Meta-Analysis

. 2024 Nov 13;27(1):e301159.

doi: 10.1136/bmjment-2024-301159.

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

Simonne Wright^{1

2}, Eirini Karyotaki², Pim Cuijpers^{2

3}, Jonathan Bisson⁴, Davide Papola^{5

6}, Anke B Witteveen⁷, Sudie E Back⁸, Dana Bichescu-Burian⁹, Liuva Capezzani¹⁰, Marylene Cloitre¹¹, Grant J Devilly¹², Thomas Elbert¹³, Marcelo Mello¹⁴, Julian D Ford¹⁵, Damion Grasso¹⁵, Pedro Gamito¹⁶, Richard Gray¹⁷, Moira Haller¹⁸, Nigel Hunt¹⁹, Rolf J Kleber^{20

21}, Julia König²², Claire Kullack²³, Jonathan Laugharne²⁴, Rachel Liebman²⁵, Christopher William Lee²⁴, Jeannette Lely²⁶, John C Markowitz^{27

28}, Candice Monson²⁹, Mirjam J Nijdam^{21

30}, Sonya B Norman³¹, Miranda Olff^{21

30}, Tahereh Mina Orang³², Luca Ostacoli³³, Nenad Paunovic³⁴, Eva Petkova³⁵, Patricia Resick³⁶, Rita Rosner²², Maggie Schauer¹³, Joy M Schmitz³⁷, Ulrich Schnyder³⁸, Brian N Smith^{39

40}, Anka A Vujanovic⁴¹, Yinyin Zang⁴², Érica Panzani Duran⁴³, Francisco Lotufo Neto⁴³, Soraya Seedat^{44

45}, Marit Sijbrandij²

Affiliations

¹ South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa simonnewright87@gmail.com.
² Department 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, Netherlands.
³ International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania.
⁴ Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
⁵ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
⁶ Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Department 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, Netherlands.
⁸ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
⁹ 6 Center for Psychiatry Reichenau, Academic Hospital of the University of Konstanz, Konstanz, Germany.
¹⁰ International School of Psychotherapy in the Institutional Setting (SIPSI), Rome, Italy.
¹¹ National Center for PTSD Dissemination and Training Division. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.
¹² School of Applied Psychology & Griffith, Criminology Institute, Griffith University, Brisbane, Queensland, Australia.
¹³ Department of Psychology, University of Konstanz, Konstanz, Germany.
¹⁴ Departamento de Psiquiatria Escola Paulista de Medicina, UNIFESP, Sao Paulo, São Paulo, Brazil.
¹⁵ University of Connecticut School of Medicine, Farmington, Connecticut, USA.
¹⁶ Universidade Lusófona/HEI-Lab, Lisboa, Portugal.
¹⁷ Research at Research and Recognition Project, New York, New York, USA.
¹⁸ National Center for PTSD. San Diego School of Medicine, University California, White River Junction, California, USA.
¹⁹ Faculty of Medicine & Health Sciences, School of Medicine, The University of Nottingham, Nottingham, UK.
²⁰ Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands.
²¹ ARQ National Psychotrauma Centre, Diemen, Netherlands.
²² Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt and Ingolstadt, Germany.
²³ Pax Centre, West Leederville, Perth, Australia.
²⁴ Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Perth, Australia.
²⁵ Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
²⁶ ARQ Centrum'45, Diemen, Noord-Holland, Netherlands.
²⁷ New York State Psychiatric Institute, New York, New York, USA.
²⁸ Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA.
²⁹ Toronto Metropolitan University, Toronto, Ontario, Canada.
³⁰ Department of Psychiatry & Amsterdam Public Health, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, Netherlands.
³¹ National Center for PTSD, White River Junction, Vermont, USA.
³² International Psychosocial Organisation, Berlin, Germany.
³³ Department of Clinical and Biological Sciences, University of Turin, Torino, Italy.
³⁴ Department of Psychology, Stockholm University, Stockholm, Sweden.
³⁵ Department of Population Health. Langone School of Medicine, New York University, New York, New York, USA.
³⁶ Duke Health, Durham, North Carolina, USA.
³⁷ Center for Neurobehavioral Research on Addiction. Department of Psychiatry and Behavioral Sciences. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
³⁸ University of Zurich, Zurich, Switzerland.
³⁹ National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA.
⁴⁰ Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
⁴¹ Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA.
⁴² School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China.
⁴³ Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
⁴⁴ South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁴⁵ South African Medical Research Council Unit on the Genomics of Brain Disorders. Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.

