Zur Wirksamkeit von psychotherapeutischen Interventionen bei jungen Flüchtlingen und Binnenvertriebenen mit posttraumatischen Symptomen

Trotz hoher Zahlen junger Flüchtlinge und der häufig hohen Belastung mit Symptomen einer Posttraumatischen Belastungsstörung (PTBS) gibt es Unsicherheiten über Therapiemöglichkeiten und deren Effektivität in dieser Patientengruppe. Zur Untersuchung der Wirksamkeit unterschiedlicher Interventionen wurde ein systematischer Review durchgeführt. Nach einer Literaturrecherche mit 798 Treffern erfüllten zehn Studien die Einschlusskriterien. Acht Studien konnten signifikante Reduktionen der PTBS-Symptomatik feststellen. Vielversprechend erscheinen dabei folgende Therapien: Narrative Expositionstherapie für Kinder, „Meditation-Relaxation”, Eye Movement Desensitization and Reprocessing und „Rapid-Ed-Therapie”. Aufgrund der dürftigen Studienlage und methodischer Mängel ist eine genauere Empfehlung allerdings schwierig

The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis

Background: The United Nations reported that in 2016 over 65 million people worldwide have forcibly left home. Over 50% are children and adolescents; a substantial number has been traumatized and displaced by war. Objective: To provide an overview of the effectiveness of psychosocial interventions in this group we conducted a narrative review and a meta-analysis of intervention studies providing data on posttraumatic stress symptoms (PTSS), depression, anxiety, grief, and general distress. Method: We searched PILOTS, MEDLINE, WoS, Embase, CENTRAL, LILACS, PsycINFO, ASSIA, CSA, and SA for studies on treatment outcomes for war-traumatized displaced children and adolescents. Between-group effect sizes (ES) and pre-post ES were reconstructed for each trial. Overall pre-post ES were calculated using a random effects model. Results: The narrative review covers 23 studies with a variety of treatments. Out of the 35 calculated between-group ES, only six were significant, all compared to untreated controls. Two of them indicated significant adverse effects on symptoms of general distress or depression. When calculating pre-post effect sizes, the positive between-group results of cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) were reproduced and singular other treatments showed significant positive effects. However, the mean pre-post effects for PTSS and depression could not be interpreted due to the high heterogeneity of the included studies (PTSS: ES = 0.78; I2 = 88.6%; depression: ES = 0.35; I2 = 93.1%). Only the mean pre-post effect for seven active CBT treatment groups for depression (ES = 0.30, 95% CI [0.18, 0.43]) was interpretable (Q = 3.3, df = 6, p = .77). Conclusion: Given the large number of children and adolescents displaced by war there were regrettably few treatment studies available, and many of them were of low methodological quality. The effect sizes lagged behind the effects observed in traumatized minors in general, and often were small or non-significant. However, CBT and IPT showed promising results that need further replication

Experiences With a Migration-Adapted Service in Case Management for Children and Adolescents in Need of Treatment After Child Abuse and Neglect

Für Kinder und Jugendliche aus Familien mit Migrationshintergrund (MHG) ist der Zugang zu evidenzbasierter Psychotherapie möglicherweise erschwert. Im Rahmen einer randomisierten und kontrollierten Multicenter-Studie zur Evaluation eines Case Management-Ansatzes für Kinder und Jugendliche, die nach Misshandlung, sexuellem Missbrauch oder Vernachlässigung eine psychische Störung entwickelt haben, wurden zur Projektmitte die beteiligten Case Manager zusätzlich hinsichtlich kultur- und migrationsspezifischer Aspekte geschult und in ihrer Arbeit mit Migrantenfamilien durch übersetzte Materialen und die Finanzierung von Dolmetschern unterstützt. Obwohl mit einem Anteil von 30 % Fällen mit MHG in der Interventionsstudie die anvisierte Zielgruppe erreicht wurde, waren die Fallzahlen im Case Management-Arm mit n = 7 vor der migrationsspezifischen Schulung und n = 8 danach zu gering, um einen klinischen Nutzen der Maßnahmen im Sinne einer besseren Versorgung nachzuweisen

Trauma-Focused Cognitive Behavioral Therapy with Unaccompanied Refugee Minors : A Case Series

Background: Unaccompanied refugee minors (URMs) are a group who are vulnerable to developing posttraumatic stress symptoms (PTSS). However, they rarely receive the treatment that is indicated and there are no treatment studies focusing exclusively on this group of adolescents. This case study evaluates the feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) for URMs with PTSS. Method: A health care utilization sample of N = 6 was assessed prior to and after treatment with TF-CBT. Therapists were asked to report differences in treatment application and content in comparison to TF-CBT standard protocol. Results: We found moderate to high levels of PTSS at baseline and a clinically significant decrease in symptoms at posttest. Some modifications to the TF-CBT protocol were made with regard to affective modulation which required more sessions than usual whereas fewer caregiver sessions were conducted. Conclusion: TF-CBT is feasible in reducing PTSS in severely traumatized URMs. Further research with controlled trials is necessary