A Systematic Review of Dropout From Psychotherapy for Posttraumatic Stress Disorder Among Iraq and Afghanistan Combat Veterans

Goetter, Elizabeth M.; Bui, Eric; Ojserkis, Rebecca A.; Zakarian, Rebecca J.; Brendel, Rebecca Weintraub; Simon, Naomi M.

doi:10.1002/jts.22038

Cited by 215Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsMigration, Health and Trauma

A Systematic Review of Dropout From Psychotherapy for Posttraumatic Stress Disorder Among Iraq and Afghanistan Combat Veterans

Goetter, Elizabeth M., Bui, Eric, Ojserkis, Rebecca A., Zakarian, Rebecca J., Brendel, Rebecca Weintraub, Simon, Naomi M.·2015·Journal of Traumatic Stress

DOI 10.1002/jts.22038

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Abstract

A significant number of veterans of the conflicts in Iraq and Afghanistan have posttraumatic stress disorder (PTSD), yet underutilization of mental health treatment remains a significant problem. The purpose of this review was to summarize rates of dropout from outpatient, psychosocial PTSD interventions provided to U.S. Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) veterans with combat‐related PTSD. There were 788 articles that were identified which yielded 20 studies involving 1,191 individuals eligible for the review. The dropout rates in individual studies ranged from 5.0% to 78.2%, and the overall pooled dropout rate was 36%, 95% CI [26.20, 43.90]. The dropout rate differed marginally by study type (routine clinical care settings had higher dropout rates than clinical trials) and treatment format (group treatment had higher dropout rates than individual treatment), but not by whether comorbid substance dependence was excluded, by treatment modality (telemedicine vs. in‐person treatment), or treatment type (exposure therapy vs. nonexposure therapy). Dropout is a critical aspect of the problem of underutilization of care among OEF/OIF/OND veterans with combat‐related PTSD. Innovative strategies to enhance treatment retention are needed.

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The withdrawal/dropout rate of 17.2% is in line with overall attrition rates found in adult psychotherapy across settings (19.7%), slightly lower than treatment dropout rates found among veterans and their families (24%), and substantially lower than dropout rates found among veterans in treatment for PTSD (36%).
“This rate is in line with overall attrition rates found in adult psychotherapy across settings (19.7%) [58], is slightly lower than treatment dropout rates found among veterans and their families (24%) [59], and is substantially lower than dropout rates found among veterans in treatment for PTSD (36%) [60].”
From Feasibility, acceptability, and initial outcomes of a psychological adjustment and reintegration program for transitioned military veterans (2024) · cites this paper as [60]

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Authors: Goetter, E. M., Bui, E., Ojserkis, R. A., Zakarian, R. J., Brendel, R. W., & Simon, N. M.
Affiliations: Harvard University (US)
Department of Psychiatry Massachusetts General Hospital/Harvard Medical School Boston Massachusetts USA
ORCID: Goetter, Elizabeth M.
Brendel, Rebecca Weintraub
Simon, Naomi M.
Venue: Journal of Traumatic Stress
Publisher: Wiley
Published: 2015-09-16
Volume: 28
Issue: 5
Pages: 401-409
ISSN: 0894-9867 (ISSN-L)
1573-6598
DOI: 10.1002/jts.22038
OpenAlex: W2096342874
Cited by: 215
References: 47
Citations by year: 2026: 15 · 2025: 21 · 2024: 19 · 2023: 16 · 2022: 23 · 2021: 30 · 2020: 29 · 2019: 27 · 2018: 13 · 2017: 12 · 2016: 10
FWCI: 1.67
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Journal of Traumatic Stress (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords: post-traumatic stress disorder, combat veterans, treatment discontinuation, treatment retention, psychosocial interventions, outpatient psychotherapy, Iraq and Afghanistan wars, Iraq War, Operation Enduring Freedom, Operation New Dawn, exposure therapy, telemedicine
MeSH terms: Humans, Patient Dropouts, Psychotherapy, Risk Factors, Stress Disorders, Post-Traumatic, United States, Veterans, Databases, Bibliographic, Iraq War, 2003-2011, Afghan Campaign 2001-

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A Systematic Review of Dropout From Psychotherapy for Posttraumatic Stress Disorder Among Iraq and Afghanistan Combat Veterans

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