Psychosocial interventions for military personnel with PTSD: A network meta-analysis

Research Question: What psychological interventions and what specific components of these interventions are most effective for the treatment of PTSD in military personnel? Background: Post-traumatic stress disorder (PTSD) is a serious mental disorder that may follow exposure to distressing or life-threatening events. Military personnel may be at a higher risk for exposure to multiple traumas, both pre-service and in-service, hence putting personnel at a higher risk for PTSD. Although many psychological interventions have been developed, there is little clarity as yet regarding which interventions are most effective and in what ways individual components of the interventions (e.g., cognitive restructuring or behavioural activation) contribute to their effectiveness, and for whom these interventions are economically viable. Aims and Objectives: This study aims to improve the lives of military and ex-military personnel with PTSD by i) identifying effective psychological interventions through (component) network meta-analysis (c)NMA, ii) providing cost-effectiveness summaries of relevant PTSD intervention studies to inform clinical and policy decisions, and iii) ensuring relevance and applicability of findings across diverse military contexts. Methods: We will conduct a systematic review of existing studies on psychological interventions for military populations with PTSD. Using a (c)NMA, we will simultaneously compare multiple treatments, including those not previously compared head-to-head, to determine which interventions perform best overall and which specific components drive improvement. We will conclude the most effective intervention based on treatment effects, rankings, validity of assumptions (homogeneity and consistency), and reliability (Confidence in Network Meta-Analysis). Timeline for delivery: The project will run for 18 months. Key milestones include completing the literature search, data extraction, and preliminary analyses by month six, followed by pairwise, network, and component meta-analyses by month 12. The final months will focus on stakeholder engagement, interpretation of results, and dissemination. Involving Patients and the Public (PPI): Two UK Army Veterans (ABac and DS) with over 13 years of infantry experience each, along with a supporter of a family member with PTSD (ABry), have guided this proposal. To broaden engagement, we will convene a PPI group comprising up to 12 serving and ex-serving military personnel, family members, and healthcare professionals, meeting five times over the 18-month period. PPI members will refine eligibility criteria, co-develop outcomes, interpret findings, and ensure results are both relevant and transferable. We will prioritise diversity and inclusivity through evidence-based outreach, building on existing partnerships with trusts and military charities. Anticipated Impact and Dissemination: By pinpointing and evaluating the most effective interventions, our findings will directly inform clinical guidelines and policy decisions, benefiting serving and ex-serving military personnel populations worldwide. We will produce a comprehensive scientific report, submit a peer-reviewed manuscript, and present our findings at major conferences, including those hosted by the King’s Centre for Military Health Research. Moreover, we will publish an anonymised dataset of existing trials to support further research and innovation in PTSD care.