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.
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Wright Simonne, Karyotaki Eirini, Cuijpers Pim, Bisson Jonathan, 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, Sijbrandij Marit
Аннотация
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.