant behavioral intention to intervene and participant suicide intervention behaviors. Included studies examined GKT with adult participants and measured either behavioral intention to conduct a suicide intervention or the utilization of suicide intervention skills. Searches yielded a total of 43 studies from 46 reports, comprising 21,720 participants. To quantify change over time, the standardized mean gain effect size metric was utilized. Large effect sizes were found for behavioral intention from pre-training to post-training (1.03, 95% CI [0.80, 1.25]) and short-term follow-up (0.78, 95% CI [0.59, 0.97]). Smaller effect sizes were found for intervention behavior from pre-training to short-term (0.33, 95% CI [0.21, 0.46]) and long-term follow-up (0.22, 95% CI [0.14, 0.30]). Although this meta-analysis reveals a positive effect for GKT on behavioral outcomes, the low methodological quality of the currently available evidence limits the ability to draw conclusions from the synthesis. This work informs policymakers and interventionists on best practices for GKT and highlights that additional, rigorous research is needed.

The Efficacy of Parent-Child Interaction Therapy (PCIT) for Youth with Attention-Deficit/Hyperactivity Disorder (ADHD): A Meta-Analysis.

Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent in early childhood and has long-term negative effects when left untreated. Parent-Child Interaction Therapy (PCIT) is an early intervention for children aged 2- to-7-years that has extensive evidence for treating child externalizing problems by teaching parents effective strategies to manage child behavior. However, the effect of PCIT for families with children diagnosed with ADHD is not completely understood. This meta-analysis aims to synthesize research on the use of PCIT for children with ADHD. Nine out of 711 identified studies were analyzed. Summary effect sizes were calculated using the standardized mean gain for child ADHD symptoms, child behaviors, parent stress, and parenting behaviors, and the Fail-Safe N was calculated to determine the robustness of the results. Overall, PCIT had a significant beneficial effect on child ADHD symptoms (g = 0.90), child behavior (g = 0.44), parent stress (g = 0.82), and parenting behaviors (g = 2.15). Results of this meta-analysis suggest that PCIT is an effective treatment for reducing core symptoms of ADHD.

Alcohol Use Interventions among American Indian/Alaska Native Adults: A Meta-Analysis

Alcohol use disorder is a major issue that disproportionately affects American Indian and Alaskan Native communities. There have been recent calls to help address these disparities by providing evidence-based interventions. In this paper, we contribute to these efforts by providing a meta-analysis of studies concerning the available evidence of the effectiveness of programs aimed at alcohol consumption reduction in American Indians and Alaskan Natives. We searched the literature from 2003 to 2018 and included 26 studies in the meta-analysis. Two meta-analyses were conducted because of differences in experimental designs. The first involved one-sample studies that examined the percent of participants who consumed alcohol at the end of treatment (k = 9, mean proportion = .6, 95% CI = .49 -.73, z = 9.8, p < .001). The second involved pre and posttest of alcohol consumption behavior with a significant reduction in alcohol consumption behaviors (k = 16, standardized mean gain = -0.68, 95% CI = -1.05 - -0.32, z = 3.69, p < .001). The meta-analyses highlight the current challenges associated with measuring the effectiveness of these treatment programs and give empirically informed advice about some possible future avenues.

Effectiveness of community-based early intervention for children with autism spectrum disorder: a meta-analysis.

Research trials of early intervention (EI) programs for children with autism spectrum disorder (ASD) generally demonstrate medium-to-large gains, on average, compared with "treatment as usual," in different developmental domains. Almost all children with ASD receive their treatment through community-based services, however, and studies suggest that evidence-based interventions rarely make their way into community practice. Understanding the effectiveness of community-based EI and factors associated with these effects is the first step in developing strategies for wide-scale implementation of effective EI. Studies of community-based EI for children with ASD were identified through a systematic search. Changes in cognitive, communication, social, and adaptive functioning from pre-treatment to post-treatment were assessed using standardized mean gain scores. Effect sizes were estimated using random effects models. Moderators of interest included type of community EI program, year of publication, intervention duration, and sample selection. Moderator effects were assessed using analysis of variance of mixed-effects models and meta-regression analyses. Forty-six groups from 33 studies met inclusion criteria (1,713 participants, mean age 37.4months, 81.1% male). There were small but statistically significant gains in each of the four domains. Hedges's g ranged from 0.21 for adaptive behavior to 0.32 for communication outcomes, after removing outliers and correcting for publication bias. EI programs associated with universities and hospitals were superior, on average, to other community EI programs for cognitive and adaptive behavior outcomes. Intervention duration was negatively associated with effect sizes for communication and adaptive behavior outcomes. These results indicate that there remains a large gap between outcomes observed in community settings and those reported in efficacy trials.

Working through the blues: A meta-analysis on Interpersonal Psychotherapy for depressed adolescents (IPT-A)

Previous research has indicated that Interpersonal Psychotherapy (IPT) is generally effective for ameliorating symptoms for adults suffering from depression. Indeed, this has been demonstrated through numerous clinical and open trials, and further confirmed on a larger degree through several meta-analyses. However, no such comprehensive reviews have been conducted exclusively with adolescents, a population for which interpersonal relationships holds immense developmental importance. Therefore, a meta-analysis of the effectiveness of IPT-A, the version of IPT modified to specifically address depression in adolescents, was conducted in the present review. A total of ten studies yielding 766 participants were included in the present meta-analysis and analyzed using a standardized mean gain (SMG) effect size. The results indicate that IPT-A was significantly effective at reducing depressive symptoms in adolescents and significantly more effective than control or treatment-as-usual groups in treating depression in adolescents. IPT-A yielded an overall effect size (Hedges g) of 1.19, while the aggregate effect size for control/placebo groups was 0.58. Overall, the results of this review suggest that IPT-A holds similar promise for improving adolescent depression as the original version does for adults.

