Mindfulness-enhanced parenting programmes for improving the psychosocial outcomes of children (0 to 18 years) and their parents.

Featherston R ，Barlow J ，Song Y ，Haysom Z ，Loy B ，Tufford L ，Shlonsky A ... -  《Cochrane Database of Systematic Reviews》

Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment.

Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.

Jones KA ，Freijah I ，Brennan SE ，McKenzie JE ，Bright TM ，Fiolet R ，Kamitsis I ，Reid C ，Davis E ，Andrews S ，Muzik M ，Segal L ，Herrman H ，Chamberlain C ... -  《Cochrane Database of Systematic Reviews》

Music-based therapeutic interventions for people with dementia.

Dementia is a clinical syndrome with a number of different causes. It is characterised by deterioration in cognitive, behavioural, social and emotional functioning. Pharmacological interventions are available but have limited effect on many of the syndrome's features. However, receptivity to music may remain until the late phases of dementia, and music-based therapeutic interventions (which include, but are not limited to, music therapy) are suitable for people with advanced dementia. As there is uncertainty about the effectiveness of music-based therapeutic interventions, trials are being conducted to evaluate this. This review updates one last published in 2018 and examines the current evidence for the effects of music-based interventions for people with dementia. To assess the effects of music-based therapeutic interventions for people with dementia on emotional well-being (including quality of life), mood disturbance or negative affect (i.e. depressive symptoms and anxiety), behavioural problems (i.e. overall behavioural problems or neuropsychiatric symptoms, and more specifically agitation or aggression), social behaviour and cognition, at the end of therapy and four or more weeks after the end of treatment, and to assess any adverse effects. We searched the Cochrane Dementia and Cognitive Improvement Group's Specialised Register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (ISI Web of Science), LILACS (BIREME), ClinicalTrials.gov and the World Health Organisation's meta-register-the International Clinical Trials Registry Platform on 30 November 2023. We included randomised controlled trials of music-based therapeutic interventions (of at least five sessions) for people with dementia that measured any of our outcomes of interest. Control groups either received usual care or other activities with or without music. Two review authors worked independently to screen the retrieved studies against the inclusion criteria and then to extract data from included studies and assess their risk of bias. If necessary, we contacted trial authors to ask for additional data, such as relevant subscales. We pooled data using the random-effects model. We assessed the certainty of the evidence for our two comparisons and our main outcomes of interest using GRADE. We included 30 studies with 1720 randomised participants that were conducted in 15 countries. Twenty-eight studies with 1366 participants contributed data to meta-analyses. Ten studies contributed data to long-term outcomes. Participants had dementia of varying degrees of severity and resided in institutions in most of the studies. Seven studies delivered an individual intervention; the other studies delivered the intervention to groups. Most interventions involved both active and receptive elements of musical experience. The studies were at high risk of performance