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

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

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-behavi...

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Main Authors: 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
Format: Article
Language:English
Published: BMJ Publishing Group 2024-11-01
Series:BMJ Mental Health
Online Access:https://mentalhealth.bmj.com/content/27/1/e301159.full
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Summary: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.
ISSN:2755-9734

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