Nonpharmacological interventions to reduce posttraumatic stress disorder, depression, or anxiety symptoms after trauma: A systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: Recent novel digital interventions may be transformative in overcoming persistent barriers to access in-person psychological therapies. OBJECTIVE: This study aimed to synthesize evidence from randomized controlled trials (RCTs) of nonpharmacological interventions that prevents or treats anxiety, depression, or posttraumatic stress disorder (PTSD) among civilians recovering from physical traumatic injury. METHODS: We searched PubMed, Embase, Web of Science, PsychINFO, Cochrane Central Register of Controlled Trials, and Google Scholar for articles since inception to December 28, 2023. We performed English-language RCTs of patients 18 years or older who sustained a physical injury and were assessed for symptoms of PTSD, depression, or anxiety within 1 year of injury. Dual reviewers performed screening for advancement to full-text review, data extraction, and final eligibility for systematic review and meta-analysis, and conflicts were resolved by the senior author. Meta-analysis used random effects. The primary outcome was standardized mean difference (SMD) between intervention and comparator groups. RESULTS: We identified 3,001 articles for title and abstract review. Overall, nonpharmacological interventions significantly prevented or treated PTSD (pooled SMD, -0.71; 95% confidence interval [CI], -1.06 to -0.36), depression (pooled SMD, -0.42; 95% CI, -0.68 to -0.17), and anxiety (pooled SMD, -0.69; 95% CI, -1.01 to -0.37). Cognitive behavioral therapy (CBT) was associated with decreased symptoms of PTSD (pooled SMD, -1.10; 95% CI, -1.54 to -0.66), depression (pooled SMD, -0.87; 95% CI, -1.22 to -0.52), and anxiety. Non-CBT significantly reduced anxiety (pooled SMD, -0.40; 95% CI, -0.74 to -0.07). Collaborative care, non-CBT, and digital treatments failed to reach significance for PTSD and depression. CONCLUSION: Our systematic review and meta-analysis of RCTs suggest efficacy of CBT for PTSD, depression, and anxiety and non-CBT for anxiety, after physical trauma. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis; Level III.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.037 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.021 | 0.036 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".