Systematic review and meta-analysis: do best-evidenced trauma-focused interventions for children and young people with PTSD lead to changes in social and interpersonal domains?

Objective

Young people with post-traumatic stress disorder experience difficulties in social and interpersonal domains. We examined whether the best-evidenced treatments of PTSD for children and young people (Trauma-focussed Cognitive Behavioural Therapy or Eye Movement Desensitisation and Reprocessing; aged 5-25) improve social or interpersonal factors in randomised controlled trials, compared to a comparator condition.Method: The review was preregistered on PROSPERO (CRD42023455615; 18th August 2023). Web of Science Core Collection, EMBASE, CINAHL, Pubmed, PsycINFO, Cochrane Central Register of Controlled Trials and PTSDPubs were searched, and data were extracted for social and interpersonal outcomes post treatment. A random effect meta-analysis was conducted to obtain between-group pooled effect size estimates.

Results

The search resulted in 792 studies, of which 17 met our inclusion criteria (N = 2498). Our meta-analysis included 13 studies which investigated social skills and functioning, revealing a small but non-significant effect favouring the evidence-based treatment versus comparison (g = .20, 95% CI [-0.03, 0.44], p = .09). We narratively synthesised six studies which reported other social-related outcomes (e.g. perceptions of social support), and four out of six reported improved social domain outcomes for the evidence-based PTSD treatment condition. There was a large amount of heterogeneity, with no evidence that this could be explained by moderators.

Conclusion

Few trials report on social and interpersonal outcomes, and where they are reported the evidence is mixed. It may be that trauma-focused therapies for PTSD need to be adapted in some circumstances, so that they address social and interpersonal deficits often seen in children and young people with PTSD.