Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis

• Published in: European journal of psychotraumatology Vol. 11; no. 1; p. 1709709
• Main Authors: Lewis, Catrin, Roberts, Neil P., Gibson, Samuel, Bisson, Jonathan I.
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.01.2020; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Abandono; dropout; Dropout data from 116 Randomised Controlled Trials (RCTs) of psychological therapies for adults with PTSD was meta-analysed. The pooled rate of dropout was 16% (95% CI 14-18%). Meta-regression was conducted to explore possible predictors of dropout; Meta-analysis; Meta-Análisis; Post traumatic stress disorder; psychological; Review; Revisión Sistemática; Systematic review; Terapia Psicológica; therapy; Trastorno de Estrés Postraumático (TEPT); trauma; 中途退出; 元分析; 创伤后应激障碍 (PTSD); 心理治疗; 系统综述; trauma; psychological; review; therapy; Post-traumatic stress disorder; dropout
• ISSN: 2000-8066; 2000-8198; 2000-8066
• DOI: 10.1080/20008198.2019.1709709

Background: Despite the established efficacy of psychological therapies for post-traumatic stress disorder (PTSD) there has been little systematic exploration of dropout rates. Objective: To ascertain rates of dropout across different modalities of psychological therapy for PTSD and to explore potential sources of heterogeneity. Method: A systematic review of dropout rates from randomized controlled trials (RCTs) of psychological therapies was conducted. The pooled rate of dropout from psychological therapies was estimated and reasons for heterogeneity explored using meta-regression. Results:: The pooled rate of dropout from RCTs of psychological therapies for PTSD was 16% (95% CI 14-18%). There was evidence of substantial heterogeneity across studies. We found evidence that psychological therapies with a trauma-focus were significantly associated with greater dropout. There was no evidence of greater dropout from therapies delivered in a group format; from studies that recruited participants from clinical services rather than via advertisements; that included only military personnel/veterans; that were limited to participants traumatized by sexual traumas; that included a higher proportion of female participants; or from studies with a lower proportion of participants who were university educated. Conclusions: Dropout rates from recommended psychological therapies for PTSD are high and this appears to be particularly true of interventions with a trauma focus. There is a need to further explore the reasons for dropout and to look at ways of increasing treatment retention.