Research methodology used in studies of child disaster mental health interventions for posttraumatic stress

Betty Pfefferbauma,⁎, Elana Newmanb,c, Summer D. Nelsonb,c, Brandi D. Lilesb,c,
Robert P. Tettc, Vandana Varmaa, Pascal Nitiémaa, Department of Psychiatry and Behavioral Sciences, College of Medicine, and Terrorism and Disaster Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA bInstitute of Trauma, Abuse and Neglect, University of Tulsa, Tulsa, OK, USA
Department of Psychology, University of Tulsa, Tulsa, OK, USA
Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

Abstract

Objective: In the last decade, the development of community-based and clinical interventions to assist children and adolescents after a disaster has become an international priority. Clinicians and researchers have begun to scientifically evaluate these interventions despite challenging conditions. The objective of this study was to conduct a systematic review of the research methodology used in studies of child disaster mental health interventions for posttraumatic stress.
Method: This scientifically rigorous analysis used standards for methodological rigor of psychosocial treatments for posttraumatic stress
disorder (PTSD) to examine 29 intervention studies.
Results: This analysis revealed that further refinement of methodology is needed to determine if certain intervention approaches are superior
to other approaches and if they provide benefit beyond natural recovery. Most studies (93.1%) clearly described the interventions being tested
or used manuals to guide application and most (89.7%) used standardized instruments to measure outcomes, and many used random
assignment (69.0%) and provided assessor training (65.5%). Fewer studies used blinded assessment (44.8%) or measured treatment
adherence (48.3%), and sample size in most studies (82.8%) was not adequate to detect small effects generally expected when comparing two
active interventions. Moreover, it is unclear what constitutes meaningful change in relation to treatment especially for the numerous
interventions administered to children in the general population.
Conclusions: Overall, the results are inconclusive about which children, what settings, and what approaches are most likely to be beneficial.
© 2014 Elsevier Inc. All rights reserved.