The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis.

BACKGROUND: Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES: To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN: For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS: Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS: Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES: Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS: Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS: We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS: It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS: Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK: Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003889. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Covid-19 pandemic and exercise for healthcare workers (COPE HCW) trial : secondary analyses examining the effects of at-home exercise on healthcare workers' multidimensional well-being

Background. Current research on employee well-being largely entails focus on physical and mental health and illness, as well as functioning specific to the workplace. Yet, more recent conceptualizations of well-being extend beyond the presence or absence of health or illness to concepts of thriving or languishing, measured using an outcome-wide measurement approach. Accordingly, healthcare worker (HCW) multidimensional well-being as an overarching concept should be inclusive of a broad range of ill-being and well-being indictors that span multiple dimensions, including physical, psychological, and psychosocial realms of life. A recent 12- week mHealth exercise intervention for HCWs in Vancouver, BC demonstrated significant treatment effects for depressive symptoms, burnout symptoms, and absenteeism among those randomized to an exercise versus waitlist control condition. Secondary analyses were conducted to examine whether positive treatment effects could extend to a broader range of multidimensional ill-being and well-being outcomes. Methods. Data was from the COVID-19 Pandemic and Exercise for Healthcare Workers (COPE HCW) trial, a two-arm parallel randomized controlled trial for low-active HCWs working at Providence Health Care centers across Vancouver, BC. The effects of engagement with a suite of exercise applications for 80 minutes per week for 12 weeks (vs. waitlist control) on indicators of multidimensional ill-being and well-being were examined. Treatment effects for physical health symptoms, recent global stress, work-to-personal life interference, overall physical health, overall mental/emotional health, life satisfaction, psychological flourishing, resilience, and work- to-personal life enhancement were analyzed using intent-to-treat analyses with a structural equation modelling (SEM) growth model approach. Results. By the end of the trial, significant treatment effects were observed for all outcomes, such that those in the exercise condition (vs. waitlist control) reported significant reductions in ill-being and improvements in well-being measures. Adherence to the intervention decreased over time, and treatment effects were most apparent for those who engaged with the exercise apps the most. Conclusions. mHealth exercise is one individual-level behavioral intervention which was successful in improving multidimensional ill-being and well-being among HCWs. Findings will help inform future employee wellness programming by providing evidence that mHealth exercise can be used as a modality to support well-being across different life domains.Education, Faculty ofKinesiology, School ofGraduat

COvid-19 Pandemic and Exercise for Health Care Workers (COPE HCW) Trial: A Randomized Study Examining Physical Activities and Wellbeing.

A 12-week app-based exercise at-home randomized controlled trial in healthcare worker

Canadian healthcare workers’ mental health and health behaviours during the COVID-19 pandemic: results from nine representative samples between April 2020 and February 2022

Objective: In the context of COVID-19, Canadian healthcare workers (HCWs) worked long hours, both to respond to the pandemic and to compensate for colleagues who were not able to work due to infection and burnout. This may have had detrimental effects on HCWs’ mental health, as well as engagement in health-promoting behaviours. This study aimed to identify changes in mental health outcomes and health behaviours experienced by Canadian HCWs throughout the COVID-19 pandemic.  Methods: Nine representative samples (N total = 1615 HCWs) completed the iCARE survey using an online polling firm between April 2020 (Time 1) and February 2022 (Time 9). Participants were asked about the psychological effects of COVID-19 (e.g., feeling anxious) and about changes in their health behaviours (e.g., alcohol use, physical activity).  Results: A majority of the HCWs identified as female (65%), were younger than 44 years old (66%), and had a university degree (55%). Female HCWs were more likely than male HCWs to report feeling anxious (OR = 2.68 [1.75, 4.12]), depressed (OR = 1.63 [1.02, 2.59]), and irritable (OR = 1.61 [1.08, 2.40]) throughout the first two years of the pandemic. Female HCWs were more likely than their male counterparts to report eating more unhealthy diets (OR = 1.54 [1.02, 2.31]). Significant differences were also revealed by age, education level, income, parental status, health status, and over time. Conclusion: Results demonstrate that the impacts of COVID-19 on HCWs’ mental health and health behaviours were significant, and varied by sociodemographic characteristics (e.g., sex, age, income).</p