This is a protocol for a Cochrane Review (qualitative). The objectives are as follows:
This review will gather and synthesise the experiences of interventions for survivors of sexual abuse and ...violence, their families, as well as the professionals who deliver them.
Specifically, this review seeks to:
identify, appraise and synthesise qualitative studies exploring the experiences of child and adult survivors of sexual abuse and violence, and their caregivers, regarding psychosocial interventions aimed at supporting survivors and preventing negative health outcomes in terms of benefits, risks/harms and barriers;
identify, appraise and synthesise qualitative studies exploring the experiences of professionals who deliver psychosocial interventions for sexual abuse and violence in terms of perceived benefits, risks/harms and barriers for survivors and their families/caregivers;
develop a conceptual understanding of how different factors influence uptake, dropout or completion, and outcomes from psychosocial interventions for sexual abuse and violence;
develop understanding of how features and types of interventions respond to the needs of different user/survivor groups (e.g. age groups; types of abuse exposure; migrant populations) and contexts (healthcare/therapeutic settings; low‐ and middle‐income countries (LMICs)); and
explore how the findings of this review can enhance our understanding of the findings from the linked and related reviews assessing the effectiveness of interventions aimed at supporting survivors and preventing negative health outcomes.
Background
The coronavirus disease 2019 (COVID-19) pandemic is having a profound impact on the health and development of children worldwide. There is limited evidence on the impact of COVID-19 and ...its related school closures and disease-containment measures on the psychosocial wellbeing of children; little research has been done on the characteristics of vulnerable groups and factors that promote resilience.
Methods
We conducted a large-scale cross-sectional population study of Hong Kong families with children aged 2–12 years. Parents completed an online survey on family demographics, child psychosocial wellbeing, functioning and lifestyle habits, parent–child interactions, and parental stress during school closures due to COVID-19. We used simple and multiple linear regression analyses to explore factors associated with child psychosocial problems and parental stress during the pandemic.
Results
The study included 29,202 individual families; of which 12,163 had children aged 2–5 years and 17,029 had children aged 6–12 years. The risk of child psychosocial problems was higher in children with special educational needs, and/or acute or chronic disease, mothers with mental illness, single-parent families, and low-income families. Delayed bedtime and/or inadequate sleep or exercise duration, extended use of electronic devices were associated with significantly higher parental stress and more psychosocial problems among pre-schoolers.
Conclusions
This study identifies vulnerable groups of children and highlights the importance of strengthening family coherence, adequate sleep and exercise, and responsible use of electronic devices in promoting psychosocial wellbeing during the COVID-19 pandemic.
Background
Emotional and behavioural problems in children are common. Research suggests that parenting has an important role to play in helping children to become well‐adjusted, and that the first ...few months and years are especially important. Parenting programmes may have a role to play in improving the emotional and behavioural adjustment of infants and toddlers, and this review examined their effectiveness with parents and carers of young children.
Objectives
1. To establish whether group‐based parenting programmes are effective in improving the emotional and behavioural adjustment of young children (maximum mean age of three years and 11 months); and
2. To assess whether parenting programmes are effective in the primary prevention of emotional and behavioural problems.
Search methods
In July 2015 we searched CENTRAL (the Cochrane Library), Ovid MEDLINE, Embase (Ovid), and 10 other databases. We also searched two trial registers and handsearched reference lists of included studies and relevant systematic reviews.
Selection criteria
Two reviewers independently assessed the records retrieved by the search. We included randomised controlled trials (RCTs) and quasi‐RCTs of group‐based parenting programmes that had used at least one standardised instrument to measure emotional and behavioural adjustment in children.
Data collection and analysis
One reviewer extracted data and a second reviewer checked the extracted data. We presented the results for each outcome in each study as standardised mean differences (SMDs) with 95% confidence intervals (CIs). Where appropriate, we combined the results in a meta‐analysis using a random‐effects model. We used the GRADE (Grades of Recommendations, Assessment, Development, and Evaluation) approach to assess the overall quality of the body of evidence for each outcome.
