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Evidence review for principles of care
Evidence review H
NICE Guideline, No. 116
National Guideline Alliance (UK).
Principles of care
This evidence report contains information on 1 review relating to the treatment of PTSD.
- Review question 6.1 For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?
Review question For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?
Introduction
Adults, children and young people with post-traumatic stress disorder (PTSD) often report that the level of support available from healthcare and social care professionals can be variable. As a result of the perceived variation in the level of support and information given to adults, children and young people with PTSD and their parents and/or carers, the committee considered it was important to investigate what care and support was required. This review aims to provide guidance that will support health and social care services to standardise access to, and appropriately delivery, treatment across the country.
Summary of the protocol (PICO table)
Please see Table 1 for a summary of the Condition, Perspective, Study Design, Outcome, and Evaluation of this review.
Table 1
Summary of the protocol (PICO table).
For full details see review protocol in Appendix A.
Methods and processes
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual; see the methods chapter for further information.
Declarations of interest were recorded according to NICE’s 2014 and 2018 conflicts of interest policies.
Clinical evidence
Included studies
One hundred and forty-six studies were identified for full-text review. Of these 146 studies, 28 primary qualitative studies (N= 716) were included in the review (Bance 2014; Bermudez 2013; Borman 2013; Dittman & Jensen 2014; Eisenman 2008; Ellis 2016; Ellison 2012; Ghafoori 2014; Hundt 2015; Jindani & Khalsa 2015; Kaltman 2014; Kaltman 2016; Kehle-Forbes 2017; Murray 2016; Niles 2016; Palmer 2004; Possemato 2015; Possemato 2017; Salloum 2015; Salloum 2016; Stankovic 2011; Story & Beck 2017; Taylor 2013; Tharp 2016; Valentine 2016; Vincent 2013; West 2017; Whealin 2016).
The clinical studies included in this evidence review are summarised in Table 2 and evidence from these are summarised in the clinical GRADE-CERQual evidence profile below (Table 3).
See also the study selection flow chart in Appendix C – Clinical evidence study selection and study evidence tables in Appendix D – Clinical evidence tables.
Excluded studies
One hundred and eighteen studies were reviewed at full text and excluded from this review. Common reasons for exclusion included population outside scope, study design, non-systematic review and non-OECD country.
Studies not included in this review with reasons for their exclusions are provided in
Appendix K – Excluded studies.
Summary of qualitative studies included in the evidence review
Table 2 provides a brief summary of the included studies. See also the study selection flow chart in Appendix C.
Table 2
Summary of included studies.
Quality assessment of clinical studies included in the evidence review
The clinical evidence profile for this review question the principles of care and support for people with PTSD and their families and carers are presented in Table 3.
Table 3
Summary clinical evidence profile (CERQual approach for qualitative findings).
Economic evidence
A systematic review of the economic literature was conducted but no relevant studies were identified which were applicable to this review question. Economic modelling was not undertaken for this question because other topics were agreed as higher priorities for economic evaluation.
Resource impact
The recommendations made by the committee based on this review are not expected to have a substantial impact on resources. The committee’s considerations that contributed to the resource impact assessment are included under the ‘Cost effectiveness and resource use’ in ‘The committee’s discussion of the evidence’ section.
Evidence statements
Four themes emerged from the evidence provided from the interviews, focus groups and free-text written responses with children, young people and adults with PTSD. The themes centred on the apprehension of engaging in interventions or services, the utilisation of peer support groups, involvement of family members and carers, and the requirement of flexibility in the delivery of treatment. The four broad themes that emerged after review of the literature were: ‘Apprehension engaging in the intervention or service’, ‘organisation of the intervention or service’, ‘sharing common experience’ and ‘intervention provision by a trusted expert’.
Apprehension engaging in the intervention or service
Nineteen studies with a quality assessment range of 10-18, and an overall high confidence rating, reported on the theme apprehension engaging in the interventions or service.
In these studies, participants felt apprehension engaging in the intervention or service, and reported difficulties engaging with a therapist, stigmatisation and fear of re-traumatisation, although some participants expressed a therapeutic component to reflection of their traumatic experience.
Organisation of the intervention or service
Eighteen studies with a quality assessment range of 10-18, and an overall high confidence rating, reported on the theme organisation of the intervention or service.
In these studies, participant expressed limited awareness of interventions and services, the need for clear and structured interventions and services, flexibility in the setting of interventions, involvement of family members and carers in treatment, the requirement for post intervention or service follow-up and configuration of interventions and services.
Sharing common experiences
Eighteen studies with a quality assessment range of 10-18, and an overall high confidence rating, reported on the theme sharing common experiences.
In these studies, participants described peer recommendations as a source of engagement in services and interventions and participants expressed the perceived benefits of sharing their experiences with others who have also experienced a traumatic event. However, some participants described a reluctance to engage in peer support and they suggested support should be tailored to the individual.
Intervention provision by a trusted expert
Eighteen studies with a quality assessment range of 10-18, and an overall high confidence rating, reported on the theme intervention provision by a trusted expert.
