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Pharmacologic and Nonpharmacologic Treatments for Posttraumatic Stress Disorder: 2024 Update of the Evidence Base for the PTSD Trials Standardized Data Repository

  • This update adds 32 randomized controlled trials (RCTs) on posttraumatic stress disorder (PTSD) and comorbid PTSD/substance use disorder (SUD) to the previous Agency for Healthcare Research and Quality (AHRQ) report on this topic1 and the National Center for PTSD (NCPTSD) PTSD Trials Standardized Data Repository (PTSD-Repository);2 the new total of included RCTs is 528.
  • Across all 528 RCTs:
    • The most commonly studied intervention was psychotherapy (44%), followed by pharmacologic interventions (19%), and complementary and integrative health (6%); 7 percent of studies used both pharmacologic and psychotherapeutic interventions.
    • Overall, most studies were conducted in the United States (59%) and had sample sizes in the range of 25 to 99 participants (59%), with a relatively small number of studies enrolling more than 200 participants (8%).
    • Just under a third of studies (31%) provided data on race and ethnicity, and another 26 percent provided data on race only; data were not provided for race or ethnicity in 42 percent of studies.
    • Almost a third of studies (31%) targeted specific types of trauma: combat-related trauma was the most commonly targeted (15% of all studies), followed by terrorism/political violence/forced displacement (5%) and accidents (2%); 51 percent allowed a mix of trauma types, and 18 percent did not provide information on participant trauma types.
    • Risk of bias (RoB) was rated as low for 14 percent, some concerns for 27 percent, and high for the remaining studies (59%).
  • Across the 32 newly added RCTs:
    • The most commonly studied intervention was psychotherapy (31%), followed by nonpharmacologic cognitive (19%) and pharmacologic interventions (16%); 6 percent of studies used both pharmacologic and psychotherapeutic interventions.
    • Just over half of the newly added RCTs were conducted in the United States (53%), and enrolled community (not specifically military) participants (56%); sample sizes were in the range of 25 to 99 participants in most studies (66%).
    • About half of studies allowed a mix of trauma types (53%); 38 percent did not provide information on participant trauma types.
    • RoB was rated as low for 28 percent, some concerns for 25 percent, and high for the remaining studies (47%).

Objectives. Identify and abstract data from randomized controlled trials (RCTs) examining treatment for posttraumatic stress disorder (PTSD) and comorbid PTSD/substance use disorder to update the previous Agency for Healthcare Research and Quality (AHRQ) report on this topic and the National Center for PTSD (NCPTSD) PTSD Trials Standardized Data Repository (PTSD-Repository) with newly included trials.

Data sources. We searched PTSDpubs, Ovid® MEDLINE®, Cochrane CENTRAL, PsycINFO®, Embase®, CINAHL®, and Scopus® for eligible RCTs published from March 1, 2023, to September 11, 2023.

Review methods. In consultation with AHRQ and NCPTSD, we updated the evidence tables for the PTSD-Repository by including evidence published after publication of the last update and studies that met updated inclusion criteria for the database (e.g., interventions that do not require a provider). Evidence tables were also updated with calculated standardized effect sizes for continuous PTSD outcomes for all included studies. We assessed risk of bias (RoB) for all included studies using the Revised Cochrane Risk of Bias 2 (RoB 2) tool for randomized trials.

Results. We added 32 RCTs examining treatments for PTSD, for a total of 528 included studies published from 1988 to September 11, 2023. Among all 528 included RCTs, studies of psychotherapy interventions were the most common (44%), followed by pharmacologic interventions (19%). Most studies were conducted in the United States (59%) and had sample sizes ranging from 25 to 99 participants (59%). Approximately half of the studies enrolled community (i.e., not specifically military) participants (54%), and most were conducted in outpatient settings (77%). Studies typically enrolled participants with a mix of trauma types (51%). Among all 528 included RCTs, RoB was rated as low for 14 percent of studies, 27 percent were rated as having some concerns, and the remaining 59 percent were rated as high RoB.

Among the 32 newly added RCTs, psychotherapy interventions were the most commonly employed (31%), followed by nonpharmacologic cognitive interventions (19%). Approximately half of the studies were conducted in the United States (53%), and enrolled community participants (56%) and participants with a mix of trauma types (53%). Studies typically had sample sizes ranging from 25 to 99 participants (59%). Of the newly added RCTs, RoB was rated as low for 28 percent of studies, 25 percent were rated as having some concerns, and the remaining 47 percent were rated as high RoB.

Conclusions. This report updates the previous AHRQ report to add 32 RCTs, for a total of 528 studies. This update adds comprehensive data and RoB assessment for the newly included RCTs, and standardized effect sizes for continuous PTSD outcomes for all included studies. As with the previous AHRQ update, this report will serve as the updated evidence base for the PTSD-Repository, a comprehensive database of PTSD trials.

  1. Giacco D, Matanov A, Priebe S. Symptoms and subjective quality of life in post-traumatic stress disorder: a longitudinal study. PLoS One. 2013;8(4):e60991. doi: 10.1371/journal.pone.0060991. PMID: 23585868.
  2. Schein J, Houle C, Urganus A, et al. Prevalence of post-traumatic stress disorder in the United States: a systematic literature review. Curr Med Res Opin. 2021 Dec;37(12):2151-61. doi: 10.1080/03007995.2021.1978417. PMID: 34498953.

Project Timeline

Pharmacologic and Nonpharmacologic Treatments for Posttraumatic Stress Disorder

Jun 29, 2018
Topic Initiated
Jul 10, 2018
Sep 12, 2023
Sep 21, 2023
Mar 27, 2024
Draft Comments
Mar 27, 2024 - Apr 24, 2024
Page last reviewed March 2024
Page originally created March 2024

Internet Citation: Draft Comments: Pharmacologic and Nonpharmacologic Treatments for Posttraumatic Stress Disorder: 2024 Update of the Evidence Base for the PTSD Trials Standardized Data Repository. Content last reviewed March 2024. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.
https://effectivehealthcare.ahrq.gov/products/ptsd-pharm-non-pharm-treatment-update/draft-report

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