Predictors of PTSD Treatment Retention and Response: A Systematic Review

Format:

Book

Author/Creator:

Maglione, Margaret A.

Contributor:

Baxi, Sangita M.

Chen, Christine

Franco, Meghan

Gizaw, Mahlet

Hempel, Susanne

Shahidinia, Nima

Language:

English

Other Title:

Predictors of PTSD Treatment Retention and Response

Place of Publication:

Santa Monica, Calif. RAND Corporation 2022

Summary:

This systematic review synthesizes the evidence on pretreatment patient characteristics and program features associated with treatment retention, response, and remission in military populations with posttraumatic stress disorder (PTSD). The authors searched numerous databases and bibliographies of systematic reviews and retrieved full texts of all studies on the efficacy or effectiveness of PTSD interventions in military population; two reviewers screened texts for relevant outcomes and reports of predictors. Reviewers abstracted data and assessed each study's risk of bias. Results from studies reporting on the same potential predictor and outcome were pooled via meta-analysis where possible. Results of multivariate models were described narratively. Eighty-four articles reporting on 70 studies met inclusion criteria; 21 were rated good quality, 33 were rated fair, and 16 were rated poor, using the Quality in Prognostics Studies (QUIPS) instrument. Quality of evidence was low or insufficient for most patient and treatment characteristics due to inconsistent results, imprecision, potential publication bias, and study limitations. High-quality evidence indicates that length of stay is the strongest predictor of treatment response and that more severe PTSD is associated with lower response. Moderate-quality evidence indicates that older age is associated with better retention, that worse baseline mental health and more combat experience are associated with lower response to treatment, and that individual therapy (versus group therapy) is associated with greater response. Low-quality evidence supports a negative association of participation in atrocities with treatment response. Predictors of remission were rarely assessed.