Trauma-focused treatments for refugee children and adolescents with PTSD: a three-arm randomized controlled trial comparing the efficacy of EMDR and KIDNET versus a waitlist control group (the KIEM study).

内容摘要

Due to trauma and ongoing adversity, refugee minors are at high risk for mental health issues, including PTSD. This study evaluated the efficacy of Eye Movement Desensitization and Reprocessing therapy (EMDR) and Narrative Exposure Therapy for Children (KIDNET), in reducing PTSD symptoms, behavioural and emotional symptoms and improving quality of life in refugee children and adolescents in the Netherlands, compared to a waitlist control group (WL). A secondary objective was to compare the efficacy of EMDR and KIDNET. A randomized controlled trial was conducted with three arms (N = 96): EMDR (n = 32), KIDNET (n = 32), and WL (n = 32). After 8 weeks, WL participants were re-randomized to EMDR or KIDNET. Follow-ups were conducted at 1- and 3-months post-treatment. Participants were refugee minors aged 8-18 years, accompanied by a caregiver, and meeting criteria for a (partial) PTSD diagnosis. Both treatments included 8 weekly sessions and 1-4 parental guidance sessions. Both EMDR (d = 1.31) and KIDNET (d = 0.94) significantly reduced clinician-rated PTSD symptom severity compared to WL. Similar results were found for child-report, but not for caregiver-report. Regarding secondary outcomes, quality of life and emotional and behavioural symptoms, comparisons of both interventions to the WL revealed small to moderate effect sizes with non-significant effects for KIDNET versus WL, and significant effects for EMDR versus WL. EMDR, compared to KIDNET, showed a significantly greater reduction in clinician-rated PTSD symptom severity (T1-T3) (d=-0.38) with no significant differences on other outcome measures. Results were achieved after an average of 6.61 sessions for EMDR and 9.10 for KIDNET. Dropout rates were 20.8% for EMDR and 10.9% for KIDNET, based on the total sample after the second randomization. These findings suggest that both EMDR and KIDNET are efficacious trauma-focused treatments for refugee children and adolescents. Trial registration The trial was registered in the Overview of Medical Research in the Netherlands on February 2, 2014 (NL-OMON44793), amended on June 16, 2017, and re-registered on June 16, 2021 (NL-OMON22679), where one updated outcome measure and expanded eligibility criteria were documented.