About a third of children and adolescents in the general population report the experience of one or multiple traumatic events 1. A substantial minority of traumatized young people develop post-traumatic stress disorder (PTSD) in the aftermath 1 , with an increased risk following multiple exposures 2. Given the large individual and societal disease burden of pediatric PTSD 1 , its effective treatment constitutes a public health priority. Treatment guidelines for pediatric PTSD recommend psychological interventions, with trauma-focused cognitive behavior therapy (TF-CBT) regarded as first-line treatment. Two previous network meta-analyses on psychological interventions for pedi-atric PTSD reported good treatment efficacy 3,4. Yet, neither differentiated between single-and multiple-event-related PTSD. Consequently, the efficacy of psychological interventions for multiple event related pediatric PTSD remains unknown. Increased knowledge about treatment efficacy in this condition is crucial, since many clinicians working with it are reluctant to address trauma for fear of destabilizing patients 5. Clinicians, patients and care-givers need to be well informed about the efficacy of psychological treatments for multiple-event-related pediatric PTSD to draw evidence-based treatment decisions. The present work reports on the first network meta-analysis on the efficacy of psychological interventions for multiple-event-related pediatric PTSD. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2015 guidelines 6 were followed. All data were extracted independently by at least two authors , and discrepancies were discussed until consensus was reached. The main research question of interest was: in children and adolescents with full PTSD or PTSD symptoms, how do psychological interventions, compared to either passive or active control conditions, or with each other, perform in terms of reducing PTSD symptom severity in randomized controlled trials (RCTs) in which most participants (i.e., ≥50%) reported PTSD related to at least two traumatic events? Inclusion criteria were as follows: a) RCT investigating psychological treatment for pediatric PTSD compared to a control condition ; b) all participants presented with full or sub-threshold PTSD; d) sample mean age <19 years; d) outcome data reported for ≥10 participants per arm. We searched PsycINFO, MEDLINE, Web of Science and PTSDpubs from inception to April 18, 2023 with all-field searches by means of various terms for PTSD and treatment (see supplementary information). We also searched 71 qualitative and quantitative reviews on psychological treatment of pediatric PTSD (see supplementary information), the reference lists of included trials, Google Scholar, and ResearchGate. Risk of bias was independently assessed by two reviewers using the eight quality criteria reported by Cuijpers et al 7. We distinguished three assessment periods: short-term (i.e., treatment endpoint); mid-term (i.e., up to 5 months after treatment end-point); and long-term (i.e., longest follow-up beyond 5 months after treatment endpoint). The primary outcome of interest was the standardized mean difference in PTSD symptom severity between two arms at a given timepoint as measured with Hedges' g. Random effect network meta-analyses were performed in R (version 4.1.1) using the netmeta package 8. Analyses were run only in the light of sufficient accumulated evidence (i.e., at least four direct comparisons per psychological intervention category). Hedges' g was interpreted as small (0.20), medium (0.50) or large (0.80) effect size. Various assumption checks 9 were performed. Inconsistency was checked with the net splitting procedure. Outli-ers were defined as effect sizes scoring at least 3.3 standard deviations above or below the pooled g, but no outliers were present in any of the analyses. Potential influence of small-study effects was checked with the Egger's test. Psychological interventions were ranked by efficacy using surface under the cumulative ranking (SUCRA) based on 50,000 resamples. The systematic literature search yielded 67 eligible RCTs (N= 5,297 patients) (see supplementary information). Psychological interventions were subdivided into five categories: TF-CBT, eye movement desensitization and reprocessing (EMDR), other trauma -focused psychological interventions (i.e., not based on TF-CBT or EMDR), multidisciplinary