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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BMJ Publishing Group
2024-11-01
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| author | 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 |
| author_facet | 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 |
| author_sort | Eirini Karyotaki |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-34b9e4702d244f47971481ba11e1b8e9 |
| institution | Kabale University |
| issn | 2755-9734 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Mental Health |
| spelling | doaj-art-34b9e4702d244f47971481ba11e1b8e92024-11-14T05:05:09ZengBMJ Publishing GroupBMJ Mental Health2755-97342024-11-0127110.1136/bmjment-2024-301159Predictors of study dropout in cognitive-behavioural therapy with a trauma focus for post-traumatic stress disorder in adults: An individual participant data meta-analysisEirini Karyotaki0Pim Cuijpers1Sonya B Norman2Davide Papola3Marit Sijbrandij4Soraya Seedat5Miranda Olff6Sudie E Back7Richard Gray8Rolf J Kleber9Francisco Lotufo Neto10Jonathan Bisson11Damion Grasso12Grant J Devilly13Ulrich Schnyder14Marylene Cloitre15Nigel Hunt16Anke B Witteveen17Simonne Wright18Joy M Schmitz19Dana Bichescu-Burian20Liuva Capezzani21Thomas Elbert22Marcelo Mello23Julian D Ford24Pedro Gamito25Moira Haller26Julia König27Claire Kullack28Jonathan Laugharne29Rachel Liebman30Christopher William Lee31Jeannette Lely32John C. Markowitz33Candice Monson34Mirjam J Nijdam35Tahereh Mina Orang36Luca Ostacoli37Nenad Paunovic38Eva Petkova39Patricia Resick40Rita Rosner41Maggie Schauer42Brian N. Smith43Anka A Vujanovic44Yinyin Zang45Érica Panzani Duran46Department 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, NetherlandsDepartment 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, NetherlandsNational Center for PTSD, White River Junction, Vermont, USAWHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, ItalyDepartment 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, NetherlandsSouth Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South AfricaARQ National Psychotrauma Centre, Diemen, NetherlandsDepartment of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USAResearch at Research and Recognition Project, New York, New York, USADepartment of Clinical Psychology, Utrecht University, Utrecht, NetherlandsInstitute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, BrazilDivision of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UKUniversity of Connecticut School of Medicine, Farmington, Connecticut, USASchool of Applied Psychology & Griffith, Criminology Institute, Griffith University, Brisbane, Queensland, AustraliaUniversity of Zurich, Zurich, SwitzerlandNational Center for PTSD Dissemination and Training Division. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USAFaculty of Medicine & Health Sciences, School of Medicine, The University of Nottingham, Nottingham, UKDepartment 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, NetherlandsSouth Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South AfricaCenter for Neurobehavioral Research on Addiction. Department of Psychiatry and Behavioral Sciences. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA6 Center for Psychiatry Reichenau, Academic Hospital of the University of Konstanz, Konstanz, GermanyInternational School of Psychotherapy in the Institutional Setting (SIPSI), Rome, ItalyDepartment of Psychology, University of Konstanz, Konstanz, GermanyDepartamento de Psiquiatria Escola Paulista de Medicina, UNIFESP, Sao Paulo, São Paulo, BrazilUniversity of Connecticut School of Medicine, Farmington, Connecticut, USAUniversidade Lusófona/HEI-Lab, Lisboa, PortugalNational Center for PTSD. San Diego School of Medicine, University California, White River Junction, California, USADepartment of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt and Ingolstadt, GermanyPax Centre, West Leederville, Perth, AustraliaFaculty of Health and Medical Sciences, The University of Western Australia, Perth, Perth, AustraliaDepartment of Psychology, University of Toronto, Toronto, Ontario, CanadaFaculty of Health and Medical Sciences, The University of Western Australia, Perth, Perth, AustraliaARQ Centrum`45, Diemen, Noord-Holland, NetherlandsNew York State Psychiatric Institute, New York, New York, USAToronto Metropolitan University, Toronto, Ontario, CanadaARQ National Psychotrauma Centre, Diemen, NetherlandsInternational Psychosocial Organisation, Berlin, GermanyDepartment of Clinical and Biological Sciences, University of Turin, Torino, ItalyDepartment of Psychology, Stockholm University, Stockholm, SwedenDepartment of Population Health. Langone School of Medicine, New York University, New York, New York, USADuke Health, Durham, North Carolina, USADepartment of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt and Ingolstadt, GermanyDepartment of Psychology, University of Konstanz, Konstanz, GermanyNational Center for PTSD Women’s Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USADepartment of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USAchool of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, ChinaInstitute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, BrazilBackground 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.https://mentalhealth.bmj.com/content/27/1/e301159.full |
| spellingShingle | 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 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 BMJ Mental Health |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://mentalhealth.bmj.com/content/27/1/e301159.full |
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