Systematic review and meta-analysis of the Skills for Social and Academic Success (SASS) program

The purpose of this systematic review and meta-analysis was to synthesize the available research on the Skills for Social and Academic Success (SASS) program, a school-based cognitive/behavioural intervention for adolescents with social anxiety disorder. A search of online databases, combined with reference list examination and communication with program implementers/developers, led to the identification of five (5) studies that explored the effects of the SASS program (N = 227). Given the age of target individuals, analyses focused on self-report of anxiety, with effect sizes aggregated according to a random effects model and calculated as differences in scores between time points (e.g. Standardized Mean Gain). This program is unique in that it was developed specifically for implementation within school systems. The preliminary evidence based on existing studies suggests that the program holds promise for assisting teens with social anxiety in an ecologically valid setting. In the contemporary context of evidence-based practice, it demonstrates initial empirical support, though additional trials are needed to bolster the overall sample size of youth served, and additional generalization studies are needed.

Atomoxetine treatment for children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): a comprehensive meta-analysis of outcomes on parent-rated core symptomatology.

Attention-Deficit/Hyperactivity Disorder (ADHD) impacts a significant number of children and adolescents and often leads to deleterious functional impairment. Psychostimulant medication has historically been the first line of pharmacological intervention, though recent years have seen greater attention paid to non-stimulant alternatives. The objective of the present study was to conduct the most comprehensive meta-analysis to date evaluating the efficacy of atomoxetine in reducing core symptomatology of ADHD according to parent report. Selection criteria were applied, and studies were located by searching electronic databases, review of reference sections, and contact with expert researchers; article searching began on 10/01/2013, and the final search was conducted on 09/01/2014. A total of 42 studies met inclusion criteria-33 with control groups and 9 without-for a total sample of 8398 individuals. For those receiving atomoxetine, the summary pre-post (e.g., standardized mean gain) effect size estimate was 1.37 (95% CI [1.24, 1.51], p<.001); atomoxetine was found to statistically significantly outperform control conditions overall (Z=4.07, p<.001), though results differed by the type of control group; for instance, when comparing atomoxetine to alternative medications as controls, significant differences were no longer present. The non-stimulant atomoxetine led to significant improvement in core ADHD symptomatology and should be considered as a viable pharmacological treatment option for ADHD.

Effectiveness of and dropout from outpatient cognitive behavioral therapy for adult unipolar depression: A meta-analysis of nonrandomized effectiveness studies.

The primary aim of this study was to assess the overall effectiveness of and dropout from individual and group outpatient cognitive behavioral therapy (CBT) for adults with a primary diagnosis of unipolar depressive disorder in routine clinical practice. We conducted a random effects meta-analysis of 34 nonrandomized effectiveness studies on outpatient individual and group CBT for adult unipolar depressive disorder. Standardized mean gain effect sizes are reported for end-of-treatment and 6-month follow-up effects for depression severity, dysfunctional cognitions, general anxiety, psychological distress, and functional impairment. The mean dropout rate from CBT is reported. We benchmarked our results against high-quality randomized controlled trials (RCTs). Outpatient CBT was effective in reducing depressive severity in completer (d = 1.13) and intention-to-treat (ITT) samples (d = 1.06). Moderate to large posttreatment effect sizes (d = 0.67-0.88) were found for secondary outcomes. The weighted mean dropout rate was 24.63%. Posttreatment gains for depression were maintained at 6 months after completion of therapy. Effect sizes for depression were inferior to those of benchmark RCTs. Although clinical practice patients show lesser improvements in depressive symptoms than RCT patients, individual and group outpatient CBT can be effectively transported to routine clinical practice. The considerable treatment dropout rate, especially in individual CBT, must be improved. The small number of available studies and low quality of some reports stress the need for high-quality effectiveness studies.

Revisiting the affect regulation model of binge eating: A meta-analysis of studies using ecological momentary assessment.

The affect regulation model of binge eating, which posits that patients binge eat to reduce negative affect (NA), has received support from cross-sectional and laboratory-based studies. Ecological momentary assessment (EMA) involves momentary ratings and repeated assessments over time and is ideally suited to identify temporal antecedents and consequences of binge eating. This meta-analytic review includes EMA studies of affect and binge eating. Electronic database and manual searches produced 36 EMA studies with N = 968 participants (89% Caucasian women). Meta-analyses examined changes in affect before and after binge eating using within-subjects standardized mean gain effect sizes (ESs). Results supported greater NA preceding binge eating relative to average affect (ES = 0.63) and affect before regular eating (ES = 0.68). However, NA increased further following binge episodes (ES = 0.50). Preliminary findings suggested that NA decreased following purging in bulimia nervosa (ES = -0.46). Moderators included diagnosis (with significantly greater elevations of NA prior to bingeing in binge eating disorder compared to bulimia nervosa) and binge definition (with significantly smaller elevations of NA before binge vs. regular eating episodes for the Diagnostic and Statistical Manual of Mental Disorders definition compared to lay definitions of binge eating). Overall, results fail to support the affect regulation model of binge eating and challenge reductions in NA as a maintenance factor for binge eating. However, limitations of this literature include unidimensional analyses of NA and inadequate examination of affect during binge eating, as binge eating may regulate only specific facets of affect or may reduce NA only during the episode.