Summary of findings 3. Summary of findings table ‐ Service system approaches compared to inactive control (usual care care, attention control, waitlist) for for parents who are experiencing CPTSD symptoms or have experienced maltreatment in their childhood.

Service system approaches compared to inactive control (usual care care, attention control, waitlist) for for parents who are experiencing CPTSD symptoms or have experienced maltreatment in their childhood
Patient or population: for parents who are experiencing CPTSD symptoms or have experienced maltreatment in their childhood Setting: Community‐based programs, hospitals, out‐patient clinics, public community health centres Intervention: Service system approaches Comparison: inactive control (usual care care, attention control, waitlist)
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with inactive control (usual care care, attention control, waitlist)	Risk with Service system approaches
Trauma‐related symptoms ‐ post‐intervention ‐ not reported	‐	‐	‐	‐	‐	No studies reported data
Psychological well‐being ‐ post‐interventiona	‐	SMD 0.42 SD higher (0.15 lower to 0.99 higher)	‐	52 (1 RCT)	⊕⊕⊝⊝ Lowb,c	Service system approaches may worsen psychological wellbeing (depression) slightly.d
Substance use ‐ post‐intervention ‐ not reported	‐	‐	‐	‐	‐	No studies reported data
Parent relationship quality ‐ not reported	‐	‐	‐	‐	‐	No studies reported data
Parental self‐harm ‐ post‐intervention ‐ not reported	‐	‐	‐	‐	‐	No studies reported data
Parent–child relationship ‐ not reported	‐	‐	‐	‐	‐	No studies reported data
Parenting skills ‐ post‐intervention ‐ not reported	‐	‐	‐	‐	‐	No studies reported data
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_433493680305253470.

^a Outcome: Depression symptom severity assessed with Center for Epidemiological Studies Depression scale (CESD), lower scores = less harm.
^b Evidence downgraded 1 level for risk of bias; one study with high risk of bias.
^c Evidence downgraded 1 level for imprecision; the 95% CI includes 'little or no difference' and large appreciable benefit (i.e. crosses the threshold for important harm: SMD ≥ 0.4).
^d Interpretation of importance of SMD effect sizes: < 0.40 = small (trivial) effect ‐ (little or no difference), 0.40 to 0.7 = small but important effect (‘slight’ reduction/increase in outcome), > 0.7 = large effect (large reduction/increase in outcome)