bias and some were at high risk of detection or other bias. For music-based therapeutic interventions compared to usual care, we found moderate-certainty evidence that, at the end of treatment, music-based therapeutic interventions probably improved depressive symptoms slightly (standardised mean difference (SMD) -0.23, 95% confidence interval (CI) -0.42 to -0.04; 9 studies, 441 participants), and we found low-certainty evidence that it may have improved overall behavioural problems (SMD -0.31, 95% CI -0.60 to -0.02; 10 studies, 385 participants). We found moderate-certainty evidence that music-based therapeutic interventions likely did not improve agitation or aggression (SMD -0.05, 95% CI -0.27 to 0.17; 11 studies, 503 participants). Low to very low certainty evidence showed that they did not improve emotional well-being (SMD 0.14, 95% CI -0.29 to 0.56; 4 studies, 154 participants), anxiety (SMD -0.15, 95% CI -0.39 to 0.09; 7 studies, 282 participants), social behaviour (SMD 0.22, 95% CI -0.14 to 0.57; 2 studies; 121 participants) or cognition (SMD 0.19, 95% CI -0.02 to 0.41; 7 studies, 353 participants). Low or very-low -certainty evidence showed that music-based therapeutic interventions may not have been more effective than usual care in the long term (four weeks or more after the end of treatment) for any of the outcomes. For music-based therapeutic interventions compared to other interventions, we found low-certainty evidence that, at the end of treatment, music-based therapeutic interventions may have been more effective than the other activities for social behaviour (SMD 0.52, 95% CI 0.08 to 0.96; 4 studies, 84 participants). We found very low-certainty evidence of a positive effect on anxiety (SMD -0.75, 95% CI -1.27 to -0.24; 10 studies, 291 participants). For all other outcomes, low-certainty evidence showed no evidence of an effect: emotional well-being (SMD 0.20, 95% CI -0.09 to 0.49; 9 studies, 298 participants); depressive symptoms (SMD -0.14, 95% CI -0.36 to 0.08; 10 studies, 359 participants); agitation or aggression (SMD 0.01, 95% CI -0.31 to 0.32; 6 studies, 168 participants); overall behavioural problems (SMD -0.08, 95% CI -0.33 to 0.17; 8 studies, 292 participants) and cognition (SMD 0.12, 95% CI -0.21 to 0.45; 5 studies; 147 participants). We found low or very-low certainty evidence that music-based therapeutic interventions may not have been more effective than other interventions in the long term (four weeks or more after the end of treatment) for any of the outcomes. Adverse effects were inconsistently measured or recorded, but no serious adverse events were reported. When compared to usual care, providing people with dementia with at least five sessions of a music-based therapeutic intervention probably improves depressive symptoms and may improve overall behavioural problems at the end of treatment. When compared to other activities, music-based therapeutic interventions may improve social behaviour at the end of treatment. No conclusions can be reached about the outcome of anxiety as the certainty of the evidence is very low. There may be no effects on other outcomes at the end of treatment. There was no evidence of long-term effects from music-based therapeutic interventions. Adverse effects may be rare, but the studies were inconsistent in their reporting of adverse effects. Future studies should examine the duration of effects in relation to the overall duration of treatment and the number of sessions.