Main results
We identified 22 RCTs and two quasi‐RCTs evaluating the effectiveness of group‐based parenting programmes in improving the emotional and behavioural adjustment of children aged up to three years and 11 months (maximum mean age three years 11 months).
The total number of participants in the studies were 3161 parents and their young children. Eight studies were conducted in the USA, five in the UK, four in Canada, five in Australia, one in Mexico, and one in Peru. All of the included studies were of behavioural, cognitive‐behavioural or videotape modelling parenting programmes.
We judged 50% (or more) of the included studies to be at low risk for selection bias, detection bias (observer‐reported outcomes), attrition bias, selective reporting bias, and other bias. As it is not possible to blind participants and personnel to the type of intervention in these trials, we judged all studies to have high risk of performance bias. Also, there was a high risk of detection bias in the 20 studies that included parent‐reported outcomes.
The results provide evidence that group‐based parenting programmes reduce overall emotional and behavioural problems (SMD ‐0.81, 95% CI ‐1.37 to ‐0.25; 5 studies, 280 participants, low quality evidence) based on total parent‐reported data assessed at postintervention. This result was not, however, maintained when two quasi‐RCTs were removed as part of a sensitivity analysis (SMD ‐0.67, 95% CI ‐1.43 to 0.09; 3 studies, 221 participants). The results of data from subscales show evidence of reduced total externalising problems (SMD ‐0.23, 95% CI ‐0.46 to ‐0.01; 8 studies, 989 participants, moderate quality evidence). Single study results show very low quality evidence of reductions in externalising problems hyperactivity‐inattention subscale (SMD ‐1.34; 95% CI ‐2.37 to ‐0.31; 19 participants), low quality evidence of no effect on total internalising problems (SMD 0.34; 95% CI ‐0.12 to 0.81; 73 participants), and very low quality evidence of an increase in social skills (SMD 3.59; 95% CI 2.42 to 4.76; 32 participants), based on parent‐reported data assessed at postintervention. Results for secondary outcomes, which were also measured using subscales, show an impact on parent‐child interaction in terms of reduced negative behaviour (SMD ‐0.22, 95% CI ‐0.39 to ‐0.06; 7 studies, 941 participants, moderate quality evidence), and improved positive behaviour (SMD 0.48, 95% CI 0.17 to 0.79; 4 studies, 173 participants, moderate quality evidence) as rated by independent observers postintervention. No further meta‐analyses were possible. Results of subgroup analyses show no evidence for treatment duration (seven weeks or less versus more than eight weeks) and inconclusive evidence for prevention versus treatment interventions.
Authors' conclusions
The findings of this review, which relate to the broad group of universal and at‐risk (targeted) children and parents, provide tentative support for the use of group‐based parenting programmes to improve the overall emotional and behavioural adjustment of children with a maximum mean age of three years and 11 months, in the short‐term. There is, however, a need for more research regarding the role that these programmes might play in the primary prevention of both emotional and behavioural problems, and their long‐term effectiveness.
This literature review was conducted to summarise empirical evidence relating to psychosocial health following ostomy surgery during hospitalisation and after discharge. Both qualitative and ...quantitative studies were searched from 2000 to 2017 using PubMed, CINAHL, Ebrary, Elsevier, Science Direct, and Scopus. Twenty‐seven articles were included that examined the patient's psychosocial health following colostomy or ileostomy surgery. Among the 27 included studies, 11 adopted qualitative research methods and 16 used quantitative designs. Most of the studies were conducted to determine psychosocial problems and emotions of the individuals, their adaptation to the stoma, and their quality of life. Most of the psychosocial problems identified in these studies were poor body image perception and self‐respect, depression, sexual problems, and lower psychosocial adaptation. This literature review has illustrated the patient's psychosocial health following stoma surgery. Further studies exploring the effect of psychosocial interventions could be planned.
The return-to-work (RTW) process for people with multimorbidity and psychosocial difficulties can be complicated. This study explores the organisational prerequisites for coordinating these patients' ...RTW processes from the perspective of coordinators in different clinical areas in Sweden.
