Summary of findings for the main comparison. Psychological therapy compared with control for treatment of adults with mental disorders in low‐ and middle‐income countries affected by humanitarian crises.
| Psychological therapy compared with control for treatment of adults with mental disorders in low‐ and middle‐income countries affected by humanitarian crises | ||||||
| Patient or population: adults exposed to traumatic events Setting: humanitarian settings in LMICs Intervention: psychological therapy Comparison: wait list; no treatment; treatment as usual | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with control | Risk with psychological therapy | |||||
| Post‐traumatic stress disorder at endpoint (measured with IES‐R; HTQ; CAPS; UCLA‐PTSD‐RI; PDS; PCL‐5) |
‐ | SMD 1.07 lower (1.34 lower to 0.79 lower) | ‐ | 1272 (16 RCTs) | ⊕⊕⊝⊝ Lowa,b | This is a large effect according to Cohen 1992 |
| Depression at endpoint (measured with BDI‐II, HSCL‐25, HADS) |
‐ | SMD 0.86 SD lower (1.06 lower to 0.67 lower) | ‐ | 1254 (14 RCTs) | ⊕⊕⊝⊝ Lowa,c | This is a large effect according to Cohen 1992 |
| Anxiety at endpoint (measured with HADS‐A; HSCL‐25) |
‐ | SMD 0.74 SD lower (0.98 lower to 0.49 lower) | ‐ | 694 (5 RCTs) | ⊕⊕⊝⊝ Lowd,e |
This is a moderate effect according to Cohen 1992 |
| Dropouts for any reason | Study population | RR 0.98 (0.82 to 1.16) | 2950 (23 RCTs) | ⊕⊕⊕⊝ Moderatea | ||
| 195 per 1000 | 191 per 1000 (160 to 227) | |||||
| Somatic symptoms and related disorders | ‐ | ‐ | ‐ | ‐ | ‐ | No data are available |
| *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; RCT: randomised controlled trial; RR: risk ratio; SMD: standardised mean difference | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: 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 quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
BDI: Beck Depression Inventory
CAPS: Clinician Administered Post‐traumatic stress disorder Scale
HADS: Hospital Anxiety and Depression Scale
HSCL: Hopkins Symptoms Checklist
IES‐R: Impact of Event Scale‐Revised
LMIC: low‐ and middle‐income countries
PCL: Post‐traumatic stress disorder Check List
PDS: Post‐traumatic stress disorder Diagnostic Scale
UCLA‐PTSD‐ RI: University College of Los Angeles Post‐traumatic stress disorder Reaction Index
aDowngraded one level owing to study limitations (outcome assessment was not described as masked in all RCTs)
bDowngraded one level owing to inconsistency (I2 was higher than 75%)
cDowngraded one level owing to inconsistency (I2 was 55%)
dDowngraded one level owing to imprecision (the CI includes no effect)
eDowngraded one level owing to study limitations (high risk of bias detected: performance bias, attrition bias, and concerns about therapist/investigator allegiance)