Renuka Munshi, Miteshkumar Maurya
A Cross-sectional Survey of Public Knowledge and Perspective on Coronavirus Disease, Vaccination, and Related Research in India during the COVID-19 Pandemic
The Journal of the Association of Physicians of India
background people living humanitarian settings low middleincome countries lmics exposed constellation stressors make vulnerable developing mental disorders mental disorders higher prevalence settings include posttraumatic stress disorder ptsd major depressive anxiety somatoform eg medically unexplained physical symptoms mups related disorders range psychological therapies used manage symptoms mental disorders population objectives compare effectiveness acceptability psychological therapies versus control conditions wait list treatment usual attention placebo psychological placebo treatment aimed treating people mental disorders ptsd major depressive anxiety somatoform related disorders living lmics affected humanitarian crises search methods searched cochrane common mental disorders controlled trials register ccmdctr cochrane central register controlled trials wiley medline ovid embase ovid psycinfo ovid results incorporated searches 3 february 2016 also searched world health organization trials portal ictrp clinicaltrialsgov identify unpublished ongoing studies checked reference lists relevant studies reviews selection criteria randomised controlled trials rcts comparing psychological therapies versus control conditions including treatment usual care wait list attention placebo psychological placebo treat adults children mental disorders living lmics affected humanitarian crises data collection analysis used standard cochrane procedures collecting data evaluating risk bias calculated standardised mean differences continuous outcomes risk ratios dichotomous data using randomeffects model analysed data endpoint zero four weeks therapy medium term one four months therapy long term six months longer grade grades recommendation assessment development evaluation used assess quality evidence posttraumatic stress disorder ptsd depression anxiety withdrawal outcomes main results included 36 studies 33 rcts total 3523 participants included studies conducted subsaharan africa middle east north africa asia studies implemented response armed conflicts disasters triggered natural hazards types humanitarian crises together 33 rcts compared eight psychological treatments control comparator four studies included children adolescents 5 18 years age three studies included mixed populations two studies included participants 12 25 years age one study included participants 16 65 years age remaining studies included adult populations 18 years age older included trials compared psychological therapy versus control intervention wait list studies treatment treatment usual psychological therapies categorised mainly cognitivebehavioural therapy cbt 23 comparisons including seven comparisons focused narrative exposure therapy net two focused common elements treatment approach ceta one focused brief behavioural activation treatment ba eye movement desensitisation reprocessing emdr two comparisons interpersonal psychotherapy ipt three comparisons thought field therapy tft three comparisons trauma general supportive counselling two comparisons although interventions described categories several psychotherapeutic elements common range therapies ie psychoeducation coping skills adults psychological therapies may substantially reduce endpoint ptsd symptoms compared control conditions standardised mean difference smd 107 95 confidence interval ci 134 079 1272 participants 16 studies lowquality evidence effect smaller one four months smd 049 95 ci 068 031 1660 participants 18 studies six months smd 037 95 ci 061 014 400 participants five studies psychological therapies may also substantially reduce endpoint depression symptoms compared control conditions smd 086 95 ci 106 067 1254 participants 14 studies lowquality evidence similar ptsd symptoms followup data one four months showed smaller effect depression smd 042 95 ci 063 021 1386 participants 16 studies psychological therapies may moderately reduce anxiety endpoint smd 074 95 ci 098 049 694 participants five studies lowquality evidence one four months followup treatment smd 053 95 ci 066 039 969 participants seven studies dropout rates probably similar study conditions 195 control versus 191 psychological therapy rr 098 95 ci 082 116 2930 participants 23 studies moderate quality evidence children adolescents found low quality evidence lower endpoint ptsd symptoms scores psychotherapy conditions cbt compared control conditions although confidence interval wide smd 156 95 ci 313 001 130 participants three studies rcts provided data major depression anxiety children effect withdrawal uncertain rr 187 95 ci 047 747 138 participants 3 studies low quality evidence identify studies evaluated psychological treatments symptoms somatoform disorders mups lmic humanitarian settings authors conclusions low quality evidence psychological therapies large moderate effects reducing ptsd depressive anxiety symptoms adults living humanitarian settings lmics one four month six month followup assessments treatment effects smaller fewer trials focused children adolescents provide low quality evidence beneficial effect psychological therapies reducing ptsd symptoms endpoint confidence findings influenced risk bias studies substantial levels heterogeneity research evidence needed particularly children adolescents longer periods followup