Six focus group interviews were conducted with 24 coordinators working in primary healthcare (PHC), psychiatric and orthopaedic clinics. The data were analysed thematically, inspired by organisation theory.
Coordinators described varying approaches to people with multimorbidity and psychosocial difficulties, with more hesitancy among PHC coordinators, who were perceived by other coordinators as hindering patient flows between clinical areas. Most organisational barriers to RTW were identified in the healthcare sector. These were long waiting times, physicians drawing up inadequate RTW plans, coordinators being involved late in the sickness absence process, and lack of rehabilitation programmes for people with multimorbidity. The barriers in relation to organisations such as Social Insurance Agency and Employment Services were caused by regulations and differing perspectives, priorities, and procedures.
Our findings indicate what is needed to improve the RTW process for patients with complex circumstances: better working conditions, steering, and guidelines; shorter waiting times; and a willingness among coordinators from different clinical areas to collaborate around patients.
Implications for rehabilitation
RTW coordinators need sufficient physical and psychosocial working conditions as well as clear leadership.
In order to avoid inequalities in access to RTW support, better systems are needed to identify patients who would benefit from rehabilitation and RTW coordination.
There is a need for multilevel collaboration between clinical areas so that patients with multiple healthcare contacts and prolonged sickness absence can obtain support during the RTW process.
Background
Emotional and behavioural difficulties (EBD) in children are common, characterised by externalising or internalising behaviours that can be highly stable over time. EBD are an important ...cause of functional disability in childhood, and predictive of poorer psychosocial, academic, and occupational functioning into adolescence and adulthood. The prevalence, stability, and long‐term consequences of EBD highlight the importance of intervening in childhood when behavioural patterns are more easily modified.
Multiple factors contribute to the aetiology of EBD in children, and parenting plays an important role. The relationship between parenting and EBD has been described as bidirectional, with parents and children shaping one another’s behaviour. One consequence of bidirectionality is that parents with insufficient parenting skills may become involved in increasingly negative behaviours when dealing with non‐compliance in children. This can have a cyclical effect, exacerbating child behavioural difficulties and further increasing parental distress.
Behavioural or skills‐based parenting training can be highly effective in addressing EBD in children. However, emotional dysregulation may intercept some parents' ability to implement parenting skills, and there is recognition that skills‐based interventions may benefit from adjunct components that better target parental emotional responses. Mindful parenting interventions have demonstrated some efficacy in improving child outcomes via improvements in parental emotion regulation, and there is potential for mindfulness training to enhance the effectiveness of standard parent training programmes.
Objectives
To assess the effectiveness of mindfulness‐enhanced parent training programmes on the psychosocial functioning of children (aged 0 to 18 years) and their parents.
Search methods
We searched the following databases up to April 2023: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL Plus, PsycINFO, Sociological s, Social Sciences Citation Index, Conference Proceedings Citation Index – Social Science & Humanities, AMED, ERIC, ProQuest Dissertations & Theses, Cochrane Database of Systematic Reviews, Campbell Collaboration Library of Systematic Reviews, as well as the following trials registers: ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We also contacted organisations/experts in the field.
Selection criteria
We included randomised and quasi‐randomised trials. Participants were parents or caregivers of children under the age of 18. The intervention was mindfulness‐enhanced parent training programmes compared with a no‐intervention, waitlist, or attentional control, or a parent training programme with no mindfulness component. The intervention must have combined mindfulness parent training with behavioural or skills‐based parent training. We defined parent training programmes in terms of the delivery of a standardised and manualised intervention over a specified and limited period, on a one‐to‐one or group‐basis, with a well‐defined mindfulness component. The mindfulness component must have included mindfulness training (breath, visualisation, listening, or other sensory focus) and an explicit focus on present‐focused attention and non‐judgemental acceptance.
Data collection and analysis
We followed standard Cochrane procedures.
