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Four decades of military posttraumatic stress: Protocol for a meta-analysis and systematic review of treatment approaches and efficacy (Preprint)


 BACKGROUND
 Over 85% of active members of the Canadian Armed Forces (CAF) 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 one in eight Veterans has a diagnosis of PTSD. Given high rates of PTSD in military and Veteran populations, the provision of effective treatment with considerations for their unique challenges and lived experiences is critical in the support of their mental health and well-being.
 
 
 OBJECTIVE
 The current paper overviews the protocol for conducting a meta-analysis and systematic review substantiating evidence of treatment approaches and effectiveness in treating military-related PTSD.
 
 
 METHODS
 The PROSPERO pre-registered meta-analysis is being conducted in accordance with PRISMA and Cochrane guidelines. A comprehensive search of the literature was conducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertations and Theses. After removal of duplicates, a total of 12,002 studies were screened for inclusion.
 
 
 RESULTS
 Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multi-level meta-analysis will examine the overall effects, between-studies effects, and within-studies 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 sub-group analyses will explore the moderating roles of clinical characteristics (e.g., PTSD symptom clusters), treatment approaches (e.g., therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), and treatment characteristics (e.g., length of intervention) on treatment outcomes.
 
 
 CONCLUSIONS
 This meta-analysis will provide the current state of evidence on the efficacy and effectiveness of various treatment approaches in military-related PTSD while identifying factors that may influence treatment outcomes. Results will inform clinical decision-making for service providers and service users. Finally, findings will provide insights for future treatment development and practice recommendations to better support the well-being of military and Veteran populations.
