Psychological interventions for adult posttraumatic stress disorder: A systematic review of published meta-analyses

Kip, A.; Ritter, L.; Hoppen, T. H.; Papola, D.; Ostuzzi, G.; Barbui, C.; Morina, N.

Abstract

Objective A large and growing number of published meta-analyses have examined the efficacy of psychological interventions for post-traumatic stress disorder (PTSD). Conclusions drawn from these meta-analyses on treatment efficacy greatly influence clinical practice. This study aimed to develop a comprehensive review of meta-analyses of randomized controlled trials (RCTs) on psychological interventions for adult PTSD, focusing on their content, methodology, and reporting quality. Method Systematic database searches were conducted in March 2024 using MEDLINE, PsycINFO, PTSDpubs, Web of Science, and the Cochrane Database of Systematic Reviews. The quality of meta-analyses was assessed using AMSTAR 2. The systematic review was registered on PROSPERO (*masked for blinded review*). Results Overall, 55 meta-analyses with 93 meta-analytic comparisons at treatment endpoint and 28 comparisons at follow-up were included. Meta-analyses most consistently showed superiority of psychological interventions over control conditions. However, beneficial long-term effects exceeding one-month post-treatment were limited to trauma-focused cognitive behavior interventions (TF-CBT) and eye movement desensitization and reprocessing (EMDR). There was a substantial overlap of primary RCTs, indicating redundancy between meta-analyses. Furthermore, the quality of meta-analyses varied substantially. Conclusions There is a need to enhance the methodological and reporting quality of meta-analyses, avoid the production of redundant meta-analyses, and conduct more high-quality, large RCTs with long-term assessments.