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      Effectiveness of animal-assisted interventions for children and adults with post-traumatic stress disorder symptoms: a systematic review and meta-analysis Translated title: La eficacia de las intervenciones asistidas por animales para niños y adultos con síntomas de estrés postraumático: una revisión sistemática y metanálisis Translated title: 动物辅助干预对患有创伤后应激障碍症状的儿童和成人的有效性:一项系统综述和元分析

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          ABSTRACT

          Background: Animal-assisted interventions (AAI) are increasingly applied for people with post-traumatic stress disorder (PTSD) symptoms albeit its effectiveness is unclear. Objectives: To examine the effectiveness of AAI for treating PTSD symptoms. Method: We searched 11 major electronic databases for studies reporting quantitative data on effects of AAI for children and adults with PTSD symptoms. Of 22ʹ211 records identified, we included 41 studies with 1111 participants in the systematic review comprising eight controlled studies with 469 participants in the meta-analysis. We conducted random-effects meta-analyses with all controlled studies based on standardized mean differences (SMD), and calculated standardized mean change (SMC) as effect sizes for studies with a pre-post one-group design. Two independent researchers assessed the quality of the included studies using the NIH Study Quality Assessment Tools. The primary outcome was PTSD or depression symptom severity measured via a standardized measurement at pre- and post-intervention assessments. Results: There was a small but not statistically significant superiority of AAI over standard PTSD psychotherapy (SMD = −0.26, 95% CI: −0.56 to 0.04) in reducing PTSD symptom severity while AAI was superior to waitlist (SMD = −0.82, 95% CI: −1.56 to 0.08). Getting a service dog was superior to waiting for a service dog (SMD = −0.58, 95% CI: −0.88 to −0.28). AAI led to comparable effects in reducing depression as standard PTSD psychotherapy (SMD = −0.03, CI: −0.88 to 0.83). Pre-post comparisons showed large variation for the reduction in PTSD symptom severity, with SMCs ranging from −0.38 to −1.64, and for depression symptom severity, ranging from 0.01 to −2.76. Getting a service dog lowered PTSD symptoms between −0.43 and −1.10 and depression with medium effect size of −0.74. Conclusions: The results indicate that AAI are efficacious in reducing PTSD symptomatology and depression. Future studies with robust study designs and large samples are needed for valid conclusions.

          HIGHLIGHTS

          • We conducted a systematic review with meta-analysis to provide an up-to-date summary on the state of evidence regarding the effectiveness of animal-assisted interventions in treating people with PTSD symptoms.

          • Results are promising but high-quality research is lacking to date.

          Translated abstract

          Antecedentes: Las intervenciones asistidas por animales (AAI por sus siglas en inglés) se aplican cada vez más a personas con síntomas de trastorno de estrés postraumático (TEPT) aunque su eficacia no es clara.

          Objetivos: Examinar la efectividad de la AAI para el tratamiento del TEPT

          Método: Se realizaron búsqueda en 11 bases de datos electrónicas importantes para estudios que reportaran información cuantitativa sobre los efectos de AAI para niños y adultos con síntomas de TEPT. De los 22.211 registros identificados, se incluyeron 41 estudios con 1111 participantes en la revisión sistemática que comprendían ocho estudios controlados con 469 participantes en el metanálisis. Se realizaron metanálisis de efectos aleatorios con todos los estudios controlados según las diferencias medias estandarizadas (SMD según siglas en ingles), y se calculó el cambio de medias estandarizado SMC (por sus siglas en inglés) como tamaños del efecto para los estudios con diseño de un grupo pre-post. Dos investigadores independientes evaluaron la calidad de los estudios incluidos usando las Herramientas de Evaluación de Calidad del Estudio del NIH. El resultado primario fue la medición de la severidad del TEPT o síntomas depresivos a través de mediciones estandarizadas en evaluaciones pre y post intervención.

          Resultados: Hubo una pequeña superioridad, pero no estadísticamente significativa, del AAI sobre psicoterapia estándar para TEPT (SMD= −0.26, IC 95%:-0.56 a 0.04) en la reducción de la severidad de los síntomas de TEPT, mientras que la AAI fue superior a la lista de espera (SMD= −0.82, IC 95%:-1.56 a 0.08). Tener un perro de servicio fue superior a esperar por un perro de servicio (SMD= −0.58, IC 95%:-0.88 a −0.28). La AAI produjo efectos comparables en la reducción de depresión como la psicoterapia estándar para TEPT (SMD= −0.03, IC: −0.88 a 0.83). Las comparaciones pre-post mostraron una gran variación en la reducción de la severidad de síntomas de TEPT, con rangos de SMC desde −0.38 a −1.64, y para la severidad de síntomas de depresión, rangos desde 0.01 a −2.76. Tener un perro de servicio bajo los síntomas de TEPT entre −0.43 a −1.10 y la depresión con un tamaño de efecto medio de −0.74.

