Lewis Catrin, Roberts Neil P, Gibson Samuel, Bisson Jonathan I
National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK.
Psychology and Psychological Therapies, Cardiff & Vale University Health Board, Cardiff, UK.
Eur J Psychotraumatol. 2020 Mar 9;11(1):1709709. doi: 10.1080/20008198.2019.1709709. eCollection 2020.
Despite the established efficacy of psychological therapies for post-traumatic stress disorder (PTSD) there has been little systematic exploration of dropout rates. To ascertain rates of dropout across different modalities of psychological therapy for PTSD and to explore potential sources of heterogeneity. 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. : 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. 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.
尽管心理疗法对创伤后应激障碍（PTSD）的疗效已得到确立，但对其脱落率却鲜有系统的探索。目的是确定PTSD不同心理治疗方式的脱落率，并探索潜在的异质性来源。对心理治疗随机对照试验（RCT）的脱落率进行了系统评价。估计了心理治疗的合并脱落率，并使用元回归探索了异质性的原因。结果显示，PTSD心理治疗RCT的合并脱落率为16%（95%可信区间14 - 18%）。研究间存在显著异质性的证据。我们发现有证据表明，以创伤为重点的心理治疗与更高的脱落率显著相关。没有证据表明以小组形式提供的治疗、从临床服务而非通过广告招募参与者的研究、仅纳入军事人员/退伍军人的研究、仅限于遭受性创伤的参与者的研究、女性参与者比例较高的研究，或大学教育程度参与者比例较低的研究，其脱落率更高。推荐的PTSD心理治疗的脱落率很高，对于以创伤为重点的干预措施似乎尤其如此。有必要进一步探索脱落的原因，并研究提高治疗保留率的方法。
