A systematic review and meta-analysis of school-based interventions for PTSD and trauma-related symptoms: what effective elements they have in common?

Abstract

Background: Schools provide critical support for students exposed to traumatic experiences, with school-based trauma interventions demonstrating reductions in posttraumatic stress symptoms. However, heterogeneity in design, implementation, and efficacy of existing interventions makes it challenging to select suitable interventions and to understand which components of programs are effective. This review and meta-analysis identified school-based trauma interventions and evaluated the common and effective practice, process, and implementation elements of these programs.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guideline recommendations, a literature search was conducted using keywords of interest. Studies included controlled trials that described school-based interventions designed to reduce post-traumatic stress disorder (PTSD) symptoms in students. A frequency analysis of emerging elements was executed. A meta-analysis calculated the effect size of individual elements in reducing PTSD symptoms. This review was registered with PROSPERO (CRD42022337818).

Results: Forty-five studies were included, with 46 datasets used for analysis. The pooled effect size was g = -0.97 (CI: -1.29, -0.65) for all studies, or g = -0.62 (CI: -0.87, -0.38) when removing outliers, indicating a medium-large effect of school-based programs in reducing PTSD symptoms. Common practice elements included psychoeducation, cognitive behavioural therapy, and coping skills. Common process elements included group therapy, 10-12 sessions, 30-60 min in length, 4-6 weeks duration, homework assignments, run by mental health professionals. Common implementation elements included supervision of facilitators, 3-5 days facilitator training, parental involvement, and the use of a manual.

Conclusion: The identification of common and effective elements in reducing PTSD among students is critical for the implementation of existing interventions and the development of new interventions.