Have you ever wanted to know how PTSD outcomes compare for veterans versus civilians? Is drop out from trauma-focused treatment the same as drop out from other PTSD treatments? Which treatments have been studied in women with PTSD, and how do they compare? What about interventions for natural disaster-related traumatic events? Is writing about trauma as effective as talking about it? Have there been any studies of prolonged exposure delivered via telehealth? Has repetitive transcranial magnetic stimulation (rTMS) ever been tested for PTSD? Whether we are clinicians, patients, researchers, or policymakers, we ask ourselves questions like these all the time. Unfortunately, there is often no study or other resource available to answer questions like these, and if there is, it may be out of date. For these reasons and others, we created the PTSD-Repository, which stands for the PTSD Trials Standardized Data Repository. It is a publicly available database of randomized controlled trials (RCTs) of PTSD interventions that includes over 300 descriptive data elements from 318 PTSD trials.
How we did it
In a collaborative effort initiated by the National Center for PTSD, together with the Agency for Healthcare Research & Quality (AHRQ) and the Pacific Northwest Evidence Based Practice Center, we searched the research literature to find RCTs on pharmacologic and nonpharmacologic interventions that have been published since the development of PTSD in the DSM in 1980, including complementary and integrative health approaches and biological treatments. We tried to have as few exclusion criteria as possible, but we did limit the project to studies of adults, at least 80% of whom were diagnosed with PTSD. We also limited it to standalone PTSD interventions. Then we challenged ourselves to abstract detailed data from 318 published intervention trials!
In the PTSD-Repository you will find detailed information on intervention characteristics (including descriptions of the interventions in each arm of the study), participant characteristics (such as demographics, veteran status, and type(s) of trauma experienced by participants), PTSD outcomes (such as mean change, percent who had meaningful change, percent who no longer met PTSD diagnostic criteria, and between and within group effect sizes), other outcomes (such as depression, anxiety, sleep, quality of life), and harms. The 318 RCTs we included enrolled a combined total of almost 25,000 participants.
How you can use it
The data tables are currently available to view or download as Microsoft Excel® spreadsheets from the National Center for PTSD Website at https://www.ptsd.va.gov/ptsdrepository/index.asp. Our hope is that these data are useful to a broad and diverse audience. Researchers can use the data as a source to conduct a systematic review or meta-analysis, or to identify gaps they might want to address via new research projects. Educators can use data or figures from the PTSD-Repository in their classes. Clinicians can use the data to answer questions about treatment for their patients. Trauma survivors, caregivers, or other members of the public can use it to learn more about a treatment they have heard about. Policymakers can use the data to find evidence that can guide decisions about implementation or dissemination of interventions.
However, we know that spreadsheets are not user friendly. Over the coming year the National Center for PTSD is working to create a searchable, interactive, web-based interface for the PTSD-Repository. Premade graphs and data visualizations will be available to summarize data relevant to common questions and data stories will be created to explain the findings. User guides and support documentation will help those with more advanced data management and analysis skills who want to manipulate the data themselves.
Next steps
The PTSD-Repository will be updated annually to include newly published research. This is especially important when questions are asked about emerging interventions because one or two new studies can make a big difference to what is known about an intervention. Risk of bias ratings will also be added to the PTSD-Repository so users can see which studies have strengths or limitations that might bias the reported findings. We expect that members of the public may use the PTSD-Repository to look up information on a treatment they may hear about on the news. It is important that they find not only information on how well interventions work, but also find information about our confidence in those findings. We are also updating the PTSD-Repository with more studies and more variables. For example, we are working to include interventions designed to simultaneously target PTSD and substance use due to a wealth of recent studies in this area. We are also abstracting data on more variables that are important to patients, providers, and other stakeholders, such as information on suicide-related inclusion criteria and outcomes and mental health comorbidities. Take a look, poke around, and if you end up using it, please let us know (NCPTSD@va.gov)!
About the Authors
Jessica L. Hamblen is the Deputy for Education at the National Center for PTSD and Associate Professor at Geisel School of Medicine at Dartmouth. Dr. Hamblen's interests are in developing, disseminating, and evaluating cognitive behavioral treatments for PTSD and related conditions.
Maya E. O’Neil is a VA Career Development Awardee and Associate Professor at Oregon Health and Science University. Dr. O’Neil's interests are in developing and utilizing largescale, granular data combination methods to address health outcomes and services research questions for PTSD, TBI, and related conditions.
Juliette M. Harik is a Research Psychologist at the National Center for PTSD-Executive Division and Assistant Professor at Geisel School of Medicine at Dartmouth. Dr. Harik’s work focuses on improving the quality of PTSD treatment decisions. She recently developed the online PTSD Decision Aid for the National Center for PTSD website.
Sonya B. Norman is Director of the PTSD Consultation Program for the National Center for PTSD and Professor in the University of California San Diego School of Medicine. Dr. Norman's interests are in developing and evaluating treatments for PTSD and related conditions.