Main results
Eleven studies met our inclusion criteria, including one ongoing study. The studies compared a mindfulness‐enhanced parent training programme with a no‐treatment, waitlist, or attentional control (2 studies); a parent training programme with no mindfulness component (5 studies); both a no‐treatment, waitlist, or attentional control and a parent training programme with no mindfulness component (4 studies). We assessed all studies as being at an unclear or high risk of bias across multiple domains. We pooled child and parent outcome data from 2118 participants to produce effect estimates. No study explicitly reported on self‐compassion, and no adverse effects were reported in any of the studies.
Mindfulness‐enhanced parent training programmes compared to a no‐treatment, waitlist, or attentional control
Very low certainty evidence suggests there may be a small to moderate postintervention improvement in child emotional and behavioural adjustment (standardised mean difference (SMD) −0.46, 95% confidence interval (CI) −0.96 to 0.03; P = 0.06, I2 = 62%; 3 studies, 270 participants); a small improvement in parenting skills (SMD 0.22, 95% CI 0.06 to 0.39; P = 0.008, I2 = 0%; 3 studies, 587 participants); and a moderate decrease in parental depression or anxiety (SMD −0.50, 95% CI −0.96 to −0.04; P = 0.03; 1 study, 75 participants). There may also be a moderate to large decrease in parenting stress (SMD −0.79, 95% CI −1.80 to 0.23; P = 0.13, I2 = 82%; 2 studies, 112 participants) and a small improvement in parent mindfulness (SMD 0.21, 95% CI −0.14 to 0.56; P = 0.24, I2 = 69%; 3 studies, 515 participants), but we were not able to exclude little to no effect for these outcomes.
Mindfulness‐enhanced parent training programmes compared to parent training with no mindfulness component
Very low certainty evidence suggests there may be little to no difference postintervention in child emotional and behavioural adjustment (SMD −0.09, 95% CI −0.58 to 0.40; P = 0.71, I2 = 64%; 5 studies, 203 participants); parenting skills (SMD 0.13, 95% CI −0.16 to 0.42; P = 0.37, I2 = 16%; 3 studies, 319 participants); and parent mindfulness (SMD 0.11, 95% CI −0.19 to 0.41; P = 0.48, I2 = 44%; 4 studies, 412 participants). There may be a slight decrease in parental depression or anxiety (SMD −0.24, 95% CI −0.83 to 0.34; P = 0.41; 1 study, 45 participants; very low certainty evidence), though we cannot exclude little to no effect, and a moderate decrease in parenting stress (SMD −0.51, 95% CI −0.84 to −0.18; P = 0.002, I2 = 2%; 3 studies, 150 participants; low certainty evidence).
Authors' conclusions
Mindfulness‐enhanced parenting training may improve some parent and child outcomes, with no studies reporting adverse effects. Evidence for the added value of mindfulness training to skills‐based parenting training programmes is suggestive at present, with moderate reductions in parenting stress. Given the very low to low certainty evidence reviewed here, these estimates will likely change as more high‐quality studies are produced.
Introduction: Psychosocial problems can trouble anyone. Defendants living at a detention center have high risk of experiencing psychosocial problems due to restrictions on social relations with ...people outside. The purpose of this study was to determine the psychosocial problems experienced by defendants in Pekalongan Detention Center.
Background
Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. This review updates and replaces an earlier review ...(Stoffers‐Winterling 2012).
Objectives
To assess the beneficial and harmful effects of psychological therapies for people with BPD.
Search methods
In March 2019, we searched CENTRAL, MEDLINE, Embase, 14 other databases and four trials registers. We contacted researchers working in the field to ask for additional data from published and unpublished trials, and handsearched relevant journals. We did not restrict the search by year of publication, language or type of publication.
Selection criteria
Randomised controlled trials comparing different psychotherapeutic interventions with treatment‐as‐usual (TAU; which included various kinds of psychotherapy), waiting list, no treatment or active treatments in samples of all ages, in any setting, with a formal diagnosis of BPD. The primary outcomes were BPD symptom severity, self‐harm, suicide‐related outcomes, and psychosocial functioning. There were 11 secondary outcomes, including individual BPD symptoms, as well as attrition and adverse effects.
