Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members.

Berke, D. S., Kline, N. K., Wachen, J. S., McLean, C. P., Yarvis, J. S., Mintz, J., Young-McCaughan, S., Peterson, A. L., Foa, E. B., Resick, P. A., & Litz, B. T., for the STRONG STAR Consortium.
Jul 1, 2019

Behaviour Research and Therapy, 118, 7-17.

Dropout from first-line posttraumatic stress disorder (PTSD) treatments is a significant problem. We reported rates and predictors of attendance and dropout in three clinical trials of evidence-based PTSD treatments in military service members (N = 557). Service members attended 81.0% of treatment sessions and 30.7% dropped out. Individually delivered treatment was associated with greater attendance rates (β = 0.23, p < .001) than group therapy; trauma-focused treatments were associated with higher dropout (β = 0.19, p < .001) than Present-Centered Therapy. Age was a significant predictor of session attendance (β = 0.17, p < .001) and drop out (β = -0.23, p < .001). History of traumatic brain injury (TBI) predicted lower attendance rates (β = -0.26, p < .001) and greater dropout (β = 0.19, p < .001). Regardless of treatment type or format, patients who did not drop out were more likely to experience clinically significant gains (d = 0.49, p < .001). Results demonstrate that dropout from PTSD treatments in these trials was significantly associated with treatment outcome and suggest that strategies are needed to mitigate dropout, particularly in group and trauma-focused therapies, and among younger service members and those with TBI.

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