BMJ Mental Health (Nov 2024)
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
- Eirini Karyotaki,
- Pim Cuijpers,
- Sonya B Norman,
- Davide Papola,
- Marit Sijbrandij,
- Soraya Seedat,
- Miranda Olff,
- Sudie E Back,
- Richard Gray,
- Rolf J Kleber,
- Francisco Lotufo Neto,
- Jonathan Bisson,
- Damion Grasso,
- Grant J Devilly,
- Ulrich Schnyder,
- Marylene Cloitre,
- Nigel Hunt,
- Anke B Witteveen,
- Simonne Wright,
- Joy M Schmitz,
- Dana Bichescu-Burian,
- Liuva Capezzani,
- Thomas Elbert,
- Marcelo Mello,
- Julian D Ford,
- Pedro Gamito,
- Moira Haller,
- Julia König,
- Claire Kullack,
- Jonathan Laugharne,
- Rachel Liebman,
- Christopher William Lee,
- Jeannette Lely,
- John C. Markowitz,
- Candice Monson,
- Mirjam J Nijdam,
- Tahereh Mina Orang,
- Luca Ostacoli,
- Nenad Paunovic,
- Eva Petkova,
- Patricia Resick,
- Rita Rosner,
- Maggie Schauer,
- Brian N. Smith,
- Anka A Vujanovic,
- Yinyin Zang,
- Érica Panzani Duran
Affiliations
- Eirini Karyotaki
- 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
- Pim Cuijpers
- 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
- Sonya B Norman
- National Center for PTSD, White River Junction, Vermont, USA
- Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Marit Sijbrandij
- 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
- Soraya Seedat
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- Miranda Olff
- ARQ National Psychotrauma Centre, Diemen, Netherlands
- Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Richard Gray
- Research at Research and Recognition Project, New York, New York, USA
- Rolf J Kleber
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
- Francisco Lotufo Neto
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Jonathan Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Damion Grasso
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Grant J Devilly
- School of Applied Psychology & Griffith, Criminology Institute, Griffith University, Brisbane, Queensland, Australia
- Ulrich Schnyder
- University of Zurich, Zurich, Switzerland
- Marylene Cloitre
- National Center for PTSD Dissemination and Training Division. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
- Nigel Hunt
- Faculty of Medicine & Health Sciences, School of Medicine, The University of Nottingham, Nottingham, UK
- Anke B Witteveen
- 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, Noord-Holland, Netherlands
- Simonne Wright
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- Joy M Schmitz
- Center for Neurobehavioral Research on Addiction. Department of Psychiatry and Behavioral Sciences. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Dana Bichescu-Burian
- 6 Center for Psychiatry Reichenau, Academic Hospital of the University of Konstanz, Konstanz, Germany
- Liuva Capezzani
- International School of Psychotherapy in the Institutional Setting (SIPSI), Rome, Italy
- Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Marcelo Mello
- Departamento de Psiquiatria Escola Paulista de Medicina, UNIFESP, Sao Paulo, São Paulo, Brazil
- Julian D Ford
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Pedro Gamito
- Universidade Lusófona/HEI-Lab, Lisboa, Portugal
- Moira Haller
- National Center for PTSD. San Diego School of Medicine, University California, White River Junction, California, USA
- Julia König
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt and Ingolstadt, Germany
- Claire Kullack
- Pax Centre, West Leederville, Perth, Australia
- Jonathan Laugharne
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Perth, Australia
- Rachel Liebman
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Christopher William Lee
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Perth, Australia
- Jeannette Lely
- ARQ Centrum`45, Diemen, Noord-Holland, Netherlands
- John C. Markowitz
- New York State Psychiatric Institute, New York, New York, USA
- Candice Monson
- Toronto Metropolitan University, Toronto, Ontario, Canada
- Mirjam J Nijdam
- ARQ National Psychotrauma Centre, Diemen, Netherlands
- Tahereh Mina Orang
- International Psychosocial Organisation, Berlin, Germany
- Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
- Nenad Paunovic
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Eva Petkova
- Department of Population Health. Langone School of Medicine, New York University, New York, New York, USA
- Patricia Resick
- Duke Health, Durham, North Carolina, USA
- Rita Rosner
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt and Ingolstadt, Germany
- Maggie Schauer
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Brian N. Smith
- National Center for PTSD Women’s Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- Anka A Vujanovic
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
- Yinyin Zang
- chool of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
- Érica Panzani Duran
- Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- DOI
- https://doi.org/10.1136/bmjment-2024-301159
- Journal volume & issue
-
Vol. 27,
no. 1
Abstract
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.
