Functional outcomes in youth with complex trauma: a systematic review of psychosocial interventions

Figures & data

Table 1. Systematic review search terms.

Data Line	Keywords
Line One	Treatment OR therapy OR intervention OR psychotherapy OR psychosocial
Line Two	Youth OR adolescen* OR paediatric OR young adult* OR teen* OR student*
Line Three	PTSD OR trauma* OR posttrauma* OR “complex trauma” OR “complex PTSD”
Line Four	“interpersonal trauma” OR “developmental trauma” OR “childhood trauma” OR “attachment trauma” OR rape OR incest OR sexual assault OR “domestic violence” OR neglect OR abuse* OR maltreat* OR physical*
Line Five	“affect regulation” OR “interpersonal function*” OR “interpersonal problem*” OR “social function*” OR “social problem*” OR self-concept OR “identity disturbance” OR identity OR “quality of life” OR QOL OR “school attendance” OR “school participation” OR “university attendance” OR “university participation” OR “educational activity” OR “work attendance” OR “work participation” OR absenteeism OR occupation* OR vocation* OR engagement OR reengagement OR “occupational functioning” OR self-harm OR “non suicidal self-injury” OR self-injur* OR “deliberate self-harm” OR cutting OR suicid* OR “psychiatric admission*” OR “hospital admission*” OR hospitali?ation

Figure 1. PRISMA diagram of study selection.

Table 2. Study characteristics.

Author (Year), Country	Trauma Type	Study Design	Intervention and Control	N	Age, mean, (SD), range	Female (%)
Anderson et al. (2010) U.S.A.	Sexual assault	Randomised Pilot Study	Clinician assisted emotional disclosure (CAED) Waitlist control	28	19.3 (1.09) NR	100%
Woidneck et al. (2014) U.S.A.	Physical abuse & Sexual abuse	Uncontrolled Pilot Study	Acceptance and commitment therapy	4^a	NR (NR) 12–17 years	50%
Goldbeck et al. (2016) Germany	Primarily physical and sexual abuse	RCT	Trauma Focused Cognitive Behaviour Therapy Waitlist Control	135	13.03 (2.80) 7–17 years	71%
Littleton et al. (2016) U.S.A.	Childhood physical and sexual abuse, domestic violence exposure	RCT	Therapist supported e-therapy Psychoeducational website	87	22 (NR) 18–42 years	100%
Aas et al. (2019) Norway	Interpersonal trauma (not specified)	RCT	Trauma Focused Cognitive Behaviour Therapy Treatment as Usual (TAU)	156	15.1 (2.22) 10–18 years	80%
Bounds et al. (2019) U.S.A.	Sexual assault, sexual exploitation	Retrospective Observational Study	Runaway Intervention Program	362	14.84 (1.34) 11–18 years	96%
Dams et al. (2020) Germany	NR	RCT	Developmentally adapted Cognitive Processing Therapy Waitlist with treatment advice	87	18.1 (2.3) 14–21 years	85%
Peters et al. (2021) Australia	Interpersonal trauma (not specified)	Uncontrolled Pilot Study	Trauma Focused Cognitive Behaviour Therapy	18	19.5 (3.2) 15–25 years	65%

NR = Not reported; RCT = Randomised controlled trial.

^aA total of seven participants are reported in the Woidneck et al. (2014) study. However, three of those received treatment at a residential treatment centre and have been excluded from this review.

Table 3. Study outcome measures.

Reference	Diagnostic Measure	Primary PTSD/CPTSD Outcome Measures	Secondary Outcome Measures
Anderson et al. (2010)	-	IES-R IIP	OQ
Woidneck et al. (2014)	-	CAPS-CA CPSS	Com-QOL-S5
Goldbeck et al. (2016)	CAPS-CA	CAPS-CA UCLA PTSD-RI	CGAS ILK
Littleton et al. (2016)	PSS-I	PSS-I	PSS- I (Impairment Questions)
Aas et al. (2019)	-	CPSS	16D
Bounds et al. (2019)	UCLA PTSD-RI	UCLA PTSD-RI	Non-standardised Assessment of Suicidality and Self-harm
Dams et al. (2020)	CAPS-CA	CAPS-CA UCLA PTSD-RI	EQ-5D-5 L
Peters et al. (2021)	CAPS-5	CAPS-5 PCL-5	AQoL-8D DSHI ASIQ