Data collection and analysis
At least two review authors independently selected trials, extracted data, assessed risk of bias using Cochrane's 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach. We performed data analysis using Review Manager 5 and quantified the statistical reliability of the data using Trial Sequential Analysis.
Main results
We included 75 randomised controlled trials (4507 participants), predominantly involving females with mean ages ranging from 14.8 to 45.7 years. More than 16 different kinds of psychotherapy were included, mostly dialectical behaviour therapy (DBT) and mentalisation‐based treatment (MBT). The comparator interventions included treatment‐as‐usual (TAU), waiting list, and other active treatments. Treatment duration ranged from one to 36 months.
Psychotherapy versus TAU
Psychotherapy reduced BPD symptom severity, compared to TAU; standardised mean difference (SMD) −0.52, 95% confidence interval (CI) −0.70 to −0.33; 22 trials, 1244 participants; moderate‐quality evidence. This corresponds to a mean difference (MD) of −3.6 (95% CI −4.4 to −2.08) on the Zanarini Rating Scale for BPD (range 0 to 36), a clinically relevant reduction in BPD symptom severity (minimal clinical relevant difference (MIREDIF) on this scale is −3.0 points).
Psychotherapy may be more effective at reducing self‐harm compared to TAU (SMD −0.32, 95% CI −0.49 to −0.14; 13 trials, 616 participants; low‐quality evidence), corresponding to a MD of −0.82 (95% CI −1.25 to 0.35) on the Deliberate Self‐Harm Inventory Scale (range 0 to 34). The MIREDIF of −1.25 points was not reached.
Suicide‐related outcomes improved compared to TAU (SMD −0.34, 95% CI −0.57 to −0.11; 13 trials, 666 participants; low‐quality evidence), corresponding to a MD of −0.11 (95% CI −0.19 to −0.034) on the Suicidal Attempt Self Injury Interview. The MIREDIF of −0.17 points was not reached.
Compared to TAU, psychotherapy may result in an improvement in psychosocial functioning (SMD −0.45, 95% CI −0.68 to −0.22; 22 trials, 1314 participants; low‐quality evidence), corresponding to a MD of −2.8 (95% CI −4.25 to −1.38), on the Global Assessment of Functioning Scale (range 0 to 100). The MIREDIF of −4.0 points was not reached.
Our additional Trial Sequential Analysis on all primary outcomes reaching significance found that the required information size was reached in all cases.
A subgroup analysis comparing the different types of psychotherapy compared to TAU showed no clear evidence of a difference for BPD severity and psychosocial functioning.
Psychotherapy may reduce depressive symptoms compared to TAU but the evidence is very uncertain (SMD −0.39, 95% CI −0.61 to −0.17; 22 trials, 1568 participants; very low‐quality evidence), corresponding to a MD of −2.45 points on the Hamilton Depression Scale (range 0 to 50). The MIREDIF of −3.0 points was not reached.
BPD‐specific psychotherapy did not reduce attrition compared with TAU. Adverse effects were unclear due to too few data.
Psychotherapy versus waiting list or no treatment
Greater improvements in BPD symptom severity (SMD −0.49, 95% CI −0.93 to −0.05; 3 trials, 161 participants), psychosocial functioning (SMD −0.56, 95% CI −1.01 to −0.11; 5 trials, 219 participants), and depression (SMD −1.28, 95% CI −2.21 to −0.34, 6 trials, 239 participants) were observed in participants receiving psychotherapy versus waiting list or no treatment (all low‐quality evidence). No evidence of a difference was found for self‐harm and suicide‐related outcomes.
Individual treatment approaches
DBT and MBT have the highest numbers of primary trials, with DBT as subject of one‐third of all included trials, followed by MBT with seven RCTs.
