Study: PTSD treatment dropout rates vary widely – News-Medical

Report on Psychotherapy Attrition Rates for Post-Traumatic Stress Disorder (PTSD) and Implications for Sustainable Development Goal 3

Introduction: Addressing Mental Health as a Core Component of SDG 3

Achieving Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all at all ages, requires a dedicated focus on mental health. Specifically, Target 3.4 calls for the promotion of mental health and well-being. A significant challenge to meeting this target is the high rate of premature discontinuation of psychotherapy for conditions such as Post-Traumatic Stress Disorder (PTSD), particularly among vulnerable populations like military service members and veterans. This report analyzes research on treatment dropout rates and frames the findings within the context of advancing global health objectives.

Key Findings from a Meta-Analysis

A comprehensive meta-analysis, covering 181 studies and over 124,000 military participants, reveals critical data on PTSD treatment adherence. These statistics underscore the urgency of developing more sustainable and effective mental healthcare strategies to support SDG 3.

• Overall Dropout Rate: An average of 25.6% of U.S. service members and veterans prematurely discontinue PTSD psychotherapy.
• Health Impact: PTSD is linked to an increased risk of non-communicable diseases, including heart disease and stroke, directly impacting the broader aims of SDG Target 3.4.
• Prevalence: Approximately 7% of veterans are affected by PTSD, highlighting a substantial population in need of effective and sustained care.

Comparative Analysis of Therapeutic Modalities and Adherence

The research indicates a significant variance in dropout rates across different therapeutic approaches. Understanding these differences is crucial for designing patient-centered care systems that improve engagement and contribute to long-term well-being.

Therapies with High Attrition Rates

Certain effective, trauma-focused therapies present challenges to patient retention, suggesting a need for enhanced support mechanisms.

• Cognitive Processing Therapy: 40.1% dropout rate
• Virtual Reality Exposure Therapy: 37.2% dropout rate
• Prolonged Exposure Therapy: 34.7% dropout rate

Therapies with Higher Retention Rates

Conversely, several modalities demonstrate greater patient adherence, offering models for sustainable mental health interventions.

• Group-Based Exposure Therapy: 6.9% dropout rate
• Intensive Outpatient Trauma-Focused Treatments: 5.5% to 8.5% dropout rate
• Present-Centered Therapy: 16.1% dropout rate
• Mindfulness-Based Stress Reduction: 20% dropout rate

The Challenge of Comorbidity and its Impact on SDG Target 3.5

The data reveals that co-occurring disorders significantly impact treatment adherence, particularly in relation to substance use. This finding directly relates to SDG Target 3.5, which seeks to strengthen the prevention and treatment of substance abuse. The high dropout rate for individuals with comorbid PTSD and substance use disorders indicates a critical gap in integrated care.

• PTSD and Substance Use Disorders: 46.4% dropout rate
• PTSD and Depression: 23.2% dropout rate

Strategic Recommendations for Advancing SDG 3

To address the challenge of treatment dropout and make tangible progress toward achieving SDG 3, the following strategic actions are recommended:

1. Enhance Patient-Centered Care: Healthcare systems and policymakers should prioritize and invest in treatment protocols with proven higher engagement rates. Tailoring care by matching clients to their optimal treatment can significantly reduce dropout and improve outcomes.
2. Strengthen Clinical Support: Therapists utilizing treatments with higher dropout rates must be equipped with proven engagement strategies, including building therapeutic trust, monitoring progress, and respecting client preferences.
3. Develop Integrated Treatment Models: To effectively address SDG Target 3.5, it is imperative to develop and scale integrated interventions for individuals with comorbid PTSD and substance use disorders, as this group faces the highest risk of treatment discontinuation.
4. Invest in Sustainable Interventions: Focusing on approaches that are a better fit for individuals and providing robust support throughout the treatment process will help ensure that investments in mental healthcare yield lasting results for veterans’ recovery and overall community well-being.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

   • SDG 3: Good Health and Well-being: The entire article focuses on health, specifically the mental and physical well-being of U.S. service members and veterans. It discusses Post-Traumatic Stress Disorder (PTSD), a significant mental health condition, its prevalence, and the challenges associated with its treatment. The article also links PTSD to physical health risks like heart disease and stroke, directly aligning with the goal of ensuring healthy lives and promoting well-being for all.

2. What specific targets under those SDGs can be identified based on the article’s content?

   • Target 3.4: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” The article directly addresses this target by focusing on the promotion of mental health through psychotherapy for PTSD. It highlights that PTSD can “raise the risk of heart disease and stroke,” which are non-communicable diseases. The core discussion revolves around improving the effectiveness of mental health treatment by reducing dropout rates, which is a key aspect of promoting well-being.
   • Target 3.5: “Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.” This target is explicitly relevant because the article points out the significant challenges in treating co-occurring disorders. It states that treatment dropout was “especially high (46.4%) in programs treating PTSD alongside substance use disorders.” This highlights the need to strengthen treatment for this specific patient group.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

   • For Target 3.4 (Promote mental health and well-being): The article provides several specific data points that can serve as indicators to measure the effectiveness and sustainability of mental health services.
     • Indicator: Psychotherapy dropout rate for PTSD. The article provides a clear baseline, stating the average dropout rate is “25.6% of veterans and service members.” It also gives rates for specific therapies (e.g., 40.1% for cognitive processing therapy, 6.9% for group-based exposure therapy). A reduction in these rates would indicate progress.
     • Indicator: Prevalence of PTSD among veterans. The article mentions that “PTSD affects about 7% of veterans at some point in their lives.” Monitoring this prevalence rate over time would measure the overall success of prevention and treatment efforts.
   • For Target 3.5 (Strengthen treatment of substance abuse): The article implies a specific indicator for measuring progress in treating co-occurring disorders.
     • Indicator: Dropout rate from combined PTSD and substance use disorder treatment programs. The article identifies a specific high rate of “46.4%” for these programs. Tracking and reducing this specific dropout rate would be a direct measure of progress toward strengthening treatment for individuals with co-occurring substance abuse and mental health issues.

SDGs, Targets and Indicators Table

Source: news-medical.net