Nonpharmacological interventions to reduce posttraumatic stress disorder, depression, or anxiety symptoms after trauma: A systematic review and meta-analysis.
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BACKGROUND: Recent novel digital interventions may be transformative in overcoming persistent barriers to access in-person psychological therapies. OBJECTIVE: This study aimed to synthesize evidence from randomized controlled trials (RCTs) of nonpharmacological interventions that prevents or treats anxiety, depression, or posttraumatic stress disorder (PTSD) among civilians recovering from physical traumatic injury. METHODS: We searched PubMed, Embase, Web of Science, PsychINFO, Cochrane Central Register of Controlled Trials, and Google Scholar for articles since inception to December 28, 2023. We performed English-language RCTs of patients 18 years or older who sustained a physical injury and were assessed for symptoms of PTSD, depression, or anxiety within 1 year of injury. Dual reviewers performed screening for advancement to full-text review, data extraction, and final eligibility for systematic review and meta-analysis, and conflicts were resolved by the senior author. Meta-analysis used random effects. The primary outcome was standardized mean difference (SMD) between intervention and comparator groups. RESULTS: We identified 3,001 articles for title and abstract review. Overall, nonpharmacological interventions significantly prevented or treated PTSD (pooled SMD, -0.71; 95% confidence interval [CI], -1.06 to -0.36), depression (pooled SMD, -0.42; 95% CI, -0.68 to -0.17), and anxiety (pooled SMD, -0.69; 95% CI, -1.01 to -0.37). Cognitive behavioral therapy (CBT) was associated with decreased symptoms of PTSD (pooled SMD, -1.10; 95% CI, -1.54 to -0.66), depression (pooled SMD, -0.87; 95% CI, -1.22 to -0.52), and anxiety. Non-CBT significantly reduced anxiety (pooled SMD, -0.40; 95% CI, -0.74 to -0.07). Collaborative care, non-CBT, and digital treatments failed to reach significance for PTSD and depression. CONCLUSION: Our systematic review and meta-analysis of RCTs suggest efficacy of CBT for PTSD, depression, and anxiety and non-CBT for anxiety, after physical trauma. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis; Level III.
