Posttraumatic stress disorder treatment dropout among military and veteran populations: a systematic review and meta-analysis
Abstract
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.
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These treatment completion rates are high for a trauma exposed population.
“These treatment completion rates are high for a trauma exposed population (92, 93).”
From Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the unified protocol for transdiagnostic treatment of emotional disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders (2025) · cites this paper as [92]
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- Authors
- Edwards‐Stewart, A., Smolenski, D. J., Bush, N. E., Cyr, B., Beech, E. H., Skopp, N. A., & Belsher, B. E.
- Affiliations
- Department of Health Affairs Psychological Health Center of Excellence, Research Branch Tacoma Washington USA
- Department of Health Affairs Psychological Health Center of Excellence, Performance & Analytics Branch Tacoma Washington USA
- Alliant University (US)
- Corresponding author
- Edwards‐Stewart, Amanda
- ORCID
- Venue
- Journal of Traumatic Stress
- Publisher
- Wiley
- Published
- 2021-02
- Volume
- 34
- Issue
- 4
- Pages
- 808-818
- ISSN
- 0894-9867 (ISSN-L)
- 1573-6598
- OpenAlex
- W3127942947
- Cited by
- 79
- References
- 44
- Citations by year
- 2026: 15 · 2025: 14 · 2024: 20 · 2023: 17 · 2022: 11 · 2021: 2
- FWCI
- 1.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Traumatic Stress (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- post-traumatic stress disorder, treatment discontinuation, military personnel, veterans, trauma-focused psychotherapy, waitlist control, medication adherence
- MeSH terms
- Humans, Military Personnel, Patient Dropouts, Psychotherapy, Stress Disorders, Post-Traumatic, Veterans
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