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

Wright, Simonne, Karyotaki, Eirini, Cuijpers, Pim, Bisson, Jonathan ORCID: https://orcid.org/0000-0001-5170-1243, Papola, Davide, Witteveen, Anke B., Back, Sudie E., Bichescu-Burian, Dana, Capezzani, Liuva, Cloitre, Marylene, Devilly, Grant J., Elbert, Thomas, Mello, Marcelo, Ford, Julian D., Grasso, Damion, Gamito, Pedro, Gray, Richard, Haller, Moira, Hunt, Nigel, Kleber, Rolf J., König, Julia, Kullack, Claire, Laugharne, Jonathan, Liebman, Rachel, Lee, Christopher William, Lely, Jeannette, Markowitz, John C., Monson, Candice, Nijdam, Mirjam J., Norman, Sonya B., Olff, Miranda, Orang, Tahereh Mina, Ostacoli, Luca, Paunovic, Nenad, Petkova, Eva, Resick, Patricia, Rosner, Rita, Schauer, Maggie, Schmitz, Joy M., Schnyder, Ulrich, Smith, Brian N., Vujanovic, Anka A., Zang, Yinyin, Duran, Érica Panzani, Neto, Francisco Lotufo, Seedat, Soraya and Sijbrandij, Marit 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. BMJ Mental Health 27 , e301159. 10.1136/bmjment-2024-301159

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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.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by-nc/4.0/, Start Date: 2024-11-13, Type: open-access
Publisher:	BMJ Publishing Group
ISSN:	2755-9734
Date of First Compliant Deposit:	19 November 2024
Date of Acceptance:	22 September 2024
Last Modified:	19 Nov 2024 12:30
URI:	https://orca.cardiff.ac.uk/id/eprint/174143

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