High treatment dropout rates reported in recent literature have brought into question the effectiveness of trauma-focused posttraumatic stress disorder (PTSD) treatments among military populations. The aim of the current systematic review was to evaluate PTSD treatment dropout rates among military populations by treatment type and other study-level variables. We searched four databases as well as gray literature for randomized controlled trials that evaluated evidence-based PTSD treatments in samples of active duty personnel and/or veterans. In total, 26 studies were included in this review, with a total of 2,984 participants. We analyzed dropout rates across treatment types using multivariate meta-analysis. Across all forms of treatment, the aggregated dropout rate was 24.2%. Dropout percentages based on treatment type were 27.1% for trauma-focused treatments, 16.1% for non–trauma-focused treatments, and 6.8% for waitlist groups. We found substantial heterogeneity between studies that was not explained by military status or other study-level covariates. Summary risk ratios (RRs) comparing relative dropout between treatment groups indicated that trauma-focused treatment groups had a higher risk of dropout compared to non–trauma-focused treatments, RR = 1.60. The statistical heterogeneity of within-treatment dropout risk ratios was negligible. Dropout rates among military patients receiving trauma-focused therapies were only slightly higher than those reported in the literature among civilian populations and were not explained by study-level covariates.

中文翻译：

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军人和退伍军人中的创伤后应激障碍治疗辍学：系统评价和荟萃分析

最近文献报道的高治疗辍学率使军事人群中以创伤为中心的创伤后应激障碍 (PTSD) 治疗的有效性产生了疑问。当前系统评价的目的是通过治疗类型和其他研究级变量评估军事人群的 PTSD 治疗退出率。我们在四个数据库和灰色文献中搜索了评估现役人员和/或退伍军人样本中基于证据的 PTSD 治疗的随机对照试验。本综述总共纳入了 26 项研究，共有 2,984 名参与者。我们使用多变量荟萃分析分析了不同治疗类型的辍学率。在所有形式的治疗中，总辍学率为 24.2%。基于治疗类型的辍学百分比为 27。以创伤为重点的治疗为 1%，非以创伤为重点的治疗为 16.1%，等候名单组为 6.8%。我们发现研究之间存在很大的异质性，不能用军事地位或其他研究水平的协变量来解释。汇总风险比率 (RR s) 比较治疗组之间的相对辍学表明，与非以创伤为重点的治疗相比，以创伤为重点的治疗组有更高的辍学风险，RR = 1.60。治疗内退出风险比的统计异质性可以忽略不计。接受以创伤为重点的治疗的军人患者的辍学率仅略高于平民人口文献中报告的辍学率，并且无法用研究水平的协变量来解释。