In these studies, participants described avoidance of relational support from family members or friends favouring support from trusted experts. Participants expressed trust in professionals to provide appropriate and effective interventions and services.
The committee’s discussion of the evidence
Interpreting the evidence
The outcomes that matter the most
All outcomes in this review (themes that emerged from qualitative meta-synthesis) were in line with the phenomenon of interest listed in the protocol (factors or attributes that can enhance or inhibit access to services; factors or attributes that can enhance or inhibit uptake of and engagement with intervention and services; actions by services that could improve or diminish the experience of care; experience of specific service developments or models of service delivery) and were considered critical outcomes. The outcomes considered were deliberately very broad in order not to inhibit themes and sub-themes that emerged inductively through the qualitative synthesis.
The quality of the evidence
An adapted GRADE approach CERQual was used to assess the evidence by themes. Similar to GRADE in effectiveness reviews, this includes 4 domains of assessment and an overall rating:
- Limitations across studies for a particular finding or theme.
- Coherence of findings (equivalent to heterogeneity but related to unexplained differences or incoherence of descriptions).
- Applicability of evidence (equivalent to directness, i.e. how much the finding applies to our review protocol).
- Saturation or sufficiency (this related particularly to interview data and refers to whether all possible themes have been extracted or explored).
The committee agreed that the review included a range of well-conducted primary studies and was both comprehensive and of high quality. In addition, the themes that emerged were in line with the experience reported by the lay members of the committee and the concerns about experience of care expressed by clinical members of the committee. A limitation noted by the committee was the small number of studies which directly explored the experience of children with PTSD (K=3), however, the committee agreed that the principles that emerged from the more substantive adult review were equally applicable to children.
Benefits and harms
The committee recognised that a significant proportion of the qualitative findings were covered by existing recommendations (sections 1.3, 1.4 and 1.6 in the short guideline), however, these recommendations were reworded to more accurately reflect the needs of service users. One of these areas concerned the involvement of families and carers, where the committee agreed to recommend that family and carers were involved in treatment for people for PTSD where appropriate, rather than routinely, in order to reflect the somewhat mixed experiences from the qualitative evidence review that suggest that family involvement may not always be desirable and/or helpful.
Another area where the committee considered it appropriate to amend an existing recommendation (section 1.3 of the short guideline) based on the high quality of the included studies was in terms of flexible modes of intervention delivery. The committee discussed the preference for flexibility that emerged from the qualitative review and considered this in the context of the quantitative evidence for the clinical efficacy of some of these remote approaches, for example, computerised trauma-focused CBT, that suggests that patient preference can be promoted without a negative impact on therapeutic benefit. A theme emerging from the qualitative synthesis was a preference for home-based interventions. However, the committee had safety concerns around recommending home-based interventions, and considered it more appropriate to recommend care in non-clinical settings, giving examples of settings this could include (schools or offices).
The committee also considered it appropriate to amend existing recommendations (section 1.3 and 1.6 of the short guideline) about promoting access to services based on the high quality of the included studies, in order to emphasise that service users are very apprehensive about engaging in interventions or services. The committee discussed the finding that service users often find it difficult to engage with their therapist, and agreed the importance of facilitating patient preference in order to ameliorate this barrier. For example, if a female therapist is preferred by a woman who has been abused by a man. The committee also discussed challenges in terms of uptake and engagement of interventions. This finding emerged from the qualitative review, in terms of a service user need for information about services available and follow-up support, and this theme resonated with the clinical experience of the committee. In light of this, the committee agreed to amend an existing recommendation in order to highlight the need for proactive patient-centred strategies to enable people with PTSD to access appropriate treatment and facilitate the uptake of and engagement with therapeutic interventions.
An area where there was no evidence for clinical efficacy but where the qualitative meta-synthesis suggested potential benefits was for peer support groups as it is recognised it can be difficult for people with PTSD to engage socially. The committee considered that the potential benefits of peer support groups included facilitating access to services (through signposting, support and encouragement offered by peers) and could help individuals at risk of social isolation to integrate with others with shared experiences. The committee discussed how peer support groups should be offered in a way that reduces the risk of exacerbating symptoms and considered it important that the groups be constituted in a way that minimises this risk, for example, by considering the composition of the group in terms of trauma type (for instance, it might not be appropriate to include a woman who has experienced childhood sexual abuse in a predominantly male combat-related trauma peer support group). The committee also agreed that the potential risk of exacerbating symptoms could be minimised through facilitation by people with mental health training and supervision, and the provision of information and support.
The committee acknowledged the difficulties that some service-users faced at the end of an intervention or service, namely that the abrupt transition out of treatment was challenging. Therefore, the committee pointed out that there was a need for a continuation of care at the end of trauma-focused treatment, where appropriate.