PSS-I = PTSD Symptom Scale Interview; CAPS-CA = Clinician Administered PTSD Scale for Children and Adolescents; CAPS-5 = Clinician Administered PTSD Scale for DSM-5; IES-R = Impact of Events Scale Revised; IIP = Inventory of Interpersonal Problems; CPSS = Children’s PTSD Symptom Scale; UCLA PTSD-RI = University of California PTSD Reaction Index; PCL-5 = Posttraumatic Stress Disorder Checklist; OQ = Outcome Questionnaire − 45; Com-QOL-S5 = Comprehensive Quality of Life Scale – Student Version; CGAS = Children’s Global Assessment Scale; ILK = Inventory for Measuring Quality of Life in Children and Adolescents; 16D = Quality of Life Questionnaire; AQoL-8D = Assessment of Quality of Life-Eight Dimension; DSHI = Deliberate Self Harm Inventory; ASIQ = Adult Suicidal Ideation Questionnaire.

Anderson, T., Guajardo, J. F., Luthra, R., & Edwards, K. M. (2010). Effects of clinician-assisted emotional disclosure for sexual assault survivors: A pilot study. Journal of Interpersonal Violence, 25(6), 1113–1131. https://doi.org/10.1177/0886260509340542

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Woidneck, M. R., Morrison, K. L., & Twohig, M. P. (2014). Acceptance and commitment therapy for the treatment of posttraumatic stress among adolescents. Behavior Modification, 38(4), 451–476. https://doi.org/10.1177/0145445513510527

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Goldbeck, L., Muche, R., Sachser, C., Tutus, D., & Rosner, R. (2016). Effectiveness of trauma-focused cognitive behavioral therapy for children and adolescents: A randomized controlled trial in eight german mental health clinics. Psychotherapy & Psychosomatics, 85(3), 159–170. https://doi.org/10.1159/000442824

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Littleton, H., Grills, A. E., Kline, K. D., Schoemann, A. M., & Dodd, J. C. (2016). The from Survivor to Thriver program: RCT of an online therapist-facilitated program for rape-related PTSD. Journal of Anxiety Disorders, 43, 41–51. https://doi.org/10.1016/j.janxdis.2016.07.010

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Aas, E., Iversen, T., Holt, T., Ormhaug, S. M., & Jensen, T. K. (2019). Cost-effectiveness analysis of trauma-focused cognitive behavioral therapy: A randomized control trial among Norwegian youth. Journal of Clinical Child & Adolescent Psychology, 48(Suppl. 1), S298–311. https://doi.org/10.1080/15374416.2018.1463535

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Bounds, D. T., Edinburgh, L. D., Fogg, L. F., & Saeywc, E. M. (2019). A nurse practitioner-led intervention for runaway adolescents who have been sexually assaulted or sexually exploited: Effects on trauma symptoms, suicidality, and self-injury. Child Abuse & Neglect, 90, 99–107. https://doi.org/10.1016/j.chiabu.2019.01.023

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Dams, J., Rimane, E., Steil, R., Renneberg, B., Rosner, R., & König, H.-H. (2020). Reliability, validity and responsiveness of the eq-5d-5l in assessing and valuing health status in adolescents and young adults with posttraumatic stress disorder: A randomized controlled trail. The Psychiatric Quarterly, 92(2), 459–471. https://doi.org/10.1007/s11126-020-09814-6

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Peters, W., Rice, S., Cohen, J., Murray, L., Schley, C., Alvarez-Jimenez, M., & Bendall, S. (2021). Trauma-focused cognitive–behavioral therapy (TF-CBT) for interpersonal trauma in transitional-aged youth. Psychological Trauma: Theory, Research, Practice, and Policy, 13(3), 313–321. https://doi.org/10.1037/tra0001016

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