South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
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.
BMJ Ment Health. 2024 Nov 13;27(1):e301159. doi: 10.1136/bmjment-2024-301159.
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.
有关创伤后应激障碍（PTSD）心理治疗脱落的参与者水平因素的现有经验证据既有限又不确定。更全面地了解导致以创伤为重点的认知行为疗法（CBT-TF）研究脱落的各种因素，对于提高治疗效果至关重要。
使用个体参与者数据荟萃分析（IPD-MA）设计，我们研究了 PTSD 的 CBT-TF 干预研究脱落的参与者水平预测因素。
进行了全面的系统文献检索，以确定比较 CBT-TF 与等待名单对照、常规治疗或其他治疗的随机对照试验。从概念到 2021 年 1 月 11 日筛选了学术数据库。合格的干预措施必须是个体和面对面进行的。如果参与者未完成治疗后评估，则被视为脱落。
系统文献检索确定了 81 项符合条件的研究（n=3330）。数据来自 25 项可获得的 CBT-TF 研究，共 823 名参与者。总体而言，823 名参与者中有 221 名（27%）脱落。在 581 名平民中，133 名（23%）脱落，178 名军人/退伍军人中有 75 名（42%）脱落。双变量和多变量分析表明，军人/退伍军人（RR 2.37）的脱落风险明显高于平民。此外，随着年龄的增长（连续变量；RR 0.98），脱落的可能性显著降低。
这些发现强调了年轻成年人和军人/退伍军人的 CBT-TF 治疗过早终止的风险。
了解预测因素可以为制定针对高危亚组的保留策略提供信息，提高参与度，提高依从性，并产生更好的治疗效果。
