Predictors of study dropout in cognitive-behavioural therapy with a trauma focus for post-traumatic stress disorder in adults: An individual participant data meta-analysis.

Journal: BMJ mental health

Volume: 27

Issue: 1

Year of Publication: 2024

Affiliated Institutions:  South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa simonnewright@gmail.com. Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands. Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK. WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy. Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA. Center for Psychiatry Reichenau, Academic Hospital of the University of Konstanz, Konstanz, Germany. International School of Psychotherapy in the Institutional Setting (SIPSI), Rome, Italy. National Center for PTSD Dissemination and Training Division. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA. School of Applied Psychology & Griffith, Criminology Institute, Griffith University, Brisbane, Queensland, Australia. Department of Psychology, University of Konstanz, Konstanz, Germany. Departamento de Psiquiatria Escola Paulista de Medicina, UNIFESP, Sao Paulo, São Paulo, Brazil. University of Connecticut School of Medicine, Farmington, Connecticut, USA. Universidade Lusófona/HEI-Lab, Lisboa, Portugal. Research at Research and Recognition Project, New York, New York, USA. National Center for PTSD. San Diego School of Medicine, University California, White River Junction, California, USA. Faculty of Medicine & Health Sciences, School of Medicine, The University of Nottingham, Nottingham, UK. Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands. Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt and Ingolstadt, Germany. Pax Centre, West Leederville, Perth, Australia. Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Perth, Australia. Department of Psychology, University of Toronto, Toronto, Ontario, Canada. ARQ Centrum', Diemen, Noord-Holland, Netherlands. New York State Psychiatric Institute, New York, New York, USA. Toronto Metropolitan University, Toronto, Ontario, Canada. ARQ National Psychotrauma Centre, Diemen, Netherlands. National Center for PTSD, White River Junction, Vermont, USA. International Psychosocial Organisation, Berlin, Germany. Department of Clinical and Biological Sciences, University of Turin, Torino, Italy. Department of Psychology, Stockholm University, Stockholm, Sweden. Department of Population Health. Langone School of Medicine, New York University, New York, New York, USA. Duke Health, Durham, North Carolina, USA. Center for Neurobehavioral Research on Addiction. Department of Psychiatry and Behavioral Sciences. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA. University of Zurich, Zurich, Switzerland. National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA. Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA. chool of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China. Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil. South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.

Abstract summary 

Available empirical evidence on participant-level factors associated with dropout from psychotherapies for post-traumatic stress disorder (PTSD) is both limited and inconclusive. More comprehensive understanding of the various factors that contribute to study dropout from cognitive-behavioural therapy with a trauma focus (CBT-TF) is crucial for enhancing treatment outcomes.Using an individual participant data meta-analysis (IPD-MA) design, we examined participant-level predictors of study dropout from CBT-TF interventions for PTSD.A comprehensive systematic literature search was undertaken to identify randomised controlled trials comparing CBT-TF with waitlist control, treatment-as-usual or another therapy. Academic databases were screened from conception until 11 January 2021. Eligible interventions were required to be individual and in-person delivered. Participants were considered dropouts if they did not complete the post-treatment assessment.The systematic literature search identified 81 eligible studies (n=3330). Data were pooled from 25 available CBT-TF studies comprising 823 participants. Overall, 221 (27%) of the 823 dropped out. Of 581 civilians, 133 (23%) dropped out, as did 75 (42%) of 178 military personnel/veterans. Bivariate and multivariate analyses indicated that military personnel/veterans (RR 2.37) had a significantly greater risk of dropout than civilians. Furthermore, the chance of dropping out significantly decreased with advancing age (continuous; RR 0.98).These findings underscore the risk of premature termination from CBT-TF among younger adults and military veterans/personnel.Understanding predictors can inform the development of retention strategies tailored to at-risk subgroups, enhance engagement, improve adherence and yield better treatment outcomes.

Authors & Co-authors:  Wright Simonne S Karyotaki Eirini E Cuijpers Pim P Bisson Jonathan J Papola Davide D Witteveen Anke B AB Back Sudie E SE Bichescu-Burian Dana D Capezzani Liuva L Cloitre Marylene M Devilly Grant J GJ Elbert Thomas T Mello Marcelo M Ford Julian D JD Grasso Damion D Gamito Pedro P Gray Richard R Haller Moira M Hunt Nigel N Kleber Rolf J RJ König Julia J Kullack Claire C Laugharne Jonathan J Liebman Rachel R Lee Christopher William CW Lely Jeannette J Markowitz John C JC Monson Candice C Nijdam Mirjam J MJ Norman Sonya B SB Olff Miranda M Orang Tahereh Mina TM Ostacoli Luca L Paunovic Nenad N Petkova Eva E Resick Patricia P Rosner Rita R Schauer Maggie M Schmitz Joy M JM Schnyder Ulrich U Smith Brian N BN Vujanovic Anka A AA Zang Yinyin Y Duran Érica Panzani ÉP Neto Francisco Lotufo FL Seedat Soraya S Sijbrandij Marit M

Study Outcome 

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Statistics
Citations : 
Authors :  47
Identifiers
Doi : e301159
SSN : 2755-9734
Study Population
Male,Female
Mesh Terms
Humans
Other Terms
PSYCHIATRY
Study Design
Study Approach
Systemic Review
Country of Study
Publication Country
England