IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

BackgroundExposure to domestic violence and abuse (DVA) during childhood and adolescence increases the risk of negative outcomes across the lifespan.ObjectivesTo synthesise evidence on the clinical effectiveness, cost-effectiveness and acceptability of interventions for children exposed to DVA, with the aim of making recommendations for further research.Design(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and professional experience of interventions; (3) a network meta-analysis (NMA) of controlled trials and cost-effectiveness analysis; (4) an overview of current UK provision of interventions; and (5) consultations with young people, parents, service providers and commissioners.SettingsNorth America (11), the Netherlands (1) and Israel (1) for the systematic review of controlled trials of interventions; the USA (4) and the UK (1) for the systematic review of qualitative studies of participant and professional experience of interventions; and the UK for the overview of current UK provision of interventions and consultations with young people, parents, service providers and commissioners.ParticipantsA total of 1345 children for the systematic review of controlled trials of interventions; 100 children, 202 parents and 39 professionals for the systematic review of qualitative studies of participant and professional experience of interventions; and 16 young people, six parents and 20 service providers and commissioners for the consultation with young people, parents, service providers and commissioners.InterventionsPsychotherapeutic, advocacy, parenting skills and advocacy, psychoeducation, psychoeducation and advocacy, guided self-help.Main outcome measuresInternalising symptoms and externalising behaviour, mood, depression symptoms and diagnosis, post-traumatic stress disorder symptoms and self-esteem for the systematic review of controlled trials of interventions and NMA; views about and experience of interventions for the systematic review of qualitative studies of participant and professional experience of interventions and consultations.Data sourcesMEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, Social Care Online, Sociological Abstracts, Social Science Citation Index, World Health Organization trials portal and clinicaltrials.gov.Review methodsA narrative review; a NMA and incremental cost-effectiveness analysis; and a qualitative synthesis.ResultsThe evidence base on targeted interventions was small, with limited settings and types of interventions; children were mostly &lt; 14 years of age, and there was an absence of comparative studies. The interventions evaluated in trials were mostly psychotherapeutic and psychoeducational interventions delivered to the non-abusive parent and child, usually based on the child’s exposure to DVA (not specific clinical or broader social needs). Qualitative studies largely focused on psychoeducational interventions, some of which included the abusive parent. The evidence for clinical effectiveness was as follows: 11 trials reported improvements in behavioural or mental health outcomes, with modest effect sizes but significant heterogeneity and high or unclear risk of bias. Psychoeducational group-based interventions delivered to the child were found to be more effective for improving mental health outcomes than other types of intervention. Interventions delivered to (non-abusive) parents and to children were most likely to be effective for improving behavioural outcomes. However, there is a large degree of uncertainty around comparisons, particularly with regard to mental health outcomes. In terms of evidence of cost-effectiveness, there were no economic studies of interventions. Cost-effectiveness was modelled on the basis of the NMA, estimating differences between types of interventions. The outcomes measured in trials were largely confined to children’s mental health and behavioural symptoms and disorders, although stakeholders’ concepts of success were broader, suggesting that a broader range of outcomes should be measured in trials. Group-based psychoeducational interventions delivered to children and non-abusive parents in parallel were largely acceptable to all stakeholders. There is limited evidence for the acceptability of other types of intervention. In terms of the UK evidence base and service delivery landscape, there were no UK-based trials, few qualitative studies and little widespread service evaluation. Most programmes are group-based psychoeducational interventions. However, the funding crisis in the DVA sector is significantly undermining programme delivery.ConclusionsThe evidence base regarding the acceptability, clinical effectiveness and cost-effectiveness of interventions to improve outcomes for children exposed to DVA is underdeveloped. There is an urgent need for more high-quality studies, particularly trials, that are designed to produce actionable, generalisable findings that can be implemented in real-world settings and that can inform decisions about which interventions to commission and scale. We suggest that there is a need to pause the development of new interventions and to focus on the systematic evaluation of existing programmes. With regard to the UK, we have identified three types of programme that could be justifiably prioritised for further study: psycho-education delivered to mothers and children, or children alone; parent skills training in combination with advocacy: and interventions involving the abusive parent/caregiver. We also suggest that there is need for key stakeholders to come together to explicitly identify and address the structural, practical and cultural barriers that may have hampered the development of the UK evidence base to date.Future work recommendationsThere is a need for well-designed, well-conducted and well-reported UK-based randomised controlled trials with cost-effectiveness analyses and nested qualitative studies. Development of consensus in the field about core outcome data sets is required. There is a need for further exploration of the acceptability and effectiveness of interventions for specific groups of children and young people (i.e. based on ethnicity, age, trauma exposure and clinical profile). There is also a need for an investigation of the context in which interventions are delivered, including organisational setting and the broader community context, and the evaluation of qualities, qualifications and disciplines of personnel delivering interventions. We recommend prioritisation of psychoeducational interventions and parent skills training delivered in combination with advocacy in the next phase of trials, and exploratory trials of interventions that engage both the abusive and the non-abusive parent.Study registrationThis study is registered as PROSPERO CRD42013004348 and PROSPERO CRD420130043489.FundingThe National Institute for Health Research Public Health Research programme.</jats:sec