treatments (MDTs), and non-trau ma-focused psychological interventions. In total, 44 RCTs (66% of eligible RCTs) involved ≥50% participants with multiple-event-related PTSD, whereas 14 RCTs (21% of eligible RCTs) involved mainly single-event PTSD, and the other nine RCTs did not report sufficiently on the matter (see also supplementary information). The current analyses were conducted on the 44 RCTs having ≥50% participants with multiple-event-related PTSD. TF-CBT, MDTs and non-trauma-focused psychological interventions had a sufficient number of direct comparisons for synthesis. TF-CBT could be analyzed throughout (i.e., short-, mid-and long-term efficacy); MDTs for short-and mid-term efficacy; and non-trauma-focused psychological interventions for short-and long-term efficacy. EMDR and other trauma-focused psychological interventions did not have sufficient data and could not be included in any analysis. At treatment endpoint, TF-CBT (g=1.24, p<0.001), MDTs (g= 1.00, p<0.001), and non-trauma-focused interventions (g=1.02, p< 0.001) produced large short-term effects compared to passive control con-di tions. Compared to active control conditions, however, only TF-CBT produced a significant (moderate-sized) treatment effect (g= 0.56, p<0.001). No outliers and no inconsistencies were detected. Heterogeneity in outcomes was large (see supplementary information). At mid-term (up to 5 months following treatment), compared to passive control conditions, TF-CBT produced a large effect (g= 0.84, p<0.001) and MDTs a moderate effect (g=0.67, p=0.027). Compared to active control conditions, only TF-CBT yielded a signifi

Importance Pediatric posttraumatic stress disorder (PTSD) is a common and debilitating mental disorder, yet a comprehensive network meta-analysis examining psychological interventions is lacking. Objective To synthesize all available evidence on psychological interventions for pediatric PTSD in a comprehensive systematic review and network meta-analysis. Data Sources PsycINFO, MEDLINE, Web of Science, and PTSDpubs were searched from inception to January 2, 2024, and 74 related systematic reviews were screened. Study Selection Two independent raters screened publications for eligibility. Inclusion criteria were randomized clinical trial (RCT) with at least 10 patients per arm examining a psychological intervention for pediatric PTSD compared to a control group in children and adolescents (19 years and younger) with full or subthreshold PTSD. Data Extraction and Synthesis PRISMA guidelines were followed to synthesize and present evidence. Two independent raters extracted data and assessed risk of bias with Cochrane criteria. Random-effects network meta-analyses were run. Main Outcome and Measures Standardized mean differences (Hedges g ) in PTSD severity. Results In total, 70 RCTs (N = 5528 patients) were included. Most RCTs (n = 52 [74%]) examined trauma-focused cognitive behavior therapies (TF-CBTs). At treatment end point, TF-CBTs ( g , 1.06; 95% CI, 0.86-1.26; P < .001), eye movement desensitization and reprocessing (EMDR; g , 0.86; 95% CI, 0.54-1.18; P < .001), multidisciplinary treatments (MDTs) ( g , 0.88; 95% CI, 0.53-1.23; P < .001), and non–trauma-focused interventions ( g , 0.95; 95% CI, 0.62-1.28; P < .001) were all associated with significantly larger reductions in pediatric PTSD than passive control conditions. TF-CBTs were associated with the largest short-term reductions in pediatric PTSD relative to both passive and active control conditions and across all sensitivity analyses. In a sensitivity analysis including only trials with parent involvement, TF-CBTs were associated with significantly larger reductions in pediatric PTSD than non–trauma-focused interventions ( g , 0.35; 95% CI, 0.04-0.66; P = .03). Results for midterm (up to 5 months posttreatment) and long-term data (6-24 months posttreatment) were similar. Conclusions and Relevance Results from this systematic review and network meta-analysis indicate that TF-CBTs were associated with significant reductions in pediatric PTSD in the short, mid, and long term. More long-term data are needed for EMDR, MDTs, and non–trauma-focused interventions. Results of TF-CBTs are encouraging, and disseminating these results may help reduce common treatment barriers by counteracting common misconceptions, such as the notion that TF-CBTs are harmful rather than helpful.