Cost effectiveness and resource use
No economic evidence is available for this review question. The evidence review indicated that people with PTSD might be apprehensive or anxious and avoid engaging in treatment. Therefore, the committee advised engagement strategies be implemented, such as following up service users who miss appointments, providing multiple points of access to the service and offering flexible modes of delivery, such as remote care using text messages, email, telephone or video consultation, or care in non-clinical settings such as schools or offices. These recommendations are good practice points that will help improve consistency of care. The committee acknowledged that all these engagement strategies have a modest resource impact. However they expressed the view that ensuring that people with PTSD feel and are able to access services is likely to lead to more timely management, fewer missed appointments and lower rates of early discontinuation of treatment, which, in turn, are likely to result in better clinical outcomes and to prevent further downstream costs incurred by a delay in service provision or by sub-optimal clinical outcomes due to low engagement with treatment. The recommendation to facilitate access to peer support groups has some resource implications, as peer support groups are not routinely offered across settings, however they are in fairly widespread use. The recommendation is expected to promote earlier access to support and lead to improved treatment adherence, as some treatment modalities have significant discontinuation rates, which, subsequently, can lead to improved clinical and cost effectiveness of treatment.
References for included studies
Bance 2014
Bance S, Links PS, Strike C, et al. (2014) Help-seeking in transit workers exposed to acute psychological trauma: A qualitative analysis. Work: Journal of Prevention, Assessment & Rehabilitation 48(1), 3–10. [PubMed: 23803431]Bermudez 2013
Bermudez D, Benjamin MT, Porter SE, et al. (2013) A qualitative analysis of beginning mindfulness experiences for women with post-traumatic stress disorder and a history of intimate partner violence. Complementary Therapies in Clinical Practice 19(2), 104–108 [PubMed: 23561069]Borman 2013
Bormann JE, Hurst S and Kelly A (2013) Responses to mantram repetition program from veterans with posttraumatic stress disorder: A qualitative analysis. Journal of Rehabilitation Research and Development 50(6), 769–784 [PubMed: 24203540]Dittman & Jensen 2014
Dittmann I and Jensen TK (2014) Giving a voice to traumatized youth—Experiences with trauma-focused cognitive behavioral therapy. Child abuse & neglect 38(7), 1221–30 [PubMed: 24367942]Eisenman 2008
Eisenman DP, Meredith LS, Rhodes H, et al. (2008) PTSD in Latino Patients: Illness Beliefs, Treatment Preferences, and Implications for Care. Journal of General Internal Medicine 23(9), 1386–1392 [PMC free article: PMC2518000] [PubMed: 18587619]Ellis 2016
Ellis LA (2016) Qualitative changes in recurrent PTSD nightmares after focusing-oriented dreamwork. Dreaming 26(3), 185–201Ellison 2012
Ellison ML, Mueller L, Smelson D, et al. (2012) Supporting the education goals of post-9/11 veterans with self-reported PTSD symptoms: a needs assessment. Psychiatric rehabilitation journal 35(3), 209–217 [PubMed: 22246119]Ghafoori 2014
Ghafoori B, Barragan B and Palinkas L (2014) Mental Health Service Use After Trauma Exposure: A Mixed Methods Study. The Journal of nervous and mental disease 202(3), 239–246 [DOI:10.1097/NMD.0000000000000108] [PMC free article: PMC3959109] [PubMed: 24566510] [CrossRef]Hundt 2015
Hundt NE, Mott JM, Miles SR, et al. (2015) Veterans’ perspectives on initiating evidence-based psychotherapy for posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy 7(6), 539–546 [PubMed: 25915648]Jindani & Khalsa 2015
Jindani FA and Khalsa GFS (2015) A yoga intervention program for patients suffering from symptoms of posttraumatic stress disorder: A qualitative descriptive study. Journal of Alternative and Complementary Medicine 21(7), 401–408 [PubMed: 26133204]Kaltman 2014
Kaltman S, Hurtado-de-Mendoza A, Gonzales F and Serrano A (2014) Preferences for Trauma-Related Mental Health Services Among Latina Immigrants From Central America, South America, and Mexico (Vol. 6)Kaltman 2016
Kaltman S, Hurtado de Mendoza A, Serrano A and Gonzales FA (2016) A Mental Health Intervention Strategy for Low-Income, Trauma-Exposed Latina Immigrants in Primary Care: A Preliminary Study. American Journal of Orthopsychiatry 86(3), 345–354 [PMC free article: PMC4772137] [PubMed: 26913774]Kehle-Forbes 2017
Kehle-Forbes SM, Harwood EM, Spoont MR, et al. (2017) Experiences with VHA care: a qualitative study of U.S. women veterans with self-reported trauma histories. BMC Womens Health 17(1), 38 [DOI:10.1186/s12905-017-0395-x] [PMC free article: PMC5450063] [PubMed: 28558740] [CrossRef]Murray 2016
Murray H, Merritt C, Grey N (2016) Clients’ experiences of returning to the trauma site during PTSD treatment: an exploratory study. Behavioural and cognitive psychotherapy 44(4), 420–30 [PubMed: 26190531]Niles 2016
Niles BL, Mori DL, Polizzi CP, et al. (2016) Feasibility, qualitative findings and satisfaction of a brief Tai Chi mind-body programme for veterans with post-traumatic stress symptoms. BMJ Open 6(11), (no pagination)(e012464) [PMC free article: PMC5168527] [PubMed: 27899398]Palmer 2004
Palmer S, Stalker C, Gadbois S and Harper K (2004) What Works for Survivors of Childhood Abuse: Learning from Participants in an Inpatient Treatment Program. American Journal of Orthopsychiatry 74(2), 112–121 [PubMed: 15113240]Possemato 2015
Possemato K, Acosta MC, Fuentes J, et al. (2015) A Web-Based Self-Management Program for Recent Combat Veterans With PTSD and Substance Misuse: Program Development and Veteran Feedback. Cognitive and Behavioral Practice 22(3), 345–358 [PMC free article: PMC4480783] [PubMed: 26120269]Possemato 2017
