Treating Posttraumatic Stress Disorder in Military Populations: A Meta-Analysis

Jenny J. W. Liu, PhD ; Anthony Nazarov, PhD ; Natalie Ein, PhD ; Bethany Easterbrook, PhD ; Tri Le, BHSc ; Clara Baker, BA ; Julia Gervasio, MA ; Edouard Auger, MD, FRCPC ; Ken Balderson, MD, CM, FRCPC ; Mathieu Bilodeau, MD, FRCPC ; Amer M. Burhan, MBChB, MSc, FRCPC ; Murray W. Enns, MD, FRCPC ; Fardous Hosseiny, MSc ; Vicky Lavoie, PhD ; Natalie Mota, PhD ; Maya L. Roth, PhD, C.Psych ; Sonya G. Wanklyn, PhD, C.Psych ; J. Don Richardson, MD, FRCPC

J Clin Psychiatry 2025;86(2):24r15571

Abstract

Background: 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.

Objective: This meta-analysis aims to synthesize the current literature regarding effectiveness of psychotherapies, pharmacotherapies, and combination treatments for PTSD in military populations.

Data Sources: 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.

Study Selection: The final sample included data from 414 studies.

Data Extraction: Full study methodologies can be found in the published protocol (Liu et al, 2021).

Results: The pooled random-effects model found effect size across all PTSD treatments (k = 712) was g=0.96, compared to g=0.45 for control conditions (k = 122). Clinician administered measures indicated larger treatment effects (g= 1.02) than self reported measures (g =0.82). Combination therapies yielded the largest effects (g =2.17), outperforming both psychotherapies and pharmacotherapies alone. No significant differences were found across control conditions.

Conclusion: 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.

J Clin Psychiatry 2025;86(2):24r15571

Author affiliations are listed at the end of this article.

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