Table 1 Characteristics of included studies
Authors (year) | Country | Study population | Traumatic exposure | Inclusion / exclusion criteria | Sampling method | Age and gender of participants (at baseline unless otherwise stated) | Quality |
|---|---|---|---|---|---|---|---|
An et al. (2022) [33] | China | 246 adolescents (T1), 209 (T2), 205 (T3), 121 (T4) | Yancheng tornado in China | None reported | Random sampling of several classes in two schools affected by the tornado | Mean age 14.04, range 12–17 40.7% male, 59.3% female | Fair |
Andersen et al. (2014) [34] | Denmark | 561 soldiers deployed to Afghanistan in 2009 | War in Afghanistan | None reported | Not reported | Mean age: 26.67 low-stable; 22.67 low-fluctuating; 22.20 distress-improving; 25.43 mild distress; 27.56 late onset; 23.18 relieved-worsening Female gender: 4.8% low-stable, 7.1% low-fluctuating, 13.3% distressed-improving, 8.7% mild distress, 0% late onset, 9.1% relieved-worsening | Good |
Ansell et al. (2011) [35] | United States of America | 499 adults with anxiety disorders from in- and out-patient clinical programs (n = 142 had PTSD diagnosis) | Not reported | Inclusion: Met criteria for anxiety disorder; had at least 12 months of follow-up data available | Participants drawn from a prospective naturalistic longitudinal study; details described in a different publication | Whole sample: mean age 32.5 65% female, 35% male | Fair |
Armenta et al. (2019) [36] | United States of America | 1,704 US service members and veterans with comorbid PTSD and major depressive disorder | No specific event – military experiences (some may have experienced other trauma unrelated to the military) | Inclusion: Positive screening for both PTSD and major depressive disorder at baseline; completed at least 2 follow-ups | Recruitment process described in a different paper | Mean age 29.1 60.9% male, 39.1% female | Fair |
BenÃtez et al. (2012) [37] | United States of America | 199 adults | No specific event – various Traumas most frequently reported were unwanted sex (76.2%), rape (59.8%), being attacked with intent to kill (53.7%), being attacked with a weapon (52.1%), witnessing someone injured or killed (50%), serious accident (47.6%) and fear of being killed/injured (22.3%) | Inclusion: general medical appointment on day of screening; age 18+; English proficiency; meeting DSM-IV criteria for at least one anxiety disorder Exclusion: active psychosis; absence of current address or phone number; pregnancy | Recruitment process described in a different paper | Mean age not reported – all 18+ 80.4% female | Fair |
Berntsen et al. (2012) [38] | Denmark | 366 soldiers deployed to Afghanistan | N/A – all had been deployed but may have also experienced other traumas | Inclusion: Danish soldiers with a 6-month deployment to Afghanistan Exclusion: None | Entire team of soldiers belonging to the Danish Contingent of the International Security Assistance Force 7 were invited to take part | Mean age 26.59 93.4% male, 6.6% female | Fair |
Boe et al. (2010) [15] | Norway | 48 disaster survivors | North Sea oil rig disaster | Inclusion: Survivors of the North Sea oil rig disaster, residing in Norway Exclusion: None | All survivors invited to take part | Mean age 59.8 at the 27-year follow-up 100% male | Fair |
Chopra et al. (2014) [39] | United States of America | 1,185 older adults (n = 81 with PTSD at baseline) | Various – not reported | Inclusion: Age 65+; patients at one of 10 primary care sites across the country; positive screening for depression, anxiety disorders or at-risk drinking Exclusion: Significant cognitive impairment; receiving ongoing mental health treatment | Not reported | Mean age 73.53 544, 304, 102, 66 men PTSD subgroup only: mean age 72.5, 83% male | Fair |
Davidson et al. (2005) [40] | United States of America | 57 adults with PTSD receiving either fluoxetine (n = 27) or a placebo (n = 30) | Various – trauma included combat (n = 18), sexual trauma (n = 9), other violence (n = 9), bereavement (n = 11), other (n = 10) | Inclusion: met PTSD criteria; discontinued any psychotropic medication for at least 2 weeks before the study; age 18–70 Exclusion: Pregnancy; history of schizophrenia, bipolar disorder, organic brain disease, alcohol or drug abuse/dependence (within past 6 months); ‘mental retardation’; need for ongoing psychotropic medication; significant risk of suicide or suicide attempt in past 6 months; history of significant violence within previous year; medically unstable state; prior nonresponse to adequate treatment with fluoxetine; need for trauma-focused psychotherapy; positive urine drug screen; clinically significant abnormal laboratory tests | Not reported | Mean age 43.5 53.5% female, 46.5% male | Fair |