Possemato K, Kuhn E, Johnson EM, et al. (2017) Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Translational Behavioral Medicine 7(1), 116–126 [PMC free article: PMC5352634] [PubMed: 27234150]Salloum 2015
Salloum A, Dorsey CS, Swaidan VR, Storch EA (2015) Parents’ and children’s perception of parent-led Trauma-Focused Cognitive Behavioral Therapy. Child Abuse & Neglect 40, 12–23 [PubMed: 25534316]Salloum 2016
Salloum A, Swaidan VR, Torres AC, et al. (2016) Parents’ perception of stepped care and standard care trauma-focused cognitive behavioral therapy for young children. Journal of Child and Family Studies 25(1), 262–274 [PMC free article: PMC4788389] [PubMed: 26977133]Stankovic 2011
Stankovic L (2011) Transforming trauma: a qualitative feasibility study of integrative restoration (iRest) yoga Nidra on combat-related post-traumatic stress disorder. International journal of yoga therapy (21), 23–37 [PubMed: 22398342]Story & Beck 2017
Story KM and Beck BD (2017) Guided Imagery and Music with female military veterans: An intervention development study. Arts in Psychotherapy 55, 93–102Taylor 2013
Taylor B, Carswell K and Williams AC (2013) The interaction of persistent pain and post-traumatic re-experiencing: A qualitative study in torture survivors. Journal of Pain and Symptom Management 46(4), 546–555 [PubMed: 23507129]Tharp 2016
Tharp AT, Sherman M, Holland K, et al (2016) A qualitative study of male veterans’ violence perpetration and treatment preferences. Military medicine 181(8), 735–739 [PMC free article: PMC6242277] [PubMed: 27483507]Valentine 2016
Valentine SE, Dixon L, Borba CP, et al. (2016) Mental illness stigma and engagement in an implementation trial for Cognitive Processing Therapy at a diverse community health center: A qualitative investigation. International Journal of Culture and Mental Health 9(2), 139–150 [PMC free article: PMC4972095] [PubMed: 27499808]Vincent 2013
Vincent F, Jenkins H, Larkin M and Clohessy S (2013) Asylum-seekers’ experiences of trauma-focused cognitive behaviour therapy for post-traumatic stress disorder: a qualitative study. Behavioural and cognitive psychotherapy 41(5), 579–593 [PubMed: 22794141]West 2017
West J, Liang B and Spinazzola J (2017) Trauma sensitive yoga as a complementary treatment for posttraumatic stress disorder: A qualitative descriptive analysis. International Journal of Stress Management 24(2), 173–195 [PMC free article: PMC5404814] [PubMed: 28458503]Whealin 2016
Whealin JM, Jenchura EC, Wong AC and Zulman DM (2016) How Veterans With Post-Traumatic Stress Disorder and Comorbid Health Conditions Utilize eHealth to Manage Their Health Care Needs: A Mixed-Methods Analysis. Journal of medical Internet research 18(10), e280. [Retrieved from http://ovidsp.ovid.com/ovidweb .cgi?T=JS&CSC =Y&NEWS =N&PAGE =fulltext&D =medl&AN=27784650] [PMC free article: PMC5103157] [PubMed: 27784650]
Appendices
Appendix A. Review protocols
Review protocol for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
| Topic | Principles of care and support for people with PTSD and their families and carers |
|---|---|
| Review question(s) | For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care? |
| Sub-question(s) | Where evidence exists, consideration will be given to the specific needs of:
|
| Objectives | To review the views and experiences of health and social care for people with clinically important post-traumatic stress symptoms from the perspective of service users and their families or carers. |
| Outcome | Experience of interventions or services in primary, secondary, tertiary, social care and community settings. |
| Condition or domain being studied |
Adults, children and young people with clinically important post-traumatic stress symptoms (as defined by a diagnosis of PTSD according to DSM, ICD or similar criteria, or clinically-significant PTSD symptoms as indicated by baseline scores above threshold on a validated scale). If some, but not all, of a study’s participants are eligible for the review, where possible disaggregated data will be obtained. If this is not possible then the study will be included if at least 80% of its participants are eligible for this review. |
| Exclude |
Studies of people with adjustment disorders Studies of people with traumatic grief Studies of people with psychosis as a coexisting condition Studies of people with learning disabilities Studies of women with PTSD during pregnancy or in the first year following childbirth Studies of adults in contact with the criminal justice system (not solely as a result of being a witness or victim) |
| Perspective | Service users, their family or carers |
| Phenomenon of interest |
Factors or attributes (at the individual-, practitioner-, commissioner- or service-level) that can enhance or inhibit access to services Factors or attributes (at the individual-, practitioner-, commissioner- or service-level) that can enhance or inhibit uptake of and engagement with intervention and services Actions by services that could improve or diminish the experience of care for example:
|
| Comparison | None |
| Study design |
Systematic reviews Primary qualitative studies Excluded: Commentaries, editorials, vignettes, books, policy and guidance, and non-empirical research |
| Include unpublished data? |
Unpublished data will only be included where a full study report is available with sufficient detail to properly assess the risk of bias. Authors of unpublished evidence will be asked for permission to use such data, and will be informed that summary data from the study and the study’s characteristics will be published in the full guideline Conference abstracts and dissertations will not be included. |
