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BMJ Open. 2018 Mar 12;8(3):e020198. doi: 10.1136/bmjopen-2017-020198.

Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: study protocol for a systematic review and network meta-analysis.

Author information

Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China.
Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
The Centre of Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.
Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Institute for Complementary and Integrative Medicine, University Hospital and University of Zurich, Zurich, Swaziland.
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Swaziland.
Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpétrière, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Paris, France.
Mental Health, Westmead, Western Sydney Local Health District, Parramatta, Australia.
Contributed equally



Post-traumatic stress disorder (PTSD) is common among children and adolescents who are exposed to trauma, and it is often associated with significant negative impacts on their psychosocial functioning and quality of life. Many types of psychotherapies have been found to be effective for PTSD in children and adolescents. However, due to the lack of direct comparisons between different psychotherapies, the hierarchy of treatment efficacy is still unclear. Therefore, we plan to conduct a systematic review and network meta-analysis to evaluate the efficacy and acceptability of various types of psychotherapies for PTSD in children and adolescents.


A systematic search will be conducted among eight electronic databases, including PubMed, Cochrane, Embase, Web of Science, PsycINFO, Cumulative Index of Nursing and Allied Health, Published International Literature on Traumatic Stress (PILOTS) and ProQuest Dissertations, from inception to October 2017. Randomised controlled trials, regardless of language, publication year and publication type, comparing any psychotherapies for PTSD to any control condition or alternative treatment in children and adolescents (18 years old or less) diagnosed with full or subclinical PTSD will be included. Study duration and the number of treatment sessions will not be limited. The primary outcome will be PTSD symptom severity at post-treatment as measured by a rating scale reported by the child, parent or a clinician. The secondary outcomes will include: (1) efficacy at follow-up; (2) acceptability (all-cause discontinuation); (3) anxiety symptom severity; (4) depressive symptom severity and (5) quality of life and functional improvement. Bayesian network meta-analyses for all relative outcome measures will be performed. We will conduct subgroup and sensitivity network meta-analyses to determine whether the findings are affected by study characteristics. The quality of the evidence contributing to network estimates of the primary outcome will be evaluated by the Grading of Recommendations, Assessment, Development and Evaluations framework.


No ethical issues are foreseen. The results will be published in a peer-reviewed journal, which will be disseminated electronically and in print. This network meta-analysis may be updated to inform and guide the clinical management of PTSD in children and adolescents.




network meta-analysis; post-traumatic stress disorder; psychotherapy; systematic review

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: SEH is an editor of the Cochrane Common Mental Disorders Group and an author on the Cochrane systematic review on treatments for PTSD in young people. During the last 2 years, DC reported past consultation for or the receipt of honoraria from Otsuka, Shire, Lundbeck and Roche. DG is the primary author of two reviews of psychological therapies for children and adolescents who were diagnosed with PTSD or exposed to trauma. YZ, XZ, LY, JRW, PC, JB, CDG, SY, XJ, TT , and PX declare nocompeting interests.

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