DenVelde et al. (1996) [41] | Netherlands | 123 veterans of the Dutch civilian Resistance against the Nazi occupation during World War II | War | Inclusion: Male veterans; receiving a war pension; born between 1/1/1920 and 1/1/1926 No exclusion criteria reported | A sample of individuals receiving a War Pension were randomly selected | Mean age not reported; all participants born between 1/1/1920 and 1/1/1926 100% male | Poor |
Fan et al. (2015) [42] | China | T1: 1,573 adolescent (7th or 10th grade) survivors (n = 1,436 at T2; n = 1,288 at T3; n = 1,315 at T4) | Wenchuan earthquake | Inclusion: 7th or 10th graders from schools in Dujiangyan No exclusion criteria reported | All 7th and 10th graders invited to take part | Mean age: 12.3 for the 7th graders, 15.4 for the 10th graders 45.8% male, 54.2% female | Fair |
Gonçalves et al. (2011) [43] | United Kingdom | 121 women newly diagnosed with ovarian cancer (T1: n = 93; T2: n = 78; T3: n = 69; T4: n = 69; 63 completed assessments at all time points) | Illness: ovarian cancer | Inclusion: new diagnosis of ovarian, peritonea or fallopian tube carcinoma; able to provide informed consent; understanding of English Exclusion: Pre-existing organic brain disorder or severe mental illness | Consecutive new referrals attending a specialist ovarian cancer outpatient clinic were recruited | Mean age 58 100% female | Fair |
Gross et al. (2022) [44] | United States of America | 2,870 military veterans (admission), 1,848 (discharge), 1,071 (follow-up) | Military | Inclusion: White or Black veterans who initiated PTSD residential treatment during fiscal year 2017; general admission criteria include not currently meeting criteria for an acute psychiatric or medical admission, previous participation in a less restrictive treatment alternative, needing an intensive level of care, not being at significant acute risk of harm to self or others and being capable of basic self-care | All patients invited to take part | Mean age: 42.75 (White participants), 51.26 (Black participants) 11.2% female (White participants), 13.4% female (Black participants) | Fair |
Hansen et al. (2017) [45] | Norway | 1,974 ministerial employees (T1: n = 1,974; T2: n = 1,780; T3: n = 1,578) | Terrorist attack: bombing of a workplace in Oslo | Inclusion: ministerial employees who were employed in the Norwegian ministries at the time of the attack No exclusion criteria reported | All employees in the ministries at T1 plus former employees working at the time of the attack were invited | Mean age at study start: 45.4 (T1), 45.4 (T2), 45.8 (T3) 42.3% male (T1), 41.2% male (T2), 44% male (T3) | Fair |
Hepp et al. (2008) [46] | Switzerland | 121 adult hospital patients | Severe injury after accidental injury 59% road traffic accident; 21% sports and leisure-time accident; 14% workplace accident; 6% household accident | Inclusion: age 18–70; sustained accidental injuries that caused life-threatening or critical condition; proficiency in German; clinical condition allowing an extensive clinical interview within 1 month; Injury Severity Score of 10 or more; Glasgow Coma Scale score of 9 or more Exclusion: serious somatic illness; under treatment for mental health immediately prior to accident; marked clinical signs of mental disorders unrelated to accident; attempted suicide; victims of violent assault | Intensive care unit admissions recruited consecutively | Mean age 38.9 77% male, 23% female | Fair |
Holliday et al. (2020) [47] | United States of America | 7,918 military veterans | Military | Inclusion: veterans who initiated PTSD residential treatment during fiscal years 2015-16; general admission criteria include not currently meeting criteria for an acute psychiatric or medical admission, previous participation in a less restrictive treatment alternative, needing an intensive level of care, not being at significant acute risk of harm to self or others and being capable of basic self-care | All patients | Mean age: 48.79 (those who reported experiencing military sexual trauma), 44.66 (those who did not) Female: 801 + 159 Male: 773 + 6119 | Good |
Karstoft et al. (2015) [48] | Denmark | 561 soldiers (454 who participated in 2.5-year follow-up) | War: Deployment to Afghanistan | Inclusion: Danish soldiers with a 6-month deployment to Afghanistan Exclusion: None | All Danish soldiers who deployed to Afghanistan were asked to participate | Final sample who participated in 2.5-year follow-up: mean age 26.65 94.3% male | Fair |
Liang et al. (2019) [49] Liang et al. (2021) [50] | China | 301 children at T1 (T2: n = 118; T3: n = 263; T4: n = 253; T5: n = 218) | Wenchuan earthquake | Exclusion: ‘mental retardation’; history of clinically significant head injury; neurological disorders | Convenience sampling | Mean age 12.5 (range 9–14) 52.2% male | Fair |