Factor structure of the modified timeline followback : a measure of alcohol-related consequences

Objective: Knowledge of the types of consequences as sessed by a given measure of alcohol-related consequences is important, as it may affect how the scores from that measure relate to individual differences and how the measure is used in treatment. This study was designed to examine the factor structure of the modified Timeline Followback (TLFB). Method: Undergraduate students (n = 573; 68.9% female) who drank alcohol at least once in the past 30 days completed an online version of the modified TLFB, a measure of alcohol use and alcohol-related consequences. Results: A confirmatory factor analysis supported the previously proposed four-factor structure of the consequences assessed by the modified TLFB (i.e., personal, social, role functioning, and physical consequences). Internal consistency of the four categories, as assessed by deleted-item odds ratios, was good. Additionally, correlations between subscale scores and measures of alcohol use provided evidence of convergent validity, and intraclass correlations between two administration formats (online vs. in-person) indicated preliminary concurrent validity of the four factors. Conclusions: Overall, this study found support for the factor structure that was previously proposed by Norberg et al. Both the results of the confirmatory factor analysis and the deleted-item odds ratios indicate that most items fit the model well. Four items, however, could not be included in the model as a result of either low endorsement or poor fit, suggesting that further research on these items is needed.7 page(s

Gender matters: the relationship between social anxiety and alcohol-related consequences.

BACKGROUND AND OBJECTIVES: Identification of risk factors for alcohol-related consequences is an important public health concern. Both gender and social anxiety have been associated with alcohol-related consequences broadly, but it is unknown whether these variables are differentially related to specific types of alcohol-related consequences for American college students. METHODS: In the present study, 573 undergraduate students (M(age) = 19.86 years, SD = 1.40; range 18 to 25; 68.9% female) completed an on-line assessment of social anxiety, alcohol use, and four types of alcohol-related consequences (personal, social, physical, and role). Poisson regressions were run to examine social anxiety, gender, and the interaction between social anxiety and gender as predictors of each type of alcohol-related consequences. RESULTS: After controlling for alcohol use, social anxiety was positively associated with all four types of consequences, and females endorsed higher rates of physical, personal, and role consequences. The interaction between social anxiety and gender was statistically significant only for physical consequences, with social anxiety having a stronger effect for males. DISCUSSION AND CONCLUSIONS: These findings, which diverge somewhat from those of a prior study with Australian college students, are discussed in the context of a biopsychosocial model of social anxiety and substance use problems. SCIENTIFIC SIGNIFICANCE: This study highlights the importance of further investigating cultural differences in the relationships among social anxiety, gender, and alcohol-related consequences

Results of poisson regressions.

<p>Note: ARCs  =  alcohol-related consequences; Quantity  =  total number of standard drinks during the 30-day period; for Gender, male was coded 0 and female was coded 1; for Social anxiety, low to moderate social anxiety was coded 0 and high social anxiety was coded 1; *** <i>p</i><0.001.</p><p>Results of poisson regressions.</p

Results of poisson regressions using the original factor structure [12].

<p>Note: ARCs  =  alcohol-related consequences; Quantity  =  total number of standard drinks during the 30-day period; for Gender, male was coded 0 and female was coded 1; for Social anxiety, low to moderate social anxiety was coded 0 and high social anxiety was coded 1; *** <i>p</i><0.001.</p><p>Results of poisson regressions using the original factor structure <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0115361#pone.0115361-Norberg2" target="_blank">[12]</a>.</p

Predicted Values for Each Type of Alcohol-related Consequences.

<p>Note: For estimation, quantity was held constant at the sample mean (<i>M</i> = 22.65).</p

An Analysis of the Psychache Scale in College Student Problematic Drinkers

Objectives:The objective of the present study was to evaluate the reliability and validity of the Psychache Scale in college students considered to be problematic drinkers. Methods:Cross-sectional self-report data from 463 undergraduate students who were likely to be hazardous or harmful drinkers were used to study the internal factor structure, internal consistency, and concurrent validity of the scale. Results:A series of factor analyses revealed that the scale appears to consist of 2 factors, in contrast to the hypothesized unidimensional structure. These 2 factors appear to capture the frequency and severity of the respondents\u27 levels of psychache. Moreover, these 2 factors appear to be a result of the test\u27s construction in that item stems with identical response options loaded on the same factor. The scale was also significantly correlated with other measures of psychological distress including depression, hopelessness, and substance use. Conclusion:The clinical implications of these findings are briefly discussed, with further research being needed to better understand the Psychache Scale\u27s characteristics in substance use and other populations likely to experience psychological pain, and therefore at risk for suicidal behavior