Aims Although natural hazards (e.g., tropical cyclones, earthquakes) disproportionately affect developing countries, most research on their mental health impact has been conducted in high-income countries. We aimed to summarize prevalences of mental disorders in Global South populations (classified according to the United Nations Human Development Index) affected by natural hazards. Methods To identify eligible studies for this meta-analysis, we searched MEDLINE, PsycINFO and Web of Science up to February 13, 2024, for observational studies with a cross-sectional or longitudinal design that reported on at least 100 adult survivors of natural hazards in a Global South population and assessed mental disorders with a validated instrument at least 1 month after onset of the hazard. Main outcomes were the short- and long-term prevalence estimates of mental disorders. The project was registered on the International Prospective Register of Systematic Reviews (CRD42023396622). Results We included 77 reports of 75 cross-sectional studies (six included a non-exposed control group) comprising 82,400 individuals. We found high prevalence estimates for post-traumatic stress disorder (PTSD) in the general population (26.0% [95% CI 18.5–36.3]; I ² = 99.0%) and depression (21.7% [95% CI 10.5–39.6]; I ² = 99.2%) during the first year following the event, with similar prevalences observed thereafter (i.e., 26.0% and 23.4%, respectively). Results were similar for regions with vs. without recent armed conflict. In displaced samples, the estimated prevalence for PTSD was 46.5% (95% CI 39.0–54.2; k = 6; I ² = 93.3). We furthermore found higher symptom severity in exposed, versus unexposed, individuals. Data on other disorders were scarce, apart from short-term prevalence estimates of generalised anxiety disorder (15.9% [95% CI 4.7–42.0]; I ² = 99.4). Conclusions Global South populations exposed to natural hazards report a substantial burden of mental disease. These findings require further attention and action in terms of implementation of mental health policies and low-threshold interventions in the Global South in the aftermath of natural hazards. However, to accurately quantify the true extent of this public health challenge, we need more rigorous, well-designed epidemiological studies across diverse regions. This will enable informed decision making and resource allocation for those in need.

Social comparison plays an important role in depression. However, the process of social comparison selection among depressed individuals remains understudied. This study investigated the choices made by individuals with elevated depression scores (assessed with the Patient Health Questionnaire-8) when exposed to vignettes depicting individuals with varying depression severity and coping ability. We experimentally activated either self-assessment or self-enhancement motives and had participants choose from four vignettes: (1) Mild Depression/Coping Well; (2) Mild Depression/Coping Poorly; (3) Severe Depression/Coping Well; and (4) Severe Depression/Coping Poorly. Our first hypothesis was that most participants would select the Mild Depression/Coping Well vignette, presenting a potential upward social comparison standard (H1). Additionally, we expected higher depression scores to correlate with selecting vignettes featuring greater severity (H2). We further hypothesized that those in the self-enhancement condition would prefer coping poorly vignettes more than those in the self-assessment condition (H3). We conducted a between-subject online experiment ( N = 449). Confirming H1, most participants favored the Mild Depression/Coping Well vignette, while the Severe Depression/Coping Poorly vignette was least selected. Supporting H2, higher depression levels were linked to opting for alternative comparison standards over the Mild Depression/Coping Well vignette. Contrary to H3, participants’ choices were not influenced by self-motives.

Mental health-related behaviours including addictive behaviours contribute significantly to the global burden of disease. Social norm interventions appear to be a cost-effective means of reducing addictive behaviour. We conducted a systematic review and meta-analysis of the efficacy of social norm interventions for addictive behaviours. We searched the databases Medline and PsycInfo from inception to April 2024 as well as reference lists of eligible studies and related systematic reviews for randomised controlled trials (RCTs) comparing the efficacy of social norm interventions for addictive behaviours to control conditions. Out of the 11,515 potentially eligible RCTs, 52 trials with a total of 31,764 adult participants met inclusion criteria, with 45 trials targeting alcohol consumption, three trials targeting Marijuana use, two trials targeting other substance abuse and two trials targeting gambling. Overall, 37 trials were included in the random-effects meta-analysis. The comparison of social norm interventions to control conditions at posttreatment showed a small but statistically significant effect (g = −0.12; 95% CI = −0.22 to −0.02; p < 0.01). Risk of bias was rated low in 37 RCTs, 14 RCTs were rated as having some risk of bias concerns and one RCT was rated as having high risk of bias. Social norm interventions can be an effective intervention method for reducing substance abuse and gambling. Yet, data is largely derived from studies targeting alcohol consumption and current trials suffer from methodological and practical limitations. The small effect sizes need to be appraised in the context of cost-effectiveness of these interventions.