Compared to TAU, DBT was more effective at reducing BPD severity (SMD −0.60, 95% CI −1.05 to −0.14; 3 trials, 149 participants), self‐harm (SMD −0.28, 95% CI −0.48 to −0.07; 7 trials, 376 participants) and improving psychosocial functioning (SMD −0.36, 95% CI −0.69 to −0.03; 6 trials, 225 participants). MBT appears to be more effective than TAU at reducing self‐harm (RR 0.62, 95% CI 0.49 to 0.80; 3 trials, 252 participants), suicidality (RR 0.10, 95% CI 0.04, 0.30, 3 trials, 218 participants) and depression (SMD −0.58, 95% CI −1.22 to 0.05, 4 trials, 333 participants). All findings are based on low‐quality evidence. For secondary outcomes see review text.
Authors' conclusions
Our assessments showed beneficial effects on all primary outcomes in favour of BPD‐tailored psychotherapy compared with TAU. However, only the outcome of BPD severity reached the MIREDIF‐defined cut‐off for a clinically meaningful improvement. Subgroup analyses found no evidence of a difference in effect estimates between the different types of therapies (compared to TAU) .
The pooled analysis of psychotherapy versus waiting list or no treatment found significant improvement on BPD severity, psychosocial functioning and depression at end of treatment, but these findings were based on low‐quality evidence, and the true magnitude of these effects is uncertain. No clear evidence of difference was found for self‐harm and suicide‐related outcomes.
However, compared to TAU, we observed effects in favour of DBT for BPD severity, self‐harm and psychosocial functioning and, for MBT, on self‐harm and suicidality at end of treatment, but these were all based on low‐quality evidence. Therefore, we are unsure whether these effects would alter with the addition of more data.
Background
Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children and adolescents with ADHD find it ...difficult to pay attention and they are hyperactive and impulsive. Methylphenidate is the psychostimulant most often prescribed, but the evidence on benefits and harms is uncertain. This is an update of our comprehensive systematic review on benefits and harms published in 2015.
Objectives
To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD.
Search methods
We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers up to March 2022. In addition, we checked reference lists and requested published and unpublished data from manufacturers of methylphenidate.
Selection criteria
We included all randomised clinical trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. The search was not limited by publication year or language, but trial inclusion required that 75% or more of participants had a normal intellectual quotient (IQ > 70). We assessed two primary outcomes, ADHD symptoms and serious adverse events, and three secondary outcomes, adverse events considered non‐serious, general behaviour, and quality of life.
Data collection and analysis
Two review authors independently conducted data extraction and risk of bias assessment for each trial. Six review authors including two review authors from the original publication participated in the update in 2022. We used standard Cochrane methodological procedures. Data from parallel‐group trials and first‐period data from cross‐over trials formed the basis of our primary analyses. We undertook separate analyses using end‐of‐last period data from cross‐over trials. We used Trial Sequential Analyses (TSA) to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the GRADE approach.
Main results
We included 212 trials (16,302 participants randomised); 55 parallel‐group trials (8104 participants randomised), and 156 cross‐over trials (8033 participants randomised) as well as one trial with a parallel phase (114 participants randomised) and a cross‐over phase (165 participants randomised). The mean age of participants was 9.8 years ranging from 3 to 18 years (two trials from 3 to 21 years). The male‐female ratio was 3:1. Most trials were carried out in high‐income countries, and 86/212 included trials (41%) were funded or partly funded by the pharmaceutical industry. Methylphenidate treatment duration ranged from 1 to 425 days, with a mean duration of 28.8 days. Trials compared methylphenidate with placebo (200 trials) and with no intervention (12 trials). Only 165/212 trials included usable data on one or more outcomes from 14,271 participants.
Of the 212 trials, we assessed 191 at high risk of bias and 21 at low risk of bias. If, however, deblinding of methylphenidate due to typical adverse events is considered, then all 212 trials were at high risk of bias.
