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

Background 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.

 

Objective Using an individual participant data meta-analysis (IPD-MA) design, we examined participant-level predictors of study dropout from CBT-TF interventions for PTSD.

 

Methods 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.

 

Findings 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).

 

Conclusions These findings underscore the risk of premature termination from CBT-TF among younger adults and military veterans/personnel.

 

Clinical implication Understanding predictors can inform the development of retention strategies tailored to at-risk subgroups, enhance engagement, improve adherence and yield better treatment outcomes.

Reference: 
Simonne Wright, Eirini Karyotaki, Pim Cuijpers, Jonathan Bisson, Davide Papola, Anke B Witteveen, Sudie E Back, Dana Bichescu-Burian, Liuva Capezzani, Marylene Cloitre, Grant J Devilly, Thomas Elbert, Marcelo Mello, Julian D Ford, Damion Grasso, Pedro Gamito, Richard Gray, Moira Haller, Nigel Hunt, Rolf J Kleber, Julia König, Claire Kullack, Jonathan Laugharne, Rachel Liebman, Christopher William Lee, Jeannette Lely, John C. Markowitz, Candice Monson, Mirjam J Nijdam, Sonya B Norman, Miranda Olff, Tahereh Mina Orang, Luca Ostacoli, Nenad Paunovic, Eva Petkova, Patricia Resick, Rita Rosner, Maggie Schauer, Joy M Schmitz, Ulrich Schnyder, Brian N. Smith Anka A Vujanovic, Yinyin Zang, Érica Panzani Duran, Francisco Lotufo Neto, Soraya Seedat, Marit Sijbrandij | 2024
In: BMJ Mental Health ; ISSN: 2755-9734 | 27 | e301159
https://doi.org/10.1136/bmjment-2024-301159
Keywords: 
Adults, Cognitive Behavioral Therapy, Medical Procedures, Meta Analysis, Posttraumatic Stress Disorder, Predictors, Psychotherapy, Psychotrauma, PTSD (en)
Affiliation author(s): 
ARQ Centrum’45 (en), ARQ National Psychotrauma Centre