van der Steen JT ，van der Wouden JC ，Methley AM ，Smaling HJA ，Vink AC ，Bruinsma MS ... -  《Cochrane Database of Systematic Reviews》

Patient navigator programmes for children and adolescents with chronic diseases.

Despite a substantial global improvement in infant and child mortality from communicable diseases since the early 1990s there is now a growing burden of chronic disease in children and adolescents worldwide, mimicking the trend seen in the adult population. Chronic diseases in children and adolescents can affect all aspects of their well-being and function with these burdens and their health-related consequences often carried into adulthood. Up to one third of disability-adjusted life years for children and adolescents globally are a result of chronic disease. This has profound implications for the broader family unit, communities, and health systems in which these children and young people reside. Models of chronic care delivery for children and adolescents with chronic disease have traditionally been adapted from adult models. There is a growing recognition that children and adolescents with chronic diseases have a unique set of healthcare needs. Their needs extend beyond disease education and management appropriate to the developmental stage of the child, to encompass psychological well-being for the entire family and a holistic care approach focusing on the social determinants of health. It is for this reason that patient navigators have been proposed as a potential intervention to help fulfil this critical healthcare gap. Patient navigators are trained medical or non-medical personnel (e.g. lay health workers, community health workers, nurses, or people with lived experience) who provide guidance for the patients (and their primary caregivers) as they move through complex (and often bewildering) medical and social systems. The navigator may deliver education, help to co-ordinate patient care, be an advocate for the patient (and their primary caregivers), or combinations of these. Patient navigators can assist people with a chronic illness (especially those who are vulnerable or from a marginalised population, or both) to better understand their diagnoses, treatment options, and available resources. As there is considerable variation in the purpose, design, and target population of patient navigator programmes, there is a need to systematically review and summarise the existing literature on the effectiveness of navigator programmes in children and young adults with chronic disease. To assess the effectiveness of patient navigator programmes in children and adolescents with chronic diseases. We searched the Cochrane Library and Epistemonikos up to 20 January 2023 for related systematic reviews using search terms relevant to this review. We searched CENTRAL, MEDLINE, Embase, CINAHL EBSCO, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov for primary studies. We included randomised controlled trials reporting the effect of patient navigator interventions on children and adolescents (aged 18 years or younger) with any chronic disease in hospital or community settings. Two review authors independently assessed the retrieved titles and abstracts, and where necessary, the full text to identify studies that satisfied the inclusion criteria. Two review authors extracted data using a standard data extraction form. We used a random-effects model to perform a quantitative synthesis of the data. We used the I² statistic to measure heterogeneity amongst the studies in each analysis. We indicated summary estimates as mean differences (MD), where studies used the same scale, or standardised mean differences (SMD), where studies used different scales, with 95% confidence intervals (CI). We used subgroup and univariate meta-regression to assess reasons for between-study differences. We used the Cochrane RoB 1 tool to assess the methodological quality of the included studies. We used GRADE to assess the certainty of the evidence. We included 17 studies (2895 randomised participants). All studies compared patient navigators with standard care. Most studies were at unclear or high risk of bias. Meta-analysis was undertaken only for those studies that had the same duration of patient navigator intervention and follow-up/reporting of outcome measures. The evidence is very uncertain about the effects of patient navigator programmes compared with standard care on self-reported quality of life of children with chronic illness (SMD 0.63, 95% CI -0.20 to 1.47; I2 = 96%; 4 studies, 671 participants; very low-certainty evidence); parent proxy-reported quality of life (SMD 0.09, 95% CI -2.21 to 2.40; I2 = 99%; 2 studies, 309 participants; very low-certainty evidence); or parents' or caregivers' quality of life (SMD -1.98, 95% CI -4.13 to 0.17; I2 = 99%; 3 studies, 757 participants; very low-certainty evidence). It is uncertain whether duration of patient navigator intervention accounts for any of the variances in the changes in quality of life. The evidence is very uncertain about the effects of patient navigator programmes compared with standard care on the number of hospital admissions (MD -0.05, 95% CI -0.34 to 0.23; I2 = 99%; 2 studies, 381 participants; very low-certainty evidence) and the number of presentations to the emergency department (MD 0.06, 95% CI -0.23 to 0.34; I2 = 98%; 2 studies, 381 participants; very low-certainty evidence). Furthermore, it is unclear whether patient navigator programmes reduce the number of missed school days as data were sparse (2 studies, 301 participants). Four studies (629 participants) reported data on resource use. However, given the variation in units of analysis used, meta-analysis was not possible (very low-certainty evidence). All studies reported cost savings or quality-adjusted life year improvement (or both) in the patient navigation arm. No studies reported on adverse events (specifically, abuse of any type against the navigator, the patient, or their family members). There is insufficient evidence at present to support the use of patient navigator programmes for children and adolescents with chronic diseases. The current evidence is based on limited data with very low-certainty evidence. Further studies are likely to significantly change these results.

Lalji R ，Koh L ，Francis A ，Khalid R ，Guha C ，Johnson DW ，Wong G ... -  《Cochrane Database of Systematic Reviews》

Prevention of self-harm and suicide in young people up to the age of 25 in education settings.

In 2016, globally, suicide was the second leading cause of death amongst those aged 15 to 29 years. Self-harm is increasingly common among young people in many countries, particularly among women and girls. The risk of suicide is elevated 30-fold in the year following hospital presentation for self-harm, and those with suicidal ideation have double the risk of suicide compared with the general population. Self-harm and suicide in young people are significant public health issues that cause distress for young people, their peers, and family, and lead to substantial healthcare costs. Educational settings are widely acknowledged as a logical and appropriate place to provide prevention and treatment. A comprehensive, high-quality systematic review of self-harm and suicide prevention programmes in all education settings is thus urgently required. This will support evidence-informed decision making to facilitate rational investment in prevention efforts in educational settings. Suicide and self-harm are distressing, and we acknowledge that the content of this review is sensitive as the data outlined below represents the lived and living experience of suicidal distress for individuals and their caregivers. To assess the effects of interventions delivered in educational settings to prevent or address self-harm and suicidal ideation in young people (up to the age of 25) and examine whether the relative effects on self-harm and suicide are modified by education setting. We searched the Cochrane Common Mental Disorders Specialised Register, CENTRAL, The Cochrane Database of Systematic Reviews, Ovid MEDLINE, PsycINFO, ERIC, Web of Science Social Science Citation Index, EBSCO host Australian Education Index, British Education Index, Educational Research Abstracts to 28 April 2023. We included trials where the primary aim was to evaluate an intervention specifically designed to reduce self-harm or prevent suicide in an education setting. Randomised controlled trials (RCTs), cluster-RCTs, cross-over trials and quasi-randomised trials were eligible for inclusion. Primary outcomes were self-harm postintervention and acceptability; secondary outcomes included suicidal ideation, hopelessness, and two outcomes co-designed with young people: better or more coping skills, and a safe environment, with more acceptance and understanding. We used standard methodological procedures as expected by Cochrane. Two review authors independently selected studies, extracted data, and assessed risk of bias. We analysed dichotomous data as odds ratios (ORs) and continuous data as standardised mean differences (SMDs) with 95% confidence intervals (CIs). We conducted random-effects meta-analyses and assessed certainty of evidence using the GRADE approach. For co-designed outcomes, we used vote counting based on the direction of effect, as there is a huge variation in the data and the effect measure used in the included studies. We included 51 trials involving 36,414 participants (minimum 23; maximum 11,100). Twenty-seven studies were conducted in secondary schools, one in middle school, one in primary school, 19 in universities, one in medical school, and one across education and community settings. Eighteen trials investigated universal interventions, 11 of which provided data for at least one meta-analysis, but no trials provided data for self-harm postintervention. Evidence on the acceptability of universal interventions is of very low certainty, and indicates little or no difference between groups (OR 0.77, 95% CI 0.36 to 1.67; 9 studies, 8528 participants). Low-certainty evidence showed little to no effect on suicidal ideation (SMD -0.02, 95% CI -0.23 to 0.20; 4 studies, 379 participants) nor on hopelessness (MD -0.01, 95% CI -1.98 to 1.96; 1 trial, 121 participants). Fifteen trials investigated selective interventions, eight of which provided data for at least one meta-analysis, but only one trial provided data for self-harm postintervention. Low-certainty evidence indicates that selective interventions may reduce self-harm postintervention slightly (OR 0.39, 95% CI 0.06 to 2.43; 1 trial, 148 participants). While no trial provided data for hopelessness, little to no effect was found on acceptability (OR 1.00, 95% CI 0.5 to 2.0; 6 studies, 10,208 participants; very low-certainty evidence) or suicidal ideation (SMD 0.04, 95% CI -0.36 to 0.43; 2 studies, 102 participants; low-certainty evidence). Seventeen trials investigated indicated interventions, 14 of which provided data for at least one meta-analysis, but only four trials provided data for self-harm postintervention and two reported no events in both groups. Low-certainty evidence suggests that indicated interventions may slightly reduce self-harm postintervention (OR 0.19, 95% CI 0.02 to 1.76; 2 studies, 76 participants). There is also low-certainty evidence indicating that these interventions may decrease the odds of non-suicidal self-injury (OR 0.65, 95% CI 0.24 to 1.79; 2 studies, 89 participants). Evidence of a slight decrease in acceptability in the intervention group is of low certainty (OR 1.44, 95% CI 0.86 to 2.42; 10 studies, 641 participants). Low-certainty evidence shows that indicated interventions may slightly reduce suicidal ideation (SMD -0.33, 95% CI -0.55 to -0.10; 10 studies, 685 participants) and may result in little to no difference in hopelessness postintervention (SMD -0.27, 95% CI -0.55 to 0.01; 6 studies, 455 participants). There were mixed findings regarding the effect of suicide prevention interventions on a range of constructs relevant to coping skills and safe environment. None of the trials, however, measured the impact of improvements in these constructs on self-harm or suicidal ideation. While this review provides an update on the evidence about interventions targeting self-harm and suicide prevention in education settings, there remains significant uncertainty about the impact of these interventions. There are some promising findings but large replication studies are needed, as are studies that examine the combination of different intervention approaches, and can be delivered in a safe environment and implemented over a long period of time. Further research is required to understand and measure outcomes that are meaningful to young people with lived experience, as they want coping skills and safety of the environment in which they conduct their everyday lives to be measured as key outcomes in future trials.

Sharma V ，Marshall D ，Fortune S ，Prescott AE ，Boggiss A ，Macleod E ，Mitchell C ，Clarke A ，Robinson J ，Witt KG ，Hawton K ，Hetrick SE ... -  《Cochrane Database of Systematic Reviews》