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

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

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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.

Original language	English (US)
Article number	e301159
Journal	BMJ Mental Health
Volume	27
Issue number	1
DOIs	https://doi.org/10.1136/bmjment-2024-301159
State	Published - Nov 13 2024

Keywords

PSYCHIATRY

ASJC Scopus subject areas

Psychiatry and Mental health
General Medicine

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10.1136/bmjment-2024-301159

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Wright, S., Karyotaki, E., Cuijpers, P., Bisson, J., Papola, D., Witteveen, A. B., Back, S. E., Bichescu-Burian, D., Capezzani, L., Cloitre, M., Devilly, G. J., Elbert, T., Mello, M., Ford, J. D., Grasso, D., Gamito, P., Gray, R., Haller, M., Hunt, N., ... Sijbrandij, M. (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(1), Article e301159. https://doi.org/10.1136/bmjment-2024-301159

Wright, S, Karyotaki, E, Cuijpers, P, Bisson, J, Papola, D, Witteveen, AB, Back, SE, Bichescu-Burian, D, Capezzani, L, Cloitre, M, Devilly, GJ, Elbert, T, Mello, M, Ford, JD, Grasso, D, Gamito, P, Gray, R, Haller, M, Hunt, N, Kleber, RJ, König, J, Kullack, C, Laugharne, J, Liebman, R, Lee, CW, Lely, J, Markowitz, JC, Monson, C, Nijdam, MJ, Norman, SB, Olff, M, Orang, TM, Ostacoli, L, Paunovic, N, Petkova, E, Resick, P, Rosner, R, Schauer, M, Schmitz, JM, Schnyder, U, Smith, BN, Vujanovic, AA, Zang, Y, Duran, ÉP, Neto, FL, Seedat, S & Sijbrandij, M 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, vol. 27, no. 1, e301159. https://doi.org/10.1136/bmjment-2024-301159

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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",

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",

author = "Simonne Wright and Eirini Karyotaki and Pim Cuijpers and Jonathan Bisson and Davide Papola and Witteveen, {Anke B.} and Back, {Sudie E.} and Dana Bichescu-Burian and Liuva Capezzani and Marylene Cloitre and Devilly, {Grant J.} and Thomas Elbert and Marcelo Mello and Ford, {Julian D.} and Damion Grasso and Pedro Gamito and Richard Gray and Moira Haller and Nigel Hunt and Kleber, {Rolf J.} and Julia K{\"o}nig and Claire Kullack and Jonathan Laugharne and Rachel Liebman and Lee, {Christopher William} and Jeannette Lely and Markowitz, {John C.} and Candice Monson and Nijdam, {Mirjam J.} and Norman, {Sonya B.} and Miranda Olff and Orang, {Tahereh Mina} and Luca Ostacoli and Nenad Paunovic and Eva Petkova and Patricia Resick and Rita Rosner and Maggie Schauer and Schmitz, {Joy M.} and Ulrich Schnyder and Smith, {Brian N.} and Vujanovic, {Anka A.} and Yinyin Zang and Duran, {{\'E}rica Panzani} and Neto, {Francisco Lotufo} and Soraya Seedat and Marit Sijbrandij",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2024.",

year = "2024",

month = nov,

day = "13",

doi = "10.1136/bmjment-2024-301159",

language = "English (US)",

volume = "27",

journal = "BMJ Mental Health",

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number = "1",

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TY - JOUR

T1 - Predictors of study dropout in cognitive-behavioural therapy with a trauma focus for post-traumatic stress disorder in adults

T2 - An individual participant data meta-analysis

AU - Wright, Simonne

AU - Karyotaki, Eirini

AU - Cuijpers, Pim

AU - Bisson, Jonathan

AU - Papola, Davide

AU - Witteveen, Anke B.

AU - Back, Sudie E.

AU - Bichescu-Burian, Dana

AU - Capezzani, Liuva

AU - Cloitre, Marylene

AU - Devilly, Grant J.

AU - Elbert, Thomas

AU - Mello, Marcelo

AU - Ford, Julian D.

AU - Grasso, Damion

AU - Gamito, Pedro

AU - Gray, Richard

AU - Haller, Moira

AU - Hunt, Nigel

AU - Kleber, Rolf J.

AU - König, Julia

AU - Kullack, Claire

AU - Laugharne, Jonathan

AU - Liebman, Rachel

AU - Lee, Christopher William

AU - Lely, Jeannette

AU - Markowitz, John C.

AU - Monson, Candice

AU - Nijdam, Mirjam J.

AU - Norman, Sonya B.

AU - Olff, Miranda

AU - Orang, Tahereh Mina

AU - Ostacoli, Luca

AU - Paunovic, Nenad

AU - Petkova, Eva

AU - Resick, Patricia

AU - Rosner, Rita

AU - Schauer, Maggie

AU - Schmitz, Joy M.

AU - Schnyder, Ulrich

AU - Smith, Brian N.

AU - Vujanovic, Anka A.

AU - Zang, Yinyin

AU - Duran, Érica Panzani

AU - Neto, Francisco Lotufo

AU - Seedat, Soraya

AU - Sijbrandij, Marit

PY - 2024/11/13

Y1 - 2024/11/13

N2 - 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.

AB - 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.

KW - PSYCHIATRY

UR - http://www.scopus.com/inward/record.url?scp=85209378234&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85209378234&partnerID=8YFLogxK

U2 - 10.1136/bmjment-2024-301159

DO - 10.1136/bmjment-2024-301159

M3 - Article

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AN - SCOPUS:85209378234

SN - 1468-960X

VL - 27

JO - BMJ Mental Health

JF - BMJ Mental Health

IS - 1

M1 - e301159

ER -

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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