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.

中文翻译：

---

以创伤为重点的认知行为疗法中成人创伤后应激障碍研究退出的预测因子：个体参与者数据荟萃分析。


背景 关于与创伤后应激障碍 （PTSD） 心理治疗退出相关的参与者层面因素的现有经验证据既有限又不确定。更全面地了解导致研究退出创伤焦点认知行为疗法 （CBT-TF） 的各种因素对于提高治疗结果至关重要。目的 使用个体参与者数据荟萃分析 （IPD-MA） 设计，我们检查了参与者层面的 CBT-TF 干预治疗 PTSD 而退出研究的预测因子。方法 进行全面的系统文献检索，以确定将 CBT-TF 与候补名单对照、常规治疗或其他疗法进行比较的随机对照试验。从构思到 2021 年 1 月 11 日，对学术数据库进行了筛选。符合条件的干预措施必须是个人和面对面的。如果参与者没有完成治疗后评估，则被视为退出。结果 系统文献检索确定了 81 项符合条件的研究 （n=3330）。数据来自 25 项可用的 CBT-TF 研究，涉及 823 名参与者。总体而言，823 人中有 221 人 （27%） 退出。在 581 名平民中，133 人 （23%） 退出，178 名军事人员/退伍军人中有 75 人 （42%） 退出。双变量和多变量分析表明，军事人员/退伍军人 （RR 2.37） 的辍学风险明显高于平民。此外，随着年龄的增长，辍学的机会显着降低（连续;RR 0.98）。结论 这些发现强调了年轻人和退伍军人/人员过早终止 CBT-TF 的风险。 临床意义 了解预测因子可以为针对高危亚组量身定制的保留策略的制定提供信息，增强参与度，提高依从性并产生更好的治疗结果。