Table 3Eligibility criteria for studies of PTSD prevention

CategoryInclusionExclusion
PopulationAdults (ages 18 or older) exposed to psychological trauma. Types of trauma include interpersonal or domestic violence or abuse; sexual abuse or assault; rape; combat- or military-related trauma; crime-related events; terrorism; slavery; natural disasters; injury; life-threatening illness; captivity; life-threatening medical procedures; witnessing a traumatic event; refugee trauma; prisoner of war-related trauma; and asylum seeking-related trauma

Subgroups of interest include:
  • Demographic groups (defined by age, ethnic and/or racial groups, and sex)
  • Populations with psychiatric comorbidities
  • Populations with different personal risks of developing PTSD
Children, people with PTSD
InterventionsPsychological interventions including:
  • Cognitive behavioral therapy
  • Cognitive processing therapy
  • Cognitive therapy (including cognitive restructuring therapy)
  • Coping skills therapy (including stress inoculation therapy)
  • Debriefing interventions (including critical incident stress debriefing and critical incident stress management)
  • Exposure-based therapies (including imaginal and in vivo exposure)
  • Eye movement desensitization and reprocessing
  • Interpersonal therapy
  • Psychoeducation
  • Psychological first aid
  • Other clearly defined psychological interventions
Pharmacological interventions including:
  • Alpha blockers (prazosin)
  • Anticonvulsants (topiramate, tiagabine, lamotrigine, carbamazepine, divalproex, and gabapentin)
  • Benzodiazepines (alprazolam, diazepam, lorazepam, clonazepam, and temazepam)
  • Beta blockers (propanolol)
  • Monoamine oxidase inhibitors (phenelzine, isocarboxazid, selegiline, and tranylcypromine)
  • Narcotics (morphine)
  • Nonbenzodiazepine sedative and hypnotics (zolpidem, eszopiclone, rozerem, and zaleplon)
  • Opioid antagonists (naltrexone)
  • Other second-generation antidepressants (bupropion, mirtazapine, nefazodone, and trazodone)
  • Second-generation (atypical) antipsychotics (olanzapine and risperidone)
  • Selective serotonin reuptake inhibitors (escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline)
  • Serotonin and norepinephrine reuptake inhibitors (duloxetine, desvenlafaxine and venlafaxine)
  • Steroids (hydrocortisone)
  • Tricyclic antidepressants (imipramine, amitriptyline and desipramine)
  • Other clearly defined pharmacological interventions
Emerging interventions including:
  • Complementary and alternative medicine approaches (including dietary supplements, yoga, and guided imagery)
  • New models of health care delivery (including collaborative care)
  • Other clearly defined emerging interventions
Psychological or pharmacological interventions not listed as included

Any intervention that has not been administered within 3 months of the traumatic event
Comparators
  • Psychological treatments (listed above)
  • Pharmacological treatments (listed above)
  • Combination of psychological and pharmacological treatments
  • Emerging treatments (listed above)
  • Usual care or supportive control
  • No active intervention (e.g., wait list, placebo)
Psychological or pharmacological interventions not listed as included
Outcomes
  • Incidence of PTSD
  • Incidence and severity of PTSD symptoms: assessor-rated or self-rated symptoms (e.g., sleep disturbance, anxiety)
  • Incidence and severity of coexisting conditions (e.g., depression, anxiety disorders, substance use, abuse, or dependence)
  • Quality of interpersonal or social functioning
  • Quality of life
  • Return to work or duty or ability to work
  • Incidence of self-injurious or suicidal thoughts, attempts, or behaviors (including suicide)
  • Incidence of aggressive or homicidal thoughts, attempts, or behaviors (including homicide)
  • Resilience
  • Perceived utility (subjective sense of helpfulness of the intervention)
  • Adverse events: overall adverse events, withdrawals attributed to adverse events, and specific adverse events (including, but not limited to, worsening of anxiety or agitation, increased distress, headaches, gastrointestinal effects, effects on blood pressure, heart rate, sexual side effects, sedation or insomnia, treatment-associated hypomania or mania, medication dependence or misuse, disturbed sleep, weight gain, metabolic side effects, and mortality)
  • Dropout rate (overall dropout rate, dropout because of adverse effects, dropout because of lack of efficacy)
Publication languageEnglishAll other languages
Time period1980–present; searches to be updated after draft report goes out for peer review
Settings
  • Outpatient and inpatient primary care
  • Specialty mental health care settings
  • Community settings (e.g., churches, community health centers, rape crisis centers)
  • Military settings
GeographyNo limits
TimingIntervention must be administered any time ranging from immediately to 3 months after exposure to a traumatic event

No limit for duration of followup
Admissible evidence for KQ 1 through KQ 4Original research
For KQs 1 through 4, eligible study designs include:
Randomized controlled trials
Prospective controlled cohort studies

For KQs 2 through 4 when outcomes of interest are focused on harms, additional eligible study designs are:
Retrospective controlled cohort studies
Case control studies
  • Case series
  • Case reports
  • Systematic reviews and meta-analyses
  • Nonsystematic reviews
  • Editorials
  • Letters to the editor
  • Studies with historical, rather than concurrent, control groups
  • Pre-post studies without a separate control group

KQ = Key Question; PTSD = posttraumatic stress disorder

From: Methods

Cover of Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma
Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma [Internet].
Comparative Effectiveness Reviews, No. 109.
Gartlehner G, Forneris CA, Brownley KA, et al.

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