| Restriction by date? | Publication limit 2000-current |
| Study setting |
Primary, secondary, tertiary, social care and community settings. Studies from any OECD member country will be included. However, applicability to the UK service setting will be considered during data analysis and synthesis. Treatment provided to troops on operational deployment or exercise will not be covered. |
| Evaluation | Experience and views of services. This includes experience/views of:
|
| The review strategy |
Reviews If existing systematic reviews are found, the Committee will assess their quality, completeness, and applicability to the NHS and to the scope of the guideline. If the Committee agrees that a systematic review appropriately addresses a review question, a search for studies published since the review will be conducted. Data Extraction (selection and coding) Citations from each search will be downloaded into EndNote and duplicates removed. Titles and abstracts of identified studies will be screened by two reviewers for inclusion against criteria, until a good inter-rater reliability has been observed (percentage agreement =>90% or Kappa statistics, K>0.60). Initially 10% of references will be double-screened. If inter-rater agreement is good then the remaining references will be screened by one reviewer. All primary-level studies included after the first scan of citations will be acquired in full and re-evaluated for eligibility at the time they are being entered into a study database (standardised template created in Microsoft Excel). At least 10% of data extraction will be double-coded. Discrepancies or difficulties with coding will be resolved through discussion between reviewers or the opinion of a third reviewer will be sought. Non-English-language papers will be excluded (unless data can be obtained from an existing review). Data Synthesis Where appropriate, qualitative data synthesis will be guided by a “best fit” framework synthesis approach (Carroll et al., 2011). The distinguishing characteristic of this type of approach, and the aspect in which it differs from other methods of qualitative synthesis such as meta-ethnography (Campbell et al., 2003) is that it is primarily deductive involving a priori theme identification and framework construction against which data from included studies can be mapped. This review will use the thematic framework identified and developed by the Service User Experience in Adult Mental Health guidance (NICE, 2011; NCCMH, 2012) as a starting point to systematically index and organise all relevant themes and sub-themes within an Excel-based matrix. A secondary thematic analysis will then be used to inductively identify additional themes in cyclical stages (Carroll et al., 2011). CERQual will be used to evaluate confidence in the evidence |
| Notes | Practical and social support (area of scope) is covered qualitatively by this review question |
| Topic | Principles of care and support for people with PTSD and their families and carers |
DSM – Diagnostic and Statistical Manual of Mental Disorders; ICD – International Classification of Diseases; OECD – The Organisation for Economic Co-operation and Development; NICE – National Institute of Care Excellence; PTSD – Post Traumatic Stress Disorder.
Appendix B. Literature search strategies
Literature search strategy for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
Clinical evidence
Database: Medline
Last searched on Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), Embase, PsycINFO
Date of last search: 31 January 2017
Database: CDSR, DARE, HTA, CENTRAL
Date of last search: 31 January 2017
Database: CINAHL PLUS
Health economic evidence
Note: evidence resulting from the health economic search update was screened to reflect the final dates of the searches that were undertaken for the clinical reviews (see review protocols
Database: Medline
Last searched on Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), Embase, PsycINFO
Date of last search: 1 March 2018
Database: HTA, NHS EED
Appendix C. Clinical evidence study selection
Clinical evidence study selection for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
Appendix D. Clinical evidence tables
Clinical evidence table for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
Download PDF (281K)
References for included studies
- Bance, S., Links, P. S., Strike, C., Bender, A., Eynan, R., Bergmans, Y., … Antony, J. (2014). Help-seeking in transit workers exposed to acute psychological trauma: A qualitative analysis. Work: Journal of Prevention, Assessment & Rehabilitation, 48(1), 3–10. [PubMed: 23803431]
- Bermudez, D., Benjamin, M. T., Porter, S. E., Saunders, P. A., Myers, N. A. L., & Dutton, M. A. (2013). A qualitative analysis of beginning mindfulness experiences for women with post-traumatic stress disorder and a history of intimate partner violence. Complementary Therapies in Clinical Practice, 19(2), 104–108. [PubMed: 23561069]
- Bormann, J. E., Hurst, S., & Kelly, A. (2013). Responses to mantram repetition program from veterans with posttraumatic stress disorder: A qualitative analysis. Journal of Rehabilitation Research and Development, 50(6), 769–784. [PubMed: 24203540]
- Dittmann, I. and T. K. Jensen (2014). Giving a voice to traumatized youth experiences with trauma-focused cognitive behavioural therapy. Child Abuse & Neglect 38(7): 1221–1230. [PubMed: 24367942]
- Eisenman, D. P., Meredith, L. S., Rhodes, H., Green, B. L., Kaltman, S., Cassells, A., & Tobin, J. N. (2008). PTSD in latino patients: Illness beliefs, treatment preferences, and implications for care. Journal of General Internal Medicine, 23(9), 1386–1392. [PMC free article: PMC2518000] [PubMed: 18587619]
- Ellis, L. A. (2016). Qualitative changes in recurrent PTSD nightmares after focusing-oriented dreamwork. Dreaming, 26(3), 185–201.
