Systematic Review and Meta-Analysis: Imputing Response Rates for First-Line Psychological Treatments for Posttraumatic Stress Disorder in Youth - 14/05/25

Doi : 10.1016/j.jaac.2024.12.014

Katie Lofthouse, BA(Hons), PhD ^a,^⁎ : Candidate, Alana Davies, MSc ^b, Joanne Hodgekins, PhD, ClinPsyD ^a, Richard Meiser-Stedman, PhD ^a
^a University of East Anglia, Norwich, Norfolk, United Kingdom
^b Norfolk and Suffolk NHS Foundation Trust, Drayton High Road, Norwich, Norfolk, United Kingdom

^∗Correspondence to Katie Lofthouse, BA(Hons), PhD Candidate, Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, United KingdomUniversity of East AngliaNorwichNR4 7TJNorfolkUnited Kingdom

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 14 May 2025

Abstract

Objective

Meta-analyses assessing psychological therapies for posttraumatic stress disorder (PTSD) in youth have demonstrated their effectiveness using standardized mean differences. Imputation of response rates (ie, 50% or greater reduction in symptoms) may facilitate easier interpretation for clinicians.

Method

We searched 4 databases (MEDLINE, PsycINFO, PTSDPubs, and Web of Science) and screened 1,654 records to include 60 randomized controlled trials (52 trauma-focused cognitive–behavioral therapy [TF-CBT], 8 eye movement desensitization [EMDR]) with a total of 5,113 participants, comparing psychological therapies for PTSD against control conditions in youth. Data from randomized controlled trials of EMDR and TF-CBT for PTSD were used to impute response rates, establishing how many patients display 50% reduction, 20% reduction, and reliable improvement and deterioration (using reliable change indices) in PTSD and depression.

Results

The proportion of youth exhibiting a 50% reduction in PTSD symptoms was 0.48 (95% CI = 0.41-0.55) for TF-CBT, 0.30 (0.24-0.37) for EMDR, and 0.46 (0.39-0.52) for all psychological therapies, compared to 0.20 (0.16-0.24) for youth in control conditions. Reliable improvement was displayed by 0.53 (0.45-0.61; TF-CBT 0.55 [0.46-0.64], EMDR 0.42[0.30-0.55]) of youth receiving psychological therapies, compared to 0.25 (0.20-0.30) of youth in control conditions. Reliable deterioration was seen in 0.01 (0.01-0.02) of youth receiving psychological therapies, compared to 0.13 (0.08-0.20) of youth in control conditions. There was a high degree of heterogeneity in the included studies.

Conclusion

Psychological therapies, in particular TF-CBT, for young people with PTSD are effective and unlikely to cause deterioration, with around half of youth receiving TF-CBT exhibiting 50% symptom reduction.

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Key words : PTSD, youth, meta-analysis, review, therapy

Plan

Risk of Bias Assessment

Statistical Analysis

Publication Bias

Results

Selection and Characteristics of Included Studies

Risk of Bias

Absolute Response Rates

CRediT authorship contribution statement

	The authors have reported no funding for this work.
	Data Sharing: Data collected for the study will not be made available to others.
	Disclosure: Katie Lofthouse received doctoral funding from Norwich Medical School. Joanne Hodgekins has received funding from NIHR, ESRC, and the Wellcome Trust. Richard Meiser-Stedman has received funding from the UK National Institute for Health and Care Research and the UK Medical Research Council, has served on the Research and Implementation Board of the Children and War Foundation (no financial gain from their involvement) and is a member of the UK Trauma Council (no financial gain from their involvement). Katie Lofthouse and Alana Davies have reported no biomedical financial interests or potential conflicts of interest.