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2019 HSR&D/QUERI National Conference Abstract

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1046 — A Systematic Review of 38 years of PTSD Research: Groundwork for a Publicly Available Repository of Randomized Controlled Trials

Lead/Presenter: Maya O'Neil,  COIN - Portland
All Authors: O'Neil ME (VA Portland Health Care System, Oregon Health and Science University), Harik, J.M. (National Center for Post Traumatic Stress Disorder, Dartmouth College), Cheney, T. (Oregon Health and Science University) Hsu, F. (Oregon Health and Science University) McDonagh, M. (Oregon Health and Science University) Norman, S.B. (National Center for Post Traumatic Stress Disorder, University of California San Diego) Cameron, D. (VA Portland Health Care System, Oregon Health and Science University) Carlson, K.F. (VA Portland Health Care System, Oregon Health and Science University) Holmes, R. (Oregon Health and Science University) Ramirez, S. (Oregon Health and Science University) Hart, E. (Oregon Health and Science University) Murphy, K. (Oregon Health and Science University) Graham, E. (Oregon Health and Science University) Chou, R. (Oregon Health and Science University) Hamblen, J.L. (National Center for Post Traumatic Stress Disorder, Dartmouth College)

Objectives:
Posttraumatic stress disorder (PTSD) reduces quality of life and functioning. While there has been extensive research on PTSD, providing a single, updatable source of PTSD treatment studies would be useful for clinicians, researchers, and policymakers. We conducted a systematic review of randomized controlled trials (RCTs) of PTSD interventions to provide detailed information on PTSD treatment research.

Methods:
We searched multiple databases for eligible studies and reviewed reference lists of selected systematic reviews and PTSD clinical practice guidelines. Inclusion and exclusion criteria were established a priori. Researchers dually reviewed title and abstract citations to determine eligibility, then assessed full-texts of potentially includable articles, and dually reviewed abstracted data.

Results:
We identified 318 RCTs of PTSD interventions for abstraction (106 pharmacologic studies and 212 nonpharmacologic studies) published from 1988 to 2018, with a peak number of publications (31) in 2015. Most studies were conducted in the United States (61%), had sample sizes between 25 to 100 participants (60% of studies), enrolled community participants versus a military or Veteran population (57%), and were conducted in the outpatient setting (67%). Studies most often enrolled participants with a mix of trauma types (51%), followed by studies of participants with combat-related trauma (20%). Psychotherapeutic (55%) and pharmacologic (30%) interventions were the most commonly studied. The Clinician-Administered PTSD Scale and the Structured Clinical Interview for DSM were the most common PTSD diagnostic instruments. Less than half of the studies reported loss of PTSD diagnosis or clinically meaningful response/remission of symptoms.

Implications:
Results showed variation in intervention type, PTSD assessment instrument, and study population as well as other data elements. The abstracted data can be used to identify patterns in study and participant characteristics, evidence for effectiveness and harms, and evidence gaps in the body of PTSD trial literature.

Impacts:
The National Center for Posttraumatic Stress Disorder intends to deploy the data abstracted from the 318 RCTs of PTSD interventions to a publicly available web-based application. This online repository will inform future study design and conduct, and will aid researchers and policy-makers in in identifying important gaps in the research.