- Ellison, M. L., Mueller, L., Smelson, D., Corrigan, P. W., Torres Stone, R. A., Bokhour, B. G., … Drebing, C. (2012). Supporting the education goals of post-9/11 veterans with self-reported PTSD symptoms: a needs assessment. Psychiatric rehabilitation journal, 35(3), 209–217. [PubMed: 22246119]
- Ghafoori, B., Barragan, B., & Palinkas, L. (2014). Mental Health Service Use After Trauma Exposure: A Mixed Methods Study. The Journal of nervous and mental disease, 202(3), 239–246. doi:10.1097/NMD.0000000000000108 [PMC free article: PMC3959109] [PubMed: 24566510] [CrossRef]
- Hundt, N. E., Mott, J. M., Miles, S. R., Arney, J., Cully, J. A., & Stanley, M. A. (2015). Veterans’ perspectives on initiating evidence-based psychotherapy for posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 7(6), 539–546. [PubMed: 25915648]
- Jindani, F. A., & Khalsa, G. F. S. (2015). A yoga intervention program for patients suffering from symptoms of posttraumatic stress disorder: A qualitative descriptive study. Journal of Alternative and Complementary Medicine, 21(7), 401–408. [PubMed: 26133204]
- Kaltman, S., de Mendoza, A. H., Serrano, A., & Gonzales, F. A. (2016). A Mental Health Intervention Strategy for Low-Income, Trauma-Exposed Latina Immigrants in Primary Care: A Preliminary Study. American Journal of Orthopsychiatry, 86(3), 345–354. [PMC free article: PMC4772137] [PubMed: 26913774]
- Kaltman, S., Hurtado-de-Mendoza, A., Gonzales, F., & Serrano, A. (2014). Preferences for Trauma-Related Mental Health Services Among Latina Immigrants From Central America, South America, and Mexico (Vol. 6).
- Kehle-Forbes, S. M., Harwood, E. M., Spoont, M. R., Sayer, N. A., Gerould, H., & Murdoch, M. (2017). Experiences with VHA care: A qualitative study of U.S. women veterans with self-reported trauma histories. BMC Women’s Health, 17 (1) (no pagination)(38). [PMC free article: PMC5450063] [PubMed: 28558740]
- Murray, H., Merritt, C., & Grey, N. (2016). Clients’ Experiences of Returning to the Trauma Site during PTSD Treatment: An Exploratory Study. Behavioural and Cognitive Psychotherapy, 44(4), 420–430. doi:10.1017/S1352465815000338 [PubMed: 26190531] [CrossRef]
- Niles, B. L., Mori, D. L., Polizzi, C. P., Kaiser, A. P., Ledoux, A. M., & Wang, C. (2016). Feasibility, qualitative findings and satisfaction of a brief Tai Chi mind-body programme for veterans with post-traumatic stress symptoms. BMJ Open, 6 (11) (no pagination)(e012464). [PMC free article: PMC5168527] [PubMed: 27899398]
- Palmer, S., Stalker, C., Gadbois, S., & Harper, K. (2004). What Works for Survivors of Childhood Abuse: Learning from Participants in an Inpatient Treatment Program. American Journal of Orthopsychiatry, 74(2), 112–121. [PubMed: 15113240]
- Possemato, K., Acosta, M. C., Fuentes, J., Lantinga, L. J., Marsch, L. A., Maisto, S. A., … Rosenblum, A. (2015). A Web-Based Self-Management Program for Recent Combat Veterans With PTSD and Substance Misuse: Program Development and Veteran Feedback. Cognitive and Behavioral Practice, 22(3), 345–358. [PMC free article: PMC4480783] [PubMed: 26120269]
- Possemato, K., Kuhn, E., Johnson, E. M., Hoffman, J. E., & Brooks, E. (2017). Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Translational Behavioral Medicine, 7(1), 116–126. [PMC free article: PMC5352634] [PubMed: 27234150]
- Salloum, A., Dorsey, C.S., Swaidan, V.R., & Storch, E.A. (2015). Parents and children’s perception of parent-led Trauma-Focused Cognitive Behavioral Therapy. Child Abuse & Neglect 40, 12–23. [PubMed: 25534316]
- Salloum, A., Swaidan, V. R., Torres, A. C., Murphy, T. K., & Storch, E. A. (2016). Parents’ perception of stepped care and standard care trauma-focused cognitive behavioral therapy for young children. Journal of Child and Family Studies, 25(1), 262–274. [PMC free article: PMC4788389] [PubMed: 26977133]
- Stankovic, L. (2011). Transforming trauma: a qualitative feasibility study of integrative restoration (iRest) yoga Nidra on combat-related post-traumatic stress disorder. International journal of yoga therapy(21), 23–37. [PubMed: 22398342]
- Story, K. M., & Beck, B. D. (2017). Guided Imagery and Music with female military veterans: An intervention development study. Arts in Psychotherapy, 55, 93–102.
