Semmlinger Verena, Leithner Cosima, Klöck Lea Maria, Ranftl Lena, Ehring Thomas, Schreckenbach Monika
Department of Psychology, Ludwig-Maximilians-University Munich, Munich 80802, Germany.
German Center for Mental Health (DZPG), Munich 80802, Germany.
Depress Anxiety. 2024 Jul 26;2024:9899034. doi: 10.1155/2024/9899034. eCollection 2024.
Although highly efficacious psychological treatments for posttraumatic stress disorder (PTSD) exist, there is evidence that first-line psychological treatment approaches leave a substantial subgroup of patients still suffering from clinically relevant PTSD symptoms posttreatment.
We aimed to meta-analytically establish the prevalence and predictors of nonresponse to first-line guideline-recommended psychological treatments for PTSD.
This meta-analysis was preregistered (CRD42023368766). We searched the PTSD Trials Standardized Data Repository, Embase, Medline, PsychINFO, and PTSDpubs. We included randomized controlled trials (RCT), reporting data on nonresponse operationalized by (lack of) symptom reduction in PTSD symptoms at posttreatment of first-line guideline-recommended PTSD treatments for adult patients meeting criteria for a PTSD diagnosis. All studies published by October 10, 2023, were included. Data were extracted by two independent reviewers. We estimated the pooled average nonresponse rates and ORs. Subgroup and metaregression analyses targeting the nonresponse rates served to identify significant predictors. All analyses were conducted using three-level multilevel models. Study quality was assessed using Cochrane's RoB 2 tool.
Eighty six studies with 117 active treatment conditions and 7,894 participants were included in the meta-analysis. The weighted average nonresponse rate was 39.23%, 95% CI (35.08%, 43.53%). Nonresponse was less frequent in the treatment condition compared to the control condition ( = 0.22). Subgroup analyses and metaregression revealed the type of analysis, population, type of intervention, treatment format, year of publication, age, sex, PTSD symptom severity, comorbid depression, and baseline depression score as significant predictors. The heterogeneity between studies was substantial to considerable ( = 83.12%). Half of the studies had a high risk of bias.
This meta-analysis found that a substantial subgroup of patients suffering from PTSD still showed clinically significant symptoms after having received treatment. Treatment modifications should be considered for specific subgroups of PTSD patients based on predictors found to be associated with nonresponse.
尽管存在针对创伤后应激障碍（PTSD）的高效心理治疗方法，但有证据表明，一线心理治疗方法使相当一部分患者在治疗后仍遭受与临床相关的PTSD症状困扰。
我们旨在通过荟萃分析确定对PTSD一线指南推荐心理治疗无反应的患病率及预测因素。
该荟萃分析已预先注册（CRD42023368766）。我们检索了PTSD试验标准化数据存储库、Embase、Medline、PsychINFO和PTSDpubs。我们纳入了随机对照试验（RCT），这些试验报告了关于符合PTSD诊断标准的成年患者在一线指南推荐的PTSD治疗后，通过PTSD症状（未）减轻来界定的无反应数据。纳入了2023年10月10日前发表的所有研究。数据由两名独立审阅者提取。我们估计了合并平均无反应率和优势比。针对无反应率的亚组分析和元回归分析用于确定显著的预测因素。所有分析均使用三级多水平模型进行。使用Cochrane的RoB 2工具评估研究质量。
荟萃分析纳入了86项研究，涉及117种积极治疗条件和7894名参与者。加权平均无反应率为39.23%，95%置信区间（35.08%，43.53%）。与对照条件相比，治疗条件下的无反应情况较少（比值比=0.22）。亚组分析和元回归显示，分析类型、人群、干预类型、治疗形式、发表年份、年龄、性别、PTSD症状严重程度、共病抑郁症以及基线抑郁评分是显著的预测因素。研究之间的异质性很大（I²=83.12%）。一半的研究存在高偏倚风险。
该荟萃分析发现，相当一部分患有PTSD的患者在接受治疗后仍表现出具有临床意义的症状。应根据发现的与无反应相关的预测因素，考虑对特定亚组的PTSD患者进行治疗调整。
