Four Decades of Military Posttraumatic Stress: Protocol for a Meta-analysis and Systematic Review of Treatment Approaches and Efficacy.

Jenny J W Liu ,Natalie Mota,Bethany Easterbrook,Callista Forchuk,Tri Le,Mathieu Bilodeau,Fardous Hosseiny,Ken Balderson,Gabrielle Dupuis,Vicky Lavoie,Maya Roth,Patrick Smith,Alec Brandwood,Anthony Nazarov,Édouard Auger ,Murray W Enns ,Rachel A Plouffe ,Kate St Cyr ,Amer M Burhan ,J Don Richardson

doi:10.2196/33151

Abstract

BackgroundOver 85% of active members of the Canadian Armed Forces have been exposed to potentially traumatic events linked to the development of posttraumatic stress disorder (PTSD). At the time of transition to civilian life, as high as 1 in 8 veterans may be diagnosed with PTSD. Given the high prevalence of PTSD in military and veteran populations, the provision of effective treatment considering their unique challenges and experiences is critical for mental health support and the well-being of these populations.ObjectiveThis paper presents the protocol for a meta-analysis and systematic review that will examine the effectiveness of treatment approaches for military-related PTSD.MethodsThis PROSPERO-preregistered meta-analysis is being conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. A comprehensive search of the literature was conducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertation & Theses. Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multilevel meta-analysis will examine the overall effects, between-study effects, and within-study effects of available evidence for PTSD treatments in military populations. Effect sizes will be compared between pharmacotherapeutic, psychotherapeutic, and alternative/emerging treatment interventions. Finally, meta-regression and subgroup analyses will explore the moderating roles of clinical characteristics (eg, PTSD symptom clusters), treatment approaches (eg, therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), as well as treatment characteristics (eg, length of intervention) on treatment outcomes.ResultsThe literature search was completed on April 14, 2021. After the removal of duplicates, a total of 12,002 studies were screened for inclusion. As of July 2021, title and abstract screening has been completed, with 1469 out of 12,002 (12.23%) studies included for full-text review. Full review is expected to be completed in the summer of 2021, with initial results expected for publication by early winter of 2021.ConclusionsThis meta-analysis will provide information on the current state of evidence on the efficacy and effectiveness of various treatment approaches for military-related PTSD and identify factors that may influence treatment outcomes. The results will inform clinical decision-making for service providers and service users. Finally, the findings will provide insights into future treatment development and practice recommendations to better support the well-being of military and veteran populations.Trial RegistrationPROSPERO CRD42021245754; https://tinyurl.com/y9u57c59International Registered Report Identifier (IRRID)DERR1-10.2196/33151

Highlights

BackgroundOver 85% of active members of the Canadian Armed Forces have reported exposure to potentially traumatic events [1], and studies estimate that between 7.5% and 12.9% of veterans are diagnosed with posttraumatic stress disorder (PTSD) on return to civilian life [2,3]
Full review is expected to be completed in the summer of 2021, with initial results expected for publication by early winter of 2021
Coventry et al [10] noted that while trauma-focused therapies were effective in treating PTSD, the effect was less for military- and veteran-related PTSD

Summary

Introduction

Over 85% of active members of the Canadian Armed Forces have reported exposure to potentially traumatic events [1], and studies estimate that between 7.5% and 12.9% of veterans are diagnosed with posttraumatic stress disorder (PTSD) on return to civilian life [2,3]. The risk factors, etiology, and prognosis of military-related PTSD are associated with military service, deployment stressors, and unique potentially traumatic events. These events include experiences of combat, moral injury, military sexual trauma, and the LGBTQ Purge [2,5,6]. Given the high prevalence of PTSD in military and veteran populations, the provision of effective treatment considering their unique challenges and experiences is critical for mental health support and the well-being of these populations

Methods

Results

Conclusion