          Conclusiones: Los resultados indican que los AAI son eficaces para reducir la sintomatología del TEPT y depresión. Se requieren estudios futuros con diseños de estudio sólidos y muestras grandes para obtener conclusiones válidas.

          背景: 尽管有效性尚不清楚, 动物辅助干预 (AAI) 正越来越多地应用于患有创伤后应激障碍 (PTSD) 症状的人。

          目的: 探讨AAI治疗PTSD症状的有效性。

          方法: 我们搜索了11个主要的电子数据库, 以发现报告了AAI治疗患有PTSD症状的儿童和成人效果定量数据的研究。在确定的22,211条记录中, 我们纳入了41项研究, 其中1111名参与者参加了包括8项对照研究的系统综述, 其中469名参与者参加了元分析。我们对所有对照研究进行了基于标准平均差 (SMD) 的随机效应元分析, 并计算了标准平均改变 (SMC) 作为效应的大小, 用于采用前后单组设计的研究。两名独立研究人员使用NIH研究质量评估工具评估了纳入研究的质量。主要结果是干预前, 后评估中通过标准化测量方法测得的PTSD或抑郁症状严重程度。

          结果: 在降低PTSD症状严重程度方面, AAI稍优于标准PTSD心理治疗但不统计显著 (SMD = −0.26, 95%CI:-0.56至0.04), AAI优于等待清单 (SMD = −0.82, 95%, CI:-1.56至0.08) 。获得服务犬比等待服务犬好 (SMD = −0.58, 95%CI:-0.88至-0.28) 。AAI在减轻抑郁方面与标准PTSD心理疗法具有可比的效果 (SMD = −0.03, CI:-0.88至0.83) 。事前比较显示, PTSD症状严重程度的降低存在较大差异, SMC的范围从−0.38至−1.64, 抑郁症状的严重程度范围从0.01至-2.76。养一只服务犬可以将, PTSD症状降低-0.43至-1.10之间, 抑郁症能降低的中度效应值为-0.74。

          结论: 结果表明, AAI在减少PTSD症状和抑郁方面有效。需要有可靠研究设计和大样本的未来研究才能得出有效的结论。

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          Most cited references86

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              Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies

              Systematic reviews of diagnostic test accuracy synthesize data from primary diagnostic studies that have evaluated the accuracy of 1 or more index tests against a reference standard, provide estimates of test performance, allow comparisons of the accuracy of different tests, and facilitate the identification of sources of variability in test accuracy.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8198
                2000-8066
                23 March 2021
                2021
                : 12
                : 1
                Affiliations
                [a ]Faculty of Psychology, Division of Clinical Psychology and Psychotherapy, University of Basel; , Basel, Switzerland
                [b ]REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology; , Basel, Switzerland
                [c ]Department of Epidemiology and Public Health, Human and Animal Health Unit, Swiss Tropical and Public Health Institute; , Basel, Switzerland
                [d ]Institute for Interdisciplinary Research on the Human-Animal Relationship Switzerland, c/o Swiss TPH; , Basel, Switzerland
                [e ]Department of General Practice, Erasmus MC University Medical Center; , Rotterdam, The Netherlands
                Author notes
                CONTACT Karin Hediger karin.hediger@ 123456unibas.ch Faculty of Psychology, Division of Clinical Psychology and Psychotherapy, University of Basel; , Missionsstrasse 62, Basel 4055, Switzerland
                Article
                1879713
                10.1080/20008198.2021.1879713
                8330800
                34377357
                8b17fe91-8c0e-4bf6-aabc-f194158b09c8
                © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 1, Tables: 4, References: 81, Pages: 1
                Product
                Categories
                Review Article
                Review Article

                Clinical Psychology & Psychiatry
                animal-assisted intervention,animal-assisted therapy,human-animal interaction,trauma,post-traumatic stress disorder,depression,meta-analysis,intervención asistida por animales,terapia asistida por animales,interacción humano-animal,trastorno de estrés postraumático,depresión,metanálisis,动物辅助干预,动物辅助治疗,人与动物的相互作用,创伤,创伤后应激障碍,抑郁,元分析

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