Primary outcomes: methylphenidate versus placebo or no intervention may improve teacher‐rated ADHD symptoms (standardised mean difference (SMD) −0.74, 95% confidence interval (CI) −0.88 to −0.61; I² = 38%; 21 trials; 1728 participants; very low‐certainty evidence). This corresponds to a mean difference (MD) of −10.58 (95% CI −12.58 to −8.72) on the ADHD Rating Scale (ADHD‐RS; range 0 to 72 points). The minimal clinically relevant difference is considered to be a change of 6.6 points on the ADHD‐RS. Methylphenidate may not affect serious adverse events (risk ratio (RR) 0.80, 95% CI 0.39 to 1.67; I² = 0%; 26 trials, 3673 participants; very low‐certainty evidence). The TSA‐adjusted intervention effect was RR 0.91 (CI 0.31 to 2.68).
Secondary outcomes: methylphenidate may cause more adverse events considered non‐serious versus placebo or no intervention (RR 1.23, 95% CI 1.11 to 1.37; I² = 72%; 35 trials 5342 participants; very low‐certainty evidence). The TSA‐adjusted intervention effect was RR 1.22 (CI 1.08 to 1.43). Methylphenidate may improve teacher‐rated general behaviour versus placebo (SMD −0.62, 95% CI −0.91 to −0.33; I² = 68%; 7 trials 792 participants; very low‐certainty evidence), but may not affect quality of life (SMD 0.40, 95% CI −0.03 to 0.83; I² = 81%; 4 trials, 608 participants; very low‐certainty evidence).
Authors' conclusions
The majority of our conclusions from the 2015 version of this review still apply. Our updated meta‐analyses suggest that methylphenidate versus placebo or no‐intervention may improve teacher‐rated ADHD symptoms and general behaviour in children and adolescents with ADHD. There may be no effects on serious adverse events and quality of life. Methylphenidate may be associated with an increased risk of adverse events considered non‐serious, such as sleep problems and decreased appetite. However, the certainty of the evidence for all outcomes is very low and therefore the true magnitude of effects remain unclear.
Due to the frequency of non‐serious adverse events associated with methylphenidate, the blinding of participants and outcome assessors is particularly challenging. To accommodate this challenge, an active placebo should be sought and utilised. It may be difficult to find such a drug, but identifying a substance that could mimic the easily recognised adverse effects of methylphenidate would avert the unblinding that detrimentally affects current randomised trials.
Future systematic reviews should investigate the subgroups of patients with ADHD that may benefit most and least from methylphenidate. This could be done with individual participant data to investigate predictors and modifiers like age, comorbidity, and ADHD subtypes.
•Traditional and cyber bullying victimization did not predict psychosocial problems.•Adolescents with psychosocial problems were more likely to be bullied.•Psychosocial problems showed no distinct ...effects on two types of bullying victimization.•Boys high in loneliness tended to experience more cyberbullying victimization.
Traditional bullying and cyberbullying victimization are associated with adolescents’ mental health problems, but the temporal sequence of these relations remains unclear. The present study analyzed the temporal and reciprocal relationships between both types of bullying victimization and six frequent psychosocial problems during adolescence: depression, general anxiety, stress, low self-esteem, social anxiety, and loneliness.
A total of 661 Chinese adolescents in grades 7 and 8 at the initial wave of the study responded to the survey items assessing their bullying victimization experiences and self-reported psychosocial problems. This research was conducted at three separate time points, over a year and a half period.
Bullying victimization did not predict adolescents’ psychosocial problems. Instead, adolescents with psychosocial problems were more likely to experience bullying victimization. Depression and general anxiety were two common predictors of traditional bullying and cyberbullying victimization. Stress was a specific predictor of traditional bullying victimization, whereas self-esteem, social anxiety, and loneliness were specific predictors of cyberbullying victimization. Psychosocial problems did not differentially predict the two types of bullying victimization. Boys with higher levels of loneliness were more likely than girls to experience cyberbullying victimization.
The present study is limited in terms of its sample selection and self-reported instruments.
This study emphasizes adolescents’ psychosocial problems as the potential risk factors for their future bullying victimization. Education professionals should pay special attention to adolescents’ mental health problems when formulating bullying interventions and programs.
PDF
