Building Resilience Against ViolencE (BRAVE): protocol of a parenting intervention for mothers and fathers with post-traumatic stress disorder in Pakistan

Abstract Background Prevalence of post-traumatic stress disorder (PTSD) is high in Pakistan both due to natural disasters and ongoing conflicts. Offspring of trauma survivors are at increased risk for mental and physical illnesses. Parental PTSD has been linked to troubled parent–child relationships, behaviour problems, trauma symptoms, and depression in children. This study aims to explore the acceptability, feasibility and indications of the effectiveness of group learning through play plus trauma-focused cognitive behaviour therapy (LTP Plus TF-CBT) for parents experiencing PTSD. Methods/Design This is a two-arm pilot cluster randomised controlled trial (RCT). We aim to recruit 300 parents with a diagnosis of PTSD. The screening will be done using the Impact of Event Scale-Revised. Diagnosis of PTSD will be confirmed using the Clinician-Administered PTSD Scale-5 (CAPS-5). Union Councils from Peshawar and Karachi will be randomised into either group LTP Plus TF CBT arm or treatment as usual (TAU). The intervention includes 12 sessions of LTP Plus TF-CBT delivered weekly in the first 2 months and then fortnightly in a group setting by trained psychologists. The groups will be co-facilitated by the community health workers (CHWs). Parents will be assessed at baseline and 4th month (end of the intervention), using the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7) Scale, Client Service Receipt Inventory (CSRI), and Ages and Stages Questionnaire (ASQ-3) Discussion This trial would help build an understanding of the acceptability, feasibility and indications of the effectiveness of a low-cost parenting intervention

Controlled interventions to improve suicide prevention in educational settings: a systematic review and network meta-analysis

Background: Suicidal thoughts and behaviors (STBs) in young people is a major public health problem, which is on the rise globally. Aims: We applied the first network meta-analyses to examine the effectiveness of existing intervention types and contents to reduce STBs and improve suicide prevention competencies in educational settings. Method: We searched Medline, PsycInfo, and CENTRAL until April 2021. Quantitative studies focused on young people aged between 12 and 25 years which evaluated interventions at educational settings and contained comparator groups were included. Results: Overall, we identified 49 studies comprising 42,039 participants. Regarding the type of intervention, universal interventions (OR = 1.85, 95% confidence interval [CI] [1.43–2.38]) were associated with almost two-fold reductions in the odds of STBs. Selective (standardized mean difference [SMD] = 0.51, 95% CI [0.32–0.70]) and universal interventions (SMD = 0.40, 0.26–0.54) were moderately effective in increasing suicide prevention competencies. Regarding the content of the intervention, education/awareness programs (OR = 1.59, 95% CI [1.23–2.04]) and psychotherapy programs (OR = 2.22, [1.25–3.33]) were associated with 1.5- and two-fold reductions in the odds of STBs. Gatekeeper universal interventions (SMD = 1.04, 95% CI [0.73–1.34]) and gatekeeper selective interventions (SMD = 0.52, [0.26–0.77]) were strong-to-moderately more effective in increasing suicide prevention competencies when compared to no-treatment. Education/awareness interventions were also modestly effective (SMD = 0.28, 95% CI [0.12–0.44]). The quality of 81% of the included studies was low. Conclusions: Important policy actions should be taken with a focus on offering universal mental health/suicide awareness training programs and/or selective treatments to reduce STBs and improve suicide prevention competencies in educational settings

The effects of internet-based cognitive behavioral therapy for suicidal ideation or behaviors on depression, anxiety, and hopelessness in individuals with suicidal ideation : systematic review and meta-analysis of individual participant data

Background: Suicide is a global public health problem. Digital interventions are considered a low-threshold treatment option for people with suicidal ideation or behaviors. Internet-based cognitive behavioral therapy (iCBT) targeting suicidal ideation has demonstrated effectiveness in reducing suicidal ideation. However, suicidal ideation often is related to additional mental health problems, which should be addressed for optimal care. Yet, the effects of iCBT on related symptoms, such as depression, anxiety, and hopelessness, remain unclear. Objective: We aimed to analyze whether digital interventions targeting suicidal ideation had an effect on related mental health symptoms (depression, anxiety, and hopelessness). Methods: We systematically searched CENTRAL, PsycInfo, Embase, and PubMed for randomized controlled trials that investigated guided or unguided iCBT for suicidal ideation or behaviors. Participants reporting baseline suicidal ideation were eligible. Individual participant data (IPD) were collected from eligible trials. We conducted a 1-stage IPD meta-analysis on the effects on depression, anxiety, and hopelessness-analyzed as 2 indices: symptom severity and treatment response. Results: We included IPD from 8 out of 9 eligible trials comprising 1980 participants with suicidal ideation. iCBT was associated with significant reductions in depression severity (b=-0.17; 95% CI -0.25 to -0.09; P<.001) and higher treatment response (ie, 50% reduction of depressive symptoms; b=0.36; 95% CI 0.12-0.60; P=.008) after treatment. We did not find significant effects on anxiety and hopelessness. Conclusions: iCBT for people with suicidal ideation revealed significant effects on depression outcomes but only minor or no effects on anxiety and hopelessness. Therefore, individuals with comorbid symptoms of anxiety or hopelessness may require additional treatment components to optimize care. Studies that monitor symptoms with higher temporal resolution and consider a broader spectrum of factors influencing suicidal ideation are needed to understand the complex interaction of suicidality and related mental health symptoms

Digital cognitive–behavioural therapy to reduce suicidal ideation and behaviours: a systematic review and meta-analysis of individual participant data

QuestionDigital interventions based on cognitive–behavioural therapy (iCBT) is associated with reductions in suicidal ideation. However, fine-grained analyses of effects and potential effect-moderating variables are missing. This study aimed to investigate the effectiveness of iCBT on suicidal ideation, effect moderators, effects on suicide attempts and predictors of adherence.Study selection and analysisWe systematically searched CENTRAL, PsycINFO, Embase and PubMed for randomised controlled trials that investigated iCBT for suicidal ideation or behaviours. Participants reporting baseline suicidal ideation were eligible. We conducted a one-stage individual participant data (IPD) meta-analysis. Suicidal ideation was the primary outcome, analysed as three indices: severity of suicidal ideation, reliable changes and treatment response.FindingsWe included IPD from nine out of ten eligible trials (2037 participants). iCBT showed significant reductions of suicidal ideation compared with control conditions across all indices (severity: b=−0.247, 95% CI −0.322 to −0.173; reliable changes: b=0.633, 95% CI 0.408 to 0.859; treatment response: b=0.606, 95% CI 0.410 to 0.801). In iCBT, the rate of reliable improvement was 40.5% (controls: 27.3%); the deterioration rate was 2.8% (controls: 5.1%). No participant-level moderator effects were identified. The effects on treatment response were higher for trials with waitlist-controls compared with active controls. There were insufficient data on suicide attempts. Human support and female gender predicted treatment adherence. The main source of potential bias was missing outcome data.ConclusionsThe current evidence indicates that iCBT is effective in reducing suicidal ideation irrespective of age, gender and previous suicide attempts. Future studies should rigorously assess suicidal behaviour and drop-out reasons.</jats:sec