&&ReWrAp:HEADERFOOTER:0:ReWrAp&&

Author

Jennifer Liu

Degree Type

Thesis

Degree Name

Master of Science (MS)

Department

Statistics

Supervisor

Lehana Thabane

Language

English

Abstract

Meta-analysis is a statistical technique for combining findings from independent studies. A meta-analysis was performed to evaluate the effectiveness of integrated treatment programs for women with substance use issues and their children. Primary outcomes included substance use, maternal and child well-being, length of treatment, and parenting. A total of 9 randomized controlled trials (RCTs) and 84 observational studies were included in the final analysis. The p-value and capture re-capture method, were used to combine studies using different measures of treatment effect and evaluate the completeness of the literature search, respectively. Modified weights incorporating study quality were used to assess the impact of study quality on treatment effects. We also conducted a sensitivity analysis of correlation coefficients on combined estimates as a method for handling missing data.

Study quality adjusted weighting and traditional inverse variance weights provided different results for combined estimates of birth weight outcomes measured by standardized mean difference. The results from weighting by study quality provided a statistically significant result with a combined estimate of 0.2644 (95% CI: 0.0860, 0.4428), while the traditional method gave a non-significant combined estimate of 0.3032 with (95% CI: -0.0725,0.6788). The sensitivity analysis of correlation coefficients (r) on combined estimates of maternal depression effects were similar, with confidence intervals that narrowed as r increased. Values ofr = 0.2, 0.5, 0.65, 0.75, and 0.85 gave corresponding results (with 95% CI) of 0.67 (-0.10, 1.45), 0.67 (0.04, 1.3), 0.67 (0.12, 1.2),0.67 (0.18, 1.15), and 0.66 (0.25, 1.07). Robustness of the sensitivity analysis for study quality weighting and choice of correlation coefficient on combined estimates revealed benefits of integrated treatment programs for birth weight outcomes and maternal depression.

Evidence of benefit for at least some of the clients was apparent for parenting attitude measured by the Adult-Adolescent Parenting Inventory (AAPI). Results for each subscale of the AAPI were reported by timing of assessments (=< 4,5-8, => 9 months). Combined p-values were 0.0006, <0.0001, <<0.0001 for Inappropriate Expectations, 0.1938, 0.1656, <<0.0001 for Lack of Empathy, 0.0007, <0.0001 <<0.0001 for Corporal Punishment, 0.0352, 0.0002, <<0.0001 for Role Reversal, and 0.5178 (5-8 months) for Power Independence. There was insufficient evidence for concluding a significant effect of treatment on neonatal behavioural assessments measured by Apgar scores. Combined p-values of 0.6980 and 0.3294 were obtained for the 1-minute and 5-minute Apgar, respectively.

The number of missing articles estimated by the capture recapture method was 8 (95% CI: 2,24), which suggests a 90% capture rate of all relevant world literature. This result indicates that a sufficient amount of studies were retrieved to avoid bias in the results of the meta-analysis.

Conclusions regarding the effectiveness of integrated treatment programs were limited by poor quality evidence from individual studies. We suggest the use of statistical methods such as the p-value, capture re-capture, study quality weighting, and sensitivity analysis of correlation coefficients to handle missing data to address meta-analytic research questions and direct higher quality research in the future.

McMaster University Library