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Integrating fragmented evidence by network meta-analysis: relative effectiveness of psychological interventions for adults with post-traumatic stress disorder

Published online by Cambridge University Press:  16 April 2014

H. Gerger ,
T. Munder ,
A. Gemperli ,
E. Nüesch ,
S. Trelle ,
P. Jüni  and
J. Barth
H. Gerger*
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Switzerland
T. Munder
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
A. Gemperli
Affiliation:
Department of Clinical Research, CTU Bern, University of Bern, Switzerland Swiss Paraplegic Research (SPF), Nottwil, Switzerland Department of Health Sciences and Health Policy, University of Lucerne, Switzerland
E. Nüesch
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland Department of Clinical Research, CTU Bern, University of Bern, Switzerland
S. Trelle
Affiliation:
Department of Clinical Research, CTU Bern, University of Bern, Switzerland
P. Jüni
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland Department of Clinical Research, CTU Bern, University of Bern, Switzerland
J. Barth
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland Institute of Complementary and Integrative Medicine, University Hospital of Zurich, Switzerland
*
*Address for correspondence: H. Gerger, Ph.D., Department of Clinical Psychology and Psychotherapy, University of Basel, Missionsstrasse 62, 4055 Basel, Switzerland. (Email: [email protected])
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Abstract

Background.

To summarize the available evidence on the effectiveness of psychological interventions for patients with post-traumatic stress disorder (PTSD).

Method.

We searched bibliographic databases and reference lists of relevant systematic reviews and meta-analyses for randomized controlled trials that compared specific psychological interventions for adults with PTSD symptoms either head-to-head or against control interventions using non-specific intervention components, or against wait-list control. Two investigators independently extracted the data and assessed trial characteristics.

Results.

The analyses included 4190 patients in 66 trials. An initial network meta-analysis showed large effect sizes (ESs) for all specific psychological interventions (ESs between −1.10 and −1.37) and moderate effects of psychological interventions that were used to control for non-specific intervention effects (ESs −0.58 and −0.62). ES differences between various types of specific psychological interventions were absent to small (ES differences between 0.00 and 0.27). Considerable between-trial heterogeneity occurred (τ2 = 0.30). Stratified analyses revealed that trials that adhered to DSM-III/IV criteria for PTSD were associated with larger ESs. However, considerable heterogeneity remained. Heterogeneity was reduced in trials with adequate concealment of allocation and in large-sized trials. We found evidence for small-study bias.

Conclusions.

Our findings show that patients with a formal diagnosis of PTSD and those with subclinical PTSD symptoms benefit from different psychological interventions. We did not identify any intervention that was consistently superior to other specific psychological interventions. However, the robustness of evidence varies considerably between different psychological interventions for PTSD, with most robust evidence for cognitive behavioral and exposure therapies.

Keywords

Meta-analysisoutcome researchpost-traumatic stress disorderpsychotherapyPTSD
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 15 , November 2014 , pp. 3151 - 3164
Copyright
Copyright © Cambridge University Press 2014 

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