@article{pmid40215380,

title = {Treating Posttraumatic Stress Disorder in Military Populations: A Meta-Analysis},

author = {Jenny J W Liu and Anthony Nazarov and Natalie Ein and Bethany Easterbrook and Tri Le and Clara Baker and Julia Gervasio and Edouard Auger and Ken Balderson and Mathieu Bilodeau and Amer M Burhan and Murray W Enns and Fardous Hosseiny and Vicky Lavoie and Natalie Mota and Maya L Roth and Sonya G Wanklyn and J Don Richardson},

doi = {10.4088/JCP.24r15571},

issn = {1555-2101},

year  = {2025},

date = {2025-03-01},

journal = {J Clin Psychiatry},

volume = {86},

number = {2},

abstract = { Military and Veteran populations experience higher rates of posttraumatic stress disorder (PTSD) compared to civilians. While trauma focused psychotherapies are generally recommended as first-line treatments, the effectiveness of various treatments in military populations requires further investigation.  This meta-analysis aims to synthesize the current literature regarding effectiveness of psychotherapies, pharmacotherapies, and combination treatments for PTSD in military populations.  This preregistered review (PROSPERO: CRD42021245754) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses and Cochrane guidelines. A search was conducted using PsycINFO, MEDLINE, Embase, CINAHL, and ProQuest Dissertations and Theses.  The final sample included data from 414 studies.  Full study methodologies can be found in the published protocol (Liu et al, 2021).  The pooled random-effects model found effect size across all PTSD treatments ( = 712) was =0.96, compared to =0.45 for control conditions ( = 122). Clinician administered measures indicated larger treatment effects (= 1.02) than self reported measures ( =0.82). Combination therapies yielded the largest effects ( =2.17), outperforming both psychotherapies and pharmacotherapies alone. No significant differences were found across control conditions.  Findings suggest that integrating psychotherapies and pharmacotherapies may address multiple dimensions of PTSD more effectively than monotherapies. However, these results contrast with the prioritization of trauma-informed psychotherapies over pharmacotherapies, as recommended by the 2023 US Department of Veterans Affairs/Department of Defense guidelines. Future research should focus on subclass analyses and long-term outcomes to refine treatment strategies for PTSD in military populations. Tailoring treatment plans to individual needs remains crucial for optimizing recovery and long-term symptom management.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34791677,

title = {Whole-brain morphometry in Canadian soldiers with posttraumatic stress disorder},

author = {Olivier Roy and Jean Levasseur-Moreau and Emmanuelle Renauld and Luc J Hébert and Jean Leblond and Mathieu Bilodeau and Shirley Fecteau},

doi = {10.1111/nyas.14707},

issn = {1749-6632},

year  = {2022},

date = {2022-03-01},

journal = {Ann N Y Acad Sci},

volume = {1509},

number = {1},

pages = {37--49},

abstract = {Patients with posttraumatic stress disorder (PTSD) display several structural brain differences when compared with healthy individuals. However, findings are particularly inconsistent for soldiers with PTSD. Here, we characterized the brain morphometry of 37 soldiers from the Canadian Armed Forces with adulthood war-related PTSD using structural magnetic resonance imaging. We assessed time since trauma, as well as PTSD, depressive, and anxiety symptoms with the Modified PTSD Symptoms Scale, Beck Depression Inventory, and Beck Anxiety Inventory, respectively. Whole-brain morphometry was extracted with FreeSurfer and compared with a validated normative database of more than 2700 healthy individuals. Volume and thickness from several regions differed from the norms. Frontal regions were smaller and thinner, particularly the superior and rostral middle frontal gyri. Furthermore, smaller left rostral middle frontal gyrus, left pericalcarine cortex, and right fusiform gyrus were associated with more recent trauma. All subcortical structures were bigger, except the hippocampus. These findings suggest a particular brain morphometric signature of PTSD in soldiers. Smaller and thinner frontal and larger subcortical regions support impaired top-down and/or downregulation of emotional response in PTSD. Finally, the correlation of smaller frontal, temporal, and occipital regions with more recent trauma might inform future therapeutic approaches.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34694228,

title = {Four Decades of Military Posttraumatic Stress: Protocol for a Meta-analysis and Systematic Review of Treatment Approaches and Efficacy},

author = {Jenny J W Liu and Anthony Nazarov and Bethany Easterbrook and Rachel A Plouffe and Tri Le and Callista Forchuk and Alec Brandwood and Kate St Cyr and Edouard Auger and Ken Balderson and Mathieu Bilodeau and Amer M Burhan and Murray W Enns and Patrick Smith and Fardous Hosseiny and Gabrielle Dupuis and Maya Roth and Natalie Mota and Vicky Lavoie and J Don Richardson},

doi = {10.2196/33151},

issn = {1929-0748},

year  = {2021},

date = {2021-10-01},

journal = {JMIR Res Protoc},

volume = {10},

number = {10},

pages = {e33151},

abstract = {BACKGROUND: Over 85% of active members of the Canadian Armed Forces have been exposed to potentially traumatic events linked to the development of posttraumatic stress disorder (PTSD). At the time of transition to civilian life, as high as 1 in 8 veterans may be diagnosed with PTSD. Given the high prevalence of PTSD in military and veteran populations, the provision of effective treatment considering their unique challenges and experiences is critical for mental health support and the well-being of these populations.nnOBJECTIVE: This paper presents the protocol for a meta-analysis and systematic review that will examine the effectiveness of treatment approaches for military-related PTSD.nnMETHODS: This PROSPERO-preregistered meta-analysis is being conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. A comprehensive search of the literature was conducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertation & Theses. Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multilevel meta-analysis will examine the overall effects, between-study effects, and within-study effects of available evidence for PTSD treatments in military populations. Effect sizes will be compared between pharmacotherapeutic, psychotherapeutic, and alternative/emerging treatment interventions. Finally, meta-regression and subgroup analyses will explore the moderating roles of clinical characteristics (eg, PTSD symptom clusters), treatment approaches (eg, therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), as well as treatment characteristics (eg, length of intervention) on treatment outcomes.nnRESULTS: The literature search was completed on April 14, 2021. After the removal of duplicates, a total of 12,002 studies were screened for inclusion. As of July 2021, title and abstract screening has been completed, with 1469 out of 12,002 (12.23%) studies included for full-text review. Full review is expected to be completed in the summer of 2021, with initial results expected for publication by early winter of 2021.nnCONCLUSIONS: This meta-analysis will provide information on the current state of evidence on the efficacy and effectiveness of various treatment approaches for military-related PTSD and identify factors that may influence treatment outcomes. The results will inform clinical decision-making for service providers and service users. Finally, the findings will provide insights into future treatment development and practice recommendations to better support the well-being of military and veteran populations.nnTRIAL REGISTRATION: PROSPERO CRD42021245754; https://tinyurl.com/y9u57c59.nnINTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33151.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}