Madsen et al. (2014) [51] | Denmark | 456 soldiers who had deployed to Afghanistan | War in Afghanistan | Inclusion: Danish soldiers deployed to Afghanistan February-August 2009 | All soldiers deployed to Afghanistan were recruited; this study is a sub-sample with follow-up data on suicidality | Mean age: 26.7 (no suicidal ideation group, n = 394); 26.4 (suicidal ideation group, n = 62) 94.7% male (no suicidal ideation group); 91.9% male (suicidal ideation group) | Fair |
Markowitz et al. (2018) [52] | United States of America | 43 adults receiving either prolonged exposure (n = 14), relaxation therapy (n = 9) or interpersonal psychotherapy (n = 20) for chronic PTSD | Various – 93% had experienced interpersonal trauma, 62% physical trauma, 35% sexual trauma | Inclusion: Age 18–65; primary DSM-IV diagnosis of chronic PTSD; CAPS score 50+ Exclusion: Psychotic disorders; bipolar disorder; unstable medical conditions; substance dependence; suicidal ideation ; antisocial, schizotypal, borderline or schizoid personality disorder; prior non-response to 8 + weeks of therapy; outside psychotherapy or pharmacotherapy | Patients from a psychiatric institute in New York City recruited via convenience sampling and randomly assigned to an intervention in a 4:4:3 ratio, stratified by presence of major depressive disorder | Mean age 43.21 (prolonged exposure); 37.61 (interpersonal psychotherapy); 42.52 (relaxation) 57% female, 43% male (prolonged exposure); 75% female, 25% male (interpersonal psychotherapy); 78% female, 22% male (relaxation) | Fair |
Martenyi et al. (2002) [53] | Belgium, Bosnia (as it was known at the time), Croatia, Yugoslavia (as it was known at the time), Israel, South Africa | 131 patients who completed 12 weeks of acute treatment, then re-randomised and continued in a 24-week relapse prevention phase with fluoxetine (n = 69) or placebo (n = 62) | Various – combat-related (44.9% of fluoxetine group, 50% of placebo group), non-combat-related (55.1% of fluoxetine group, 50% of placebo group) | Inclusion: age 18–65; met DSM-IV criteria for PTSD; score of 50 + on the CAPS-DX and score of 4 + on Clinical Global Impression of Severity (CGI-S) scale at baseline Exclusion: Score of 20 + on the Montgomery-Åsberg Depression Rating Scale; serious comorbid illness; concomitant psychotherapy; serious suicidal risk or risk to others; diagnosis of Axis I psychiatric disorder 5 years before traumatic episode; lifetime diagnoses of bipolar disorder, obsessive compulsive disorder or schizophrenia; history of alcohol or substance misuse not resolved at least 6 months prior to the study | Not reported | Mean age 37.1 (fluoxetine), 39.4 (placebo) Fluoxetine group: 78% male, 22% female Placebo group: 84% male, 16% female | Fair |
Murphy & Smith (2018) [54] | United Kingdom | 960 military veterans | Military | Inclusion: formal diagnosis of PTSD; admitted to a residential intervention; completed at least one full day of paid employment within the UK Armed Forces; if they were taking psychiatric medication at assessment, they had to remain on a stable dose Exclusion: Evidence of significant neurological impairment that would affect ability to engage in therapy; actively psychotic; actively dependent on alcohol or drugs; actively suicidal | All patients | Mean age 42.99 Gender not reported | Fair |
Osenbach et al. (2014) [55] | United States of America | 194 acutely injured hospitalised civilian trauma survivors | Various – motor vehicle injury (46.91%); assault (20.62%); fall or jump (15.98%); burn (7.22%); sports injury (3.61%); work-related injury (2.58%); other (3.09%) | Inclusion and exclusion criteria reported in a previous publication | Hospitalised trauma survivors randomly assigned to either treatment (intervention focused on early and sustained care of posttraumatic symptoms; n = 96) or usual care (n = 98) | Mean age 39.05 51.03% female | Good |
Osofsky et al. (2017) [56] | United States of America | 340 patients at rural health clinics | Gulf Oil Spill | Inclusion: receiving integrated services at one of five rural health clinics No other criteria reported | Not reported | Not reported | Fair |
Perconte et al. (1991) [57] | United States of America | 45 combat veterans with PTSD | Vietnam War | Inclusion: Participation in a partial hospitalisation PTSD treatment programme No other criteria reported | Not reported | Mean age 36.5 Gender not reported | Fair |
Sakuma et al. (2020) [58] | Japan | 745 local municipality and hospital workers | Great East Japan earthquake | Inclusion: Employed in local municipalities or disaster base hospitals during the earthquake Exclusion: Started employment after the earthquake | All workers invited to take part | Mean age: 43.6 (range 20–66) 58. 9% female, 41.1% male | Good |
