Department of Health Affairs, Psychological Health Center of Excellence, Research Branch, Tacoma, Washington, USA.
Department of Health Affairs, Psychological Health Center of Excellence, Performance & Analytics Branch, Tacoma, Washington, USA.
J Trauma Stress. 2021 Aug;34(4):808-818. doi: 10.1002/jts.22653. Epub 2021 Feb 1.
High treatment dropout rates reported in recent literature have brought into question the effectiveness of trauma-focused posttraumatic stress disorder (PTSD) treatments among military populations. The aim of the current systematic review was to evaluate PTSD treatment dropout rates among military populations by treatment type and other study-level variables. We searched four databases as well as gray literature for randomized controlled trials that evaluated evidence-based PTSD treatments in samples of active duty personnel and/or veterans. In total, 26 studies were included in this review, with a total of 2,984 participants. We analyzed dropout rates across treatment types using multivariate meta-analysis. Across all forms of treatment, the aggregated dropout rate was 24.2%. Dropout percentages based on treatment type were 27.1% for trauma-focused treatments, 16.1% for non-trauma-focused treatments, and 6.8% for waitlist groups. We found substantial heterogeneity between studies that was not explained by military status or other study-level covariates. Summary risk ratios (RRs) comparing relative dropout between treatment groups indicated that trauma-focused treatment groups had a higher risk of dropout compared to non-trauma-focused treatments, RR = 1.60. The statistical heterogeneity of within-treatment dropout risk ratios was negligible. Dropout rates among military patients receiving trauma-focused therapies were only slightly higher than those reported in the literature among civilian populations and were not explained by study-level covariates.
近期文献报道的高治疗脱落率，使创伤后应激障碍（PTSD）治疗在军事人群中的有效性受到质疑。本系统评价的目的是评估不同治疗类型和其他研究水平变量对军事人群 PTSD 治疗脱落率的影响。我们检索了四个数据库和灰色文献，以评估在现役人员和/或退伍军人样本中，基于证据的 PTSD 治疗方法。共有 26 项研究纳入了本次综述，共计 2984 名参与者。我们使用多元荟萃分析来分析不同治疗类型的脱落率。在所有治疗形式中，总的脱落率为 24.2%。根据治疗类型，脱落百分比分别为：创伤聚焦治疗为 27.1%，非创伤聚焦治疗为 16.1%，候补组为 6.8%。研究间存在显著的异质性，无法用军事地位或其他研究水平的协变量来解释。治疗组间相对脱落的综合风险比（RR）表明，与非创伤聚焦治疗相比，创伤聚焦治疗组的脱落风险更高，RR=1.60。治疗内脱落风险比的统计学异质性可以忽略不计。接受创伤聚焦治疗的军事患者的脱落率略高于文献中报告的平民人群中的脱落率，且不能用研究水平的协变量来解释。
