Review
Preventing the onset of post traumatic stress disorder

https://doi.org/10.1016/j.cpr.2021.102004Get rights and content
Under a Creative Commons license
open access

Highlights

  • There is limited evidence for the prevention of PTSD.

  • Indicated prevention is better supported than universal or selective approaches.

  • Cognitive behavioural therapy with a trauma focus for acute stress disorder was best supported.

  • Detection and treatment of people with significant symptoms is indicated.

  • Further research is required to develop effective interventions to prevent PTSD.

Abstract

Post-traumatic stress disorder (PTSD) is a common mental health condition that requires exposure to a traumatic event. This provides unique opportunities for prevention that are not available for other disorders. The aim of this review was to undertake a systematic review and evaluation of randomized controlled trials (RCTs) of interventions designed to prevent PTSD in adults. Searches involving Cochrane, Embase, Medline, PsycINFO, PILOTS and Pubmed databases were undertaken to identify RCTs of pre-incident preparedness and post-incident interventions until May 2019. Six pre-incident and 69 post-incident trials were identified that could be included in meta-analyses. The overall quality of the evidence was low. There was emerging evidence that some interventions may be helpful but an absence of evidence for any intervention that can be strongly recommended for universal, selected or indicated prevention before or within the first three months of a traumatic event. The strongest results were found for cognitive-behavioural therapy with a trauma focus (CBT-T) in individuals with a diagnosis of acute stress disorder which supports calls to detect and treat individuals with significant symptoms rather than providing blanket preventative interventions. Further research is required to optimally configure existing interventions with some evidence of effect and to develop novel interventions to address this major public health issue.

Keywords

Prevention
PTSD
Pre-incident
Post-incident
Psychological
Psychosocial
Pharmacological

Cited by (0)

Jonathan I Bisson Jon is a practising psychiatrist and professor in psychiatry at Cardiff University. He developed his interest in PTSD during his time as a psychiatrist in the Britsh Army. He has conducted various studies including two widely cited randomized controlled trials of early psychological interventions following traumatic events and five Cochrane systematic reviews in the traumatic stress field. He was co-chair of the UK's first PTSD NICE Guideline Development Group and chairs the International Society for Traumatic Stress Studies' Treatment Guidelines Committee. He developed and continues to lead Cardiff University's Traumatic Stress Research Group and the Cardiff and Vale Traumatic Stress Service. He developed NHS Veterans Wales and the Traumatic Stress Wales, which he now directs. He has been awarded 37 research grants worth over £20 million. His current research includes a randomized controlled trial of a guided self help intervention for mild to moderate PTSD that he pioneered and a PTSD Registry. He has over 150 publications, regularly teaches and supervises undergraduates, postgraduates, health and other professionals. He has delivered over 150 presentations to various meetings and conferences in 17 different countries, including 42 keynote/plenary presentations.