Systematic review and meta-analysis: Imputing response rates for first-line psychological treatments for posttraumatic stress disorder in youth

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

Method: We searched four 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 .48 (95% CI: .41-.55) for TF-CBT, .30 (.24-.37) for EMDR, and .46 (.39-.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 .55 [.46-.64], EMDR .42[.30-.55]) of youth receiving psychological therapies, compared to .25 (.20-.30) of youth in control conditions. Reliable deterioration was seen in .01 (.01-.02) of youth receiving psychological therapies, compared to .13 (.08-.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.