Solomon & Mikulincer (2006) [59] | Israel | 214 veterans from the 1982 Lebanon War (131 with combat stress reaction during the war vs. 83 without) | Lebanon War | Inclusion: Israeli soldiers who had fought in frontline battles in the Lebanon War; combat stress reaction participants had to have been identified as psychiatric casualties by mental health personnel and had a referral for psychiatric intervention during the war and diagnosis of combat stress reaction; comparison group needed to have participated in combat in the same units but not identified as suffering combat stress reaction Exclusion: Indication of other psychiatric disorders | All veterans who met the inclusion criteria were invited to take part | Mean age: 25.81 (range 18–37) Gender not reported | Fair |
Solomon et al. (1987) [60] | Israel | 35 Israeli soldiers who fought in the 1982 Lebanon War and 1973 Yom Kippur War | Lebanon War and Yom Kippur War | Inclusion: medical files report them as suffering from combat-related PTSD during or immediately after the 1982 Lebanon War; reactivation or exacerbation of symptoms | Case histories of those showing reactivation or exacerbation were hand-selected | Median age 31 (range 28–39) Gender not reported | Fair |
Solomon et al. (2018) [61] | Israel | 349 veterans and ex-Prisoners of War Ex-Prisoners of War: 164 at T1, 144 at T2, 183 at T3 Veterans: 185 at T1, 143 at T2, 118 at T3 | Yom Kippur War | Inclusion: ex-Prisoners of War or veterans of the Yom Kippur War No other criteria reported | All ex-Prisoners of War were approached; a sample of veterans matched to the ex-Prisoners of War in age, rank, military units, psychometric grading and military quality category were drawn from computerised databanks | Mean age 39.8, range 36–50 Gender not reported | Fair |
Solomon et al. (2021) [62] | Israel | 120 ex-Prisoners of War of the 1973 Yom Kippur War and 136 comparable combat veterans of the same war | Yom Kippur War | Inclusion: Ex-Prisoners of War of the Yom Kippur War or comparable veterans matched on military background and socio-demographic variables who were not taken captive Exclusion: Physical or mental health deteriorated to the point where they could not take part | All ex-Prisoners of War were invited to take part; comparable veterans were sampled from the Israel Defense Forces computerised database | Not reported | Fair |
Sørensen et al. (2016) [63] | Denmark | 428 Danish soldiers deployed to Afghanistan in 2009 (same cohort as Andersen et al., 2014 and Madsen et al., 2014) | War in Afghanistan | Inclusion: Danish soldiers deployed to Afghanistan from February-August 2009 | Whole cohort were recruited; study is a sub-group who completed cognitive assessments and PTSD assessments at follow-up time-points | Mean age 24.0 Gender not reported | Fair |
Sungur & Kaya (2001) [64] | Turkey | 79 people exposed to the disaster (27 people saved from a burning hotel, 34 people besieged by the fundamentalists, 18 health professionals who treated the injured) | Sivas disaster – a religious fundamentalist protest which caused 37 deaths | Inclusion: Exposure to the disaster No exclusion criteria reported | Not reported | Not reported | Fair |
Zanarini et al. (2011) [65] | United States of America | 290 adults with borderline personality disorder (vs. 72 with at least one non-borderline axis II disorder) | No specific event – various Of the 163 patients with PTSD at baseline, traumas included childhood sexual abuse (83.4%), adult sexual assault (46%) or both (36.8%) (unclear why these percentages do not add up to 100%) | Inclusion: Patients initially inpatient at a Massachusetts hospital; aged 18–35; known or estimated IQ of 71 or higher; fluent in English Exclusion: History of, or current, symptoms of schizophrenia, schizoaffective disorder, bipolar I disorder or an organic condition that could cause psychiatric symptoms | Not reported | Mean age 27 77.1% female | Fair |
Zlotnick et al. (1999) [66] | United States of America | 54 adults with anxiety disorders and current PTSD vs. 13 adults with lifetime, but not current, PTSD | No specific event – various Traumatic events included childhood sexual abuse (46%), childhood physical abuse (33%), adulthood rape (22%), adulthood assault (6%), accidental physical harm (7%), witnessing violence in adulthood (4%), witnessing violence in childhood (11%), war (15%), other – including natural disaster, abortion, serious injury to loved one, serious illness and childhood separation from parents (13%) | Inclusion: at least one of panic disorder, agoraphobia, generalised anxiety disorder or social phobia; age 18+; willing and able to consent in participation Exclusion: organic mental disorder; history of schizophrenia; psychosis within last 6 months | Not reported | Current PTSD: Mean age 36 76% female Lifetime PTSD: Mean age 37 62% female | Fair |