Functional outcomes in youth with complex trauma: a systematic review of psychosocial interventions

Abstract

ABSTRACT Objective Young people with complex trauma typically experience numerous psychosocial and functional impairments. Differing models exist for measuring and determining mental health recovery from complex trauma, but those emphasising functional change may be underrepresented. Method Four databases were searched (Web of Science, CINAHL Complete, MEDLINE and Cochrane Library) for studies published between 2010 and 2021 to identify and summarise existing psychosocial interventions and their impact on quality of life, occupational activity, risk behaviour and/or use of psychiatric emergency services. One primary reviewer conducted the study with the assistance of two senior reviewers. The results are presented in the form of a narrative synthesis. Results Over 12,000 studies were examined. Eight studies met the inclusion criteria. Four functional outcomes were reported in the literature – Quality of Life, occupational functioning, self-harm, and suicidal ideation. Results were inconsistent regarding improvements in functional outcomes with treatment. All interventions were effective in reducing posttraumatic stress. Conclusions Few intervention studies report on functional outcomes. Interventions described in this paper may have potential to improve functioning in young people with complex trauma but research in this area is limited. Future researchers are encouraged to include measures of functional change alongside traditional symptom reports. KEY POINTS What is already known about this topic: (1) Young people who experience complex trauma are more likely to experience delays in psychosocial development and barriers to occupational participation. (2) Psychosocial interventions are effective in reducing the consequences of complex traumatic stress reactions such as complex PTSD. (3) Youth consumer-driven recovery models are in early development. What this topic adds: (1) Traditional concepts of recovery remain predominant in intervention research. Transitioning to consumer-driven recovery models is lagging. (2) It is not clear if current interventions for PTSD/complex PTSD in youth have any impact on Quality of Life, frequency of psychiatric crises or occupational activity. (3) There are few solutions for practitioners or service designers seeking functional improvement for youth with complex trauma and complex PTSD.