The efficacy of psychological interventions for adult post-traumatic stress disorder following exposure to single versus multiple traumatic events: a meta-analysis of randomised controlled trials.

BACKGROUND

Previous meta-analyses of psychological interventions for adult post-traumatic stress disorder (PTSD) did not investigate whether efficacy is diminished in individuals with PTSD related to multiple (vs single) traumatic events. We aimed to assess whether treatment efficacy would be lower in randomised controlled trials involving multiple-event-related PTSD versus single-event-related PTSD.

METHODS

For this meta-analysis, we searched PsycINFO, MEDLINE, Web of Science, and PTSDpubs from database inception to April 18, 2023. Randomised controlled trials involving adult clinical samples (≥70% meeting full PTSD criteria) with adequate size (≥10 participants per arm) were included. We extracted data on trial characteristics, demographics, and outcome data. Random-effects meta-analyses were run to summarise standardised mean differences (Hedges' g). Trials involving 100% of participants with single-event-related PTSD versus at least 50% of participants with multiple-event-related PTSD (ie, associated with ≥two traumatic events) were categorised. Quality of evidence was assessed using the Cochrane criteria. The review protocol was registered in PROSPERO (CRD42023407754).

FINDINGS

Overall, 137 (85%) of 161 randomised controlled trials were included in the quantitative synthesis, comprising 10 684 participants with baseline data and 9477 with post-treatment data. Of those randomly assigned, 5772 (54%) of 10 692 participants identified as female, 4917 (46%) as male, and three (<1%) as transgender or other. 34 (25%) of 137 trials exclusively involved women, 15 (11%) trials exclusively involved men, and the remainder were mixed samples. Mean age across the trials was 40·2 years (SD 9·0) ranging from 18·0 years to 65·4 years. 23 (17%) of 137 trials involved participants from low-income and middle-income countries (23 [17%] of 137). Data on ethnicity were not extracted. At treatment endpoint, psychological interventions were highly effective for PTSD when compared with passive control conditions in both samples with single-event-related PTSD (Hedges' g 1·04 [95% CI 0·77-1·31]; n=11; I

INTERPRETATION

Contrary to our hypothesis, we found strong evidence that psychological interventions are highly effective treatments for PTSD in patients with a history of multiple traumatic events. Results are encouraging for clinical practice and could counteract common misconceptions regarding treatment and treatment barriers.

FUNDING

None.

Informations de copyright

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Déclaration de conflit d'intérêts

Declaration of interests THH is a licensed cognitive behaviour therapy therapist. RM-S occasionally receives payment (from universities and private training providers) for training therapists in the delivery of cognitive therapy for PTSD for children and adolescents; is a co-investigator or chief investigator on four National Institute for Health and Care Research (NIHR)-funded or Medical Research Council-funded clinical trials of psychological therapies, particularly cognitive therapy for PTSD in children and young people; and was the chair of a steering committee for a trial addressing the online treatment of PTSD in adults. RM-S’ institution (University of East Anglia) has received payment through the following research grants: “Addressing the trauma-related distress of young people in care: a randomised feasibility trial across social-care and mental health services” (NIHR RfPB NIHR200586); “Internet-delivered Cognitive Therapy (iCT) for young people with Post Traumatic Stress Disorder (PTSD)” (MRC DPFS MR/P017355/1); “Supporting services to deliver trauma-focused cognitive-behavioural therapy for care-experienced young people: a pilot implementation study”, NIHR Applied Research Collaboration West; “Cognitive Behavioural Therapy for the treatment of post-traumatic stress disorder (PTSD) in youth exposed to multiple traumatic stressors: a phase II randomised controlled trial” (NIHR CDF-2015-08-073). RM-S’ institution part owns the intellectual property for an online guided self-help version of cognitive therapy for PTSD for children and young people as a result of RM-S’ involvement in one of these trials. MSB has served as a leader of implementation of trauma-focused cognitive behaviour therapy in Norway during the last 2 years as part of her researcher position at her institution (Norwegian Centre of Violence and Traumatic Stress Studies); has received money from the Norwegian Government for training and implementing evidence-based treatment for PTSD in generalist clinics (77% of all national clinics); has been reimbursed for her position as a group leader in this implementation endeavour; and is a licensed psychotherapist. NM is a licensed cognitive behavioural therapy therapist and occasionally receives payment from private training providers for training therapists in psychotherapy. AK declares no competing interests.