Systematic Review and Meta-Analysis of Stepped Care Psychological Prevention and Treatment Approaches for Posttraumatic Stress Disorder

Larissa N. Roberts, Reginald D.V. Nixon

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)

Abstract

Stepped care approaches have been developed to increase treatment accessibility for individuals with posttraumatic stress disorder (PTSD). However, despite guidelines recommending stepped care, it is currently unclear how the approach compares to other treatments for PTSD in terms of symptom reduction, cost, and client-rated acceptability. We conducted a systematic review and meta-analysis of randomized controlled and open trials evaluating stepped care prevention (i.e., targeting those with recent trauma exposure at risk of developing PTSD) and treatment approaches for adults and adolescents/children with PTSD. Eight prevention and four treatment studies were included. There was considerable variation in the sample types, stepped approaches, and control conditions. Most studies found no significant differences between stepped care (both prevention and treatment) and control (active and usual care) in terms of PTSD severity, loss of PTSD diagnosis, depression severity, and quality of life at the final follow-up. There was some evidence to suggest that stepped care was more cost-effective, and as acceptable or more acceptable compared to controls. Interpretations were tempered by high statistical heterogeneity, risk of bias, and lack of recommended evidence-based treatments. Stepped care can make PTSD treatment more accessible; however, more high-quality research is needed comparing stepped care to active controls.

Original languageEnglish
Pages (from-to)476-495
Number of pages20
JournalBehavior Therapy
Volume54
Issue number3
Early online date19 Dec 2022
DOIs
Publication statusPublished - May 2023

Keywords

  • posttraumatic stress disorder
  • prevention
  • stepped care
  • systematic review
  • treatment

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