PMID: 39537555
PMCID: PMC11580285
DOI: 10.1136/bmjment-2024-301159

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

Simonne Wright et al. BMJ Ment Health. 2024.

. 2024 Nov 13;27(1):e301159.

doi: 10.1136/bmjment-2024-301159.

Authors

Affiliations

¹ South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa simonnewright87@gmail.com.
² Department 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, Netherlands.
³ International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania.
⁴ Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
⁵ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
⁶ Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Department 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, Netherlands.
⁸ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
⁹ 6 Center for Psychiatry Reichenau, Academic Hospital of the University of Konstanz, Konstanz, Germany.
¹⁰ International School of Psychotherapy in the Institutional Setting (SIPSI), Rome, Italy.
¹¹ National Center for PTSD Dissemination and Training Division. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.
¹² School of Applied Psychology & Griffith, Criminology Institute, Griffith University, Brisbane, Queensland, Australia.
¹³ Department of Psychology, University of Konstanz, Konstanz, Germany.
¹⁴ Departamento de Psiquiatria Escola Paulista de Medicina, UNIFESP, Sao Paulo, São Paulo, Brazil.
¹⁵ University of Connecticut School of Medicine, Farmington, Connecticut, USA.
¹⁶ Universidade Lusófona/HEI-Lab, Lisboa, Portugal.
¹⁷ Research at Research and Recognition Project, New York, New York, USA.
¹⁸ National Center for PTSD. San Diego School of Medicine, University California, White River Junction, California, USA.
¹⁹ Faculty of Medicine & Health Sciences, School of Medicine, The University of Nottingham, Nottingham, UK.
²⁰ Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands.
²¹ ARQ National Psychotrauma Centre, Diemen, Netherlands.
²² Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt and Ingolstadt, Germany.
²³ Pax Centre, West Leederville, Perth, Australia.
²⁴ Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Perth, Australia.
²⁵ Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
²⁶ ARQ Centrum'45, Diemen, Noord-Holland, Netherlands.
²⁷ New York State Psychiatric Institute, New York, New York, USA.
²⁸ Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA.
²⁹ Toronto Metropolitan University, Toronto, Ontario, Canada.
³⁰ Department of Psychiatry & Amsterdam Public Health, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, Netherlands.
³¹ National Center for PTSD, White River Junction, Vermont, USA.
³² International Psychosocial Organisation, Berlin, Germany.
³³ Department of Clinical and Biological Sciences, University of Turin, Torino, Italy.
³⁴ Department of Psychology, Stockholm University, Stockholm, Sweden.
³⁵ Department of Population Health. Langone School of Medicine, New York University, New York, New York, USA.
³⁶ Duke Health, Durham, North Carolina, USA.
³⁷ Center for Neurobehavioral Research on Addiction. Department of Psychiatry and Behavioral Sciences. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
³⁸ University of Zurich, Zurich, Switzerland.
³⁹ National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA.
⁴⁰ Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
⁴¹ Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA.
⁴² School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China.
⁴³ Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
⁴⁴ South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁴⁵ South African Medical Research Council Unit on the Genomics of Brain Disorders. Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.

PMID: 39537555
PMCID: PMC11580285
DOI: 10.1136/bmjment-2024-301159

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.

Keywords: PSYCHIATRY.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

1. Watson P. PTSD as a Public Mental Health Priority. Curr Psychiatry Rep. 2019;21:61. doi: 10.1007/s11920-019-1032-1. - DOI - PubMed
1. Gutner CA, Gallagher MW, Baker AS, et al. Time course of treatment dropout in cognitive-behavioral therapies for posttraumatic stress disorder. Psychol Trauma. 2016;8:115–21. doi: 10.1037/tra0000062. - DOI - PMC - PubMed
1. Lewis C, Roberts NP, Gibson S, et al. Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis. Eur J Psychotraumatol. 2020;11:1709709. doi: 10.1080/20008198.2019.1709709. - DOI - PMC - PubMed
1. Berke DS, Kline NK, Wachen JS, et al. Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members. Behav Res Ther. 2019;118:7–17. doi: 10.1016/j.brat.2019.03.003. - DOI - PubMed
1. Goetter EM, Bui E, Ojserkis RA, et al. A Systematic Review of Dropout From Psychotherapy for Posttraumatic Stress Disorder Among Iraq and Afghanistan Combat Veterans. J Trauma Stress. 2015;28:401–9. doi: 10.1002/jts.22038. - DOI - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous