School-Based Versus Clinic-Based Interventions for PTSD in Children and Adolescents: A Systematic Review and Meta-Analysis on Their Differences in Effectiveness and Retention Rate.

Abstract

This systematic review and meta-analysis was conducted across multiple databases, including MEDLINE, PsycINFO, EMBASE, ERIC, PubMed, SCOPUS, Web of Science, the Published International Literature on Traumatic Stress, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journal Database (VIP Database), and ProQuest Dissertations and Theses. The search commenced in June 2022 and was updated in April 2024. Studies were identified using keywords such as "PTSD AND (psychosocial interventions OR psychotherapy) AND randomized controlled trial." The inclusion criteria were psychological and psychosocial interventions for children and adolescents with traumatic experiences in school or clinic settings. The Cochrane Risk of Bias 2.0 tool was used to assess the quality of the included studies. Effect sizes, including odds ratio (OR), standardized mean difference (SMD), and 95% confidence intervals (CI), were calculated via RevMan 5.3 for the meta-analysis. A total of 22 studies (N = 1,926, ages 4-19) were included. Compared to the control group, both school-based and clinic-based interventions significantly reduced PTSD symptoms (School: SMD = -.99, 95% CI [-1.32, -0.66]; Clinic: SMD = -.50, 95% CI [-0.83, -0.17]) and improved clinical recovery rates (School: OR = 4.52, 95% CI [2.74, 7.46]; Clinic: OR = 3.44, 95% CI [2.18, 5.42]). School-based interventions showed greater effectiveness, particularly among individuals with milder symptom severity (p = .02), and were associated with higher retention rates (p < .001), indicating better participant engagement.