Four Decades of Military Posttraumatic Stress: Protocol for a Meta-analysis and Systematic Review of Treatment Approaches and Efficacy

Jenny J W Liu; Anthony Nazarov; Bethany Easterbrook; Rachel A Plouffe; Tri Le; Callista Forchuk; Alec Brandwood; Kate St Cyr; Edouard Auger; Ken Balderson; Mathieu Bilodeau; Amer M Burhan; Murray W Enns; Patrick Smith; Fardous Hosseiny; Gabrielle Dupuis; Maya Roth; Natalie Mota; Vicky Lavoie; J Don Richardson

doi:10.2196/33151

Four Decades of Military Posttraumatic Stress: Protocol for a Meta-analysis and Systematic Review of Treatment Approaches and Efficacy

JMIR Res Protoc. 2021 Oct 25;10(10):e33151. doi: 10.2196/33151.

Authors

Jenny J W Liu^{1

2}, Anthony Nazarov^{1

2

3}, Bethany Easterbrook^{1

3}, Rachel A Plouffe^{1

2}, Tri Le¹, Callista Forchuk¹, Alec Brandwood¹, Kate St Cyr^{1

4}, Edouard Auger^{5

6}, Ken Balderson^{2

7}, Mathieu Bilodeau^{5

6}, Amer M Burhan^{8

9}, Murray W Enns^{10

11}, Patrick Smith¹², Fardous Hosseiny¹², Gabrielle Dupuis¹², Maya Roth^{7

13}, Natalie Mota¹⁴, Vicky Lavoie⁵, J Don Richardson^{1

2

15}

Affiliations

¹ The MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, ON, Canada.
² Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
³ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
⁴ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁵ Clinique pour traumatismes liés au stress opérationnel, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada.
⁶ Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Quebec, QC, Canada.
⁷ St. Joseph's Operational Stress Injury Clinic, Toronto, ON, Canada.
⁸ Ontario Shores Centre of Mental Health Sciences, Whitby, ON, Canada.
⁹ Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹¹ Winnipeg Operational Stress Injury Clinic, Winnipeg, ON, Canada.
¹² Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions, Ottawa, ON, Canada.
¹³ Yeates School of Graduate Studies, Ryerson University, Toronto, ON, Canada.
¹⁴ Department of Clinical Health Psychology, University of Manitoba, Winnipeg, ON, Canada.
¹⁵ St. Joseph's Operational Stress Injury Clinic, London, ON, Canada.

PMID: 34694228
PMCID: PMC8576591
DOI: 10.2196/33151

Abstract

Background: Over 85% of active members of the Canadian Armed Forces have been exposed to potentially traumatic events linked to the development of posttraumatic stress disorder (PTSD). At the time of transition to civilian life, as high as 1 in 8 veterans may be diagnosed with PTSD. Given the high prevalence of PTSD in military and veteran populations, the provision of effective treatment considering their unique challenges and experiences is critical for mental health support and the well-being of these populations.

Objective: This paper presents the protocol for a meta-analysis and systematic review that will examine the effectiveness of treatment approaches for military-related PTSD.

Methods: This PROSPERO-preregistered meta-analysis is being conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. A comprehensive search of the literature was conducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertation & Theses. Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multilevel meta-analysis will examine the overall effects, between-study effects, and within-study effects of available evidence for PTSD treatments in military populations. Effect sizes will be compared between pharmacotherapeutic, psychotherapeutic, and alternative/emerging treatment interventions. Finally, meta-regression and subgroup analyses will explore the moderating roles of clinical characteristics (eg, PTSD symptom clusters), treatment approaches (eg, therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), as well as treatment characteristics (eg, length of intervention) on treatment outcomes.

Results: The literature search was completed on April 14, 2021. After the removal of duplicates, a total of 12,002 studies were screened for inclusion. As of July 2021, title and abstract screening has been completed, with 1469 out of 12,002 (12.23%) studies included for full-text review. Full review is expected to be completed in the summer of 2021, with initial results expected for publication by early winter of 2021.

Conclusions: This meta-analysis will provide information on the current state of evidence on the efficacy and effectiveness of various treatment approaches for military-related PTSD and identify factors that may influence treatment outcomes. The results will inform clinical decision-making for service providers and service users. Finally, the findings will provide insights into future treatment development and practice recommendations to better support the well-being of military and veteran populations.

Trial registration: PROSPERO CRD42021245754; https://tinyurl.com/y9u57c59.

International registered report identifier (irrid): DERR1-10.2196/33151.

Keywords: Canada; disorder; efficacy; meta-analysis; military; military personnel; pharmacotherapy; posttraumatic; posttraumatic stress disorder; psychotherapy; review; stress; stress disorders; systematic review; therapy; treatment; veteran.

©Jenny J W Liu, Anthony Nazarov, Bethany Easterbrook, Rachel A Plouffe, Tri Le, Callista Forchuk, Alec Brandwood, Kate St Cyr, Edouard Auger, Ken Balderson, Mathieu Bilodeau, Amer M Burhan, Murray W Enns, Patrick Smith, Fardous Hosseiny, Gabrielle Dupuis, Maya Roth, Natalie Mota, Vicky Lavoie, J Don Richardson. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 25.10.2021.