Psychosocial interventions for adult survivors and responders exposed to mass casualty events: A systematic review and network meta-analysis.

This systematic review and network meta-analysis evaluated and ranked psychosocial interventions for reducing posttraumatic stress disorder (PTSD), depression, and anxiety among adults exposed to mass casualty events (MCEs). English- and Spanish-language databases were searched for randomized and nonrandomized trials comparing interventions with inactive (e.g., waitlist) or active (e.g., treatment-as-usual) controls. Primary outcomes were posttreatment symptoms of PTSD, depression, and anxiety. Risk of bias was assessed (Cochrane Risk of Bias 2, ROBINS-I), and random-effects network meta-analyses were conducted using standardized mean differences (SMDs), with ranking based on P-scores. Primary analyses excluded studies with a high or serious risk of bias. Fifty-four studies (N = 10,721) across 25 countries met the inclusion criteria. Compared with inactive controls, large effects for PTSD were observed for early eye movement desensitization and reprocessing (E-EMDR), SMD = 2.48; exposure therapy, SMD = 1.60; and cognitive behavioral therapy (CBT), SMD = 1.40, with E-EMDR and CBT remaining significant versus active controls, SMDs = 2.36 and 1.28, respectively. For depression, exposure therapy, SMD = 1.36; interpersonal psychotherapy, SMD = 1.15; mind-body practices, SMD = 1.01; CBT, SMD = 0.85; and integrative therapies, SMD = 0.67, outperformed inactive controls, with exposure therapy, mind-body practices, and CBT remaining significant versus active controls. For anxiety, exposure therapy, CBT, and integrative therapies outperformed both control types, with less precise estimates. Exposure and CBT ranked highly across outcomes; E-EMDR ranked highest for PTSD. The findings support prioritizing trauma-focused interventions following MCEs while highlighting the need for additional comparative and long-term research.