- Taylor, B., (2013). The interaction of persistent pain and post-traumatic re-experiencing: A qualitative study in torture survivors. Journal of Pain and Symptom Management 46(4): 546–555. doi.10.1016/j.jpainsymman.2012.10.281 [PubMed: 23507129] [CrossRef]
- Tharp, A. T., Sherman, M., Holland, K., Townsend, B., & Bowling, U. (2016). A qualitative study of male veterans’ violence perpetration and treatment preferences. Military medicine, 181(8), 735–739. [PMC free article: PMC6242277] [PubMed: 27483507]
- Valentine, S. E., Dixon, L., Borba, C. P., Shtasel, D. L., & Marques, L. (2016). Mental illness stigma and engagement in an implementation trial for Cognitive Processing Therapy at a diverse community health center: A qualitative investigation. International Journal of Culture and Mental Health, 9(2), 139–150. [PMC free article: PMC4972095] [PubMed: 27499808]
- Vincent, F., Jenkins, H., Larkin, M., & Clohessy, S. (2013). Asylum-seekers’ experiences of trauma-focused cognitive behaviour therapy for post-traumatic stress disorder: a qualitative study. Behavioural and cognitive psychotherapy, 41(5), 579–593. [PubMed: 22794141]
- West, J., Liang, B., & Spinazzola, J. (2017). Trauma sensitive yoga as a complementary treatment for posttraumatic stress disorder: A qualitative descriptive analysis. International Journal of Stress Management, 24(2), 173–195. [PMC free article: PMC5404814] [PubMed: 28458503]
- Whealin, J. M., Jenchura, E. C., Wong, A. C., & Zulman, D. M. (2016). How Veterans With Post-Traumatic Stress Disorder and Comorbid Health Conditions Utilize eHealth to Manage Their Health Care Needs: A Mixed-Methods Analysis. Journal of medical Internet research, 18(10), e280. [PMC free article: PMC5103157] [PubMed: 27784650]
Appendix E. Forest plots
Forest plots for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
As the information that has been uncovered is all qualitative, forest plots are not applicable to this review.
Appendix F. GRADE CERQual tables
GRADE CERQual tables for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
As the information that has been uncovered is all qualitative, all relevant information can be found in the summary clinical evidence profiles.
Appendix G. Economic evidence study selection
Economic evidence study selection for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
A global health economics search was undertaken for all areas covered in the guideline. The flow diagram of economic article selection across all reviews is provided in Appendix A of Supplement 1 – Methods Chapter’.
Appendix H. Economic evidence tables
Economic evidence tables for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
No health economic evidence was identified for this review.
Appendix I. Health economic evidence profiles
Health economic evidence profiles for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
No health economic evidence was identified for this review and no economic modelling was undertaken.
Appendix J. Health economic analysis
Health economic analysis for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
No health economic analysis was conducted for this review.
Appendix K. Excluded studies
Excluded studies for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
Clinical studies
| Study ID | Reason for exclusion | Ref 1 |
|---|---|---|
| Abrahams 2017 | Population outside scope: Studies of people without PTSD | Abrahams, N. and A. Gevers (2017). “A rapid appraisal of the status of mental health support in post-rape care services in the western cape.” South African Journal of Psychiatry 23 (1) (no pagination)(a959). |
| Adshead 2000 | Non-systematic review | Adshead, G. (2000). “Psychological therapies for post-traumatic stress disorder.” British Journal of Psychiatry 177(AUG.): 144-148. |
| Aitken 2004 | Population outside scope: Studies of people without PTSD | Aitken, M. E., et al. (2004). “Recovery of injured children: parent perspectives on family needs.” Archives of Physical Medicine and Rehabilitation 85(4): 567-573. |
| Ajdukovic 2013 | Setting: Non-OECD-country | Ajdukovic, D., et al. (2013). “Recovery from posttraumatic stress symptoms: a qualitative study of attributions in survivors of war.” PLoS ONE [Electronic Resource] 8(8): e70579. |
| Alderman 2009 | Study design: Quantitative | Alderman, C. P. and A. L. Gilbert (2009). “A qualitative investigation of long-term zopiclone use and sleep quality among Vietnam War veterans with PTSD.” Annals of Pharmacotherapy 43(10): 1576-1582. |
| Alyan 2015 | Study design: Dissertation | Alyan, H. N. (2015). “Experiences of Arab immigrant and Arab-American survivors of sexual violence: An exploratory study.” Dissertation Abstracts International: Section B: The Sciences and Engineering 76(5-B(E)): No Pagination Specified. |
| Angelo 2008 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Angelo, F. N., et al. (2008). “I Need to Talk About It”: A Qualitative Analysis of Trauma-Exposed Women’s Reasons for Treatment Choice.” Behavior Therapy 39(1): 13-21. |
| Anketell 2011 | Population outside scope: Studies of people with psychosis as a coexisting condition | Anketell, C., et al. (2011). “A preliminary qualitative investigation of voice hearing and its association with dissociation in chronic PTSD.” Journal of Trauma and Dissociation 12(1): 88-101 |
| Arnault 2016 | Population outside scope: Studies of people without PTSD | Arnault, D. S. and S. O’Halloran (2016). “Using mixed methods to understand the healing trajectory for rural Irish women years after leaving abuse.” Journal of Research in Nursing 21(5-6): 369-383. |
| Arroyo 2017 | Study design: Quantitative | Arroyo, K., et al. (2017). “Short-term interventions for survivors of intimate partner violence: A systematic review and meta-analysis.” Trauma, Violence, & Abuse 18(2): 155-171. |
| Austern 2017 | Study design: Dissertation | Austern, D. J. (2017). “Written exposure therapy as step one in reducing the burden of PTSD: The composite cases of “Alex,” “Bruno,” and “Charles".” Pragmatic Case Studies in Psychotherapy 13(2): 82-141. |
| Ayers 2006 | Population outside scope: Studies of women with PTSD during pregnancy or in the first year following childbirth | Ayers, S., et al. (2006). “The effects of childbirth-related post-traumatic stress disorder on women and their relationships: A qualitative study.” Psychology, Health and Medicine 11(4): 389-398. |
| Bacchus 2003 | Population outside scope: Studies of women with PTSD during pregnancy or in the first year following childbirth | Bacchus, L., et al. (2003). “Experiences of seeking help from health professionals in a sample of women who experienced domestic violence.” Health and Social Care in the Community 11(1): 10-18. |
| Batool 2016 | Population outside scope: Studies of people without PTSD | Batool, S. S. and H. Azam (2016). “Miscarriage: Emotional burden and social suffering for women in Pakistan.” Death studies 40(10): 638-647. |
| Beck 2015 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Beck, C. T., et al. (2015). “A Mixed-Methods Study of Secondary Traumatic Stress in Certified Nurse-Midwives: Shaken Belief in the Birth Process.” Journal of Midwifery and Women’s Health 60(1): 16-23. |
| Berzoff 2013 | Study design: Non-empirical research | Berzoff, J. (2013). “Group therapy with homeless women.” Smith College Studies in Social Work 83(2-3): 233-248. |
| Bills 2008 | Study design: Quantitative | Bills, C. B., et al. (2008). “Mental health of workers and volunteers responding to events of 9/11: Review of the literature.” Mount Sinai Journal of Medicine 75(2): 115-127. |
| Bishop 2012 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Bishop, T. M., et al. (2012). “Moving forward: Update on the development of a web-based cognitive behavioral treatment for OEF/OIF veterans with PTSD symptoms and substance misuse.” Alcoholism: Clinical and Experimental Research 36: 347A. |
| Borah 2013 | Population outside scope: Studies of soldiers on active service | Borah, E. V., et al. (2013). “Implementation outcomes of military provider training in cognitive processing therapy and prolonged exposure therapy for post-traumatic stress disorder.” Military medicine 178(9): 939-944. |
| Brewerton 2007 | Non-systematic review | Brewerton, T. D. (2007). “Eating disorders, trauma, and comorbidity: Focus on PTSD.” Eating Disorders 15(4): 285-304. |
| Buchanan 2011 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Buchanan, C., et al. (2011). “Awareness of posttraumatic stress disorder in veterans: a female spouse/intimate partner perspective.” Military medicine 176(7): 743-751. |
| Bujarski 2016 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Bujarski, S. J., et al. (2016). “Cannabis Use Disorder Treatment Barriers and Facilitators among Veterans with PTSD.” Psychology of Addictive Behaviors 30(1): 73-81. |
| Chung 2012 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Chung, J. Y., et al. (2012). “A qualitative evaluation of barriers to care for trauma-related mental health problems among low-income minorities in primary care.” Journal of Nervous and Mental Disease 200(5): 438-443. |
| Cohen 2010 | Non-systematic review | Cohen, J. A., et al. (2010). “Practice Parameter for the Assessment and Treatment of Children and Adolescents With Posttraumatic Stress Disorder.” Journal of the American Academy of Child and Adolescent Psychiatry 49(4): 414-430. |
| Cook 2013 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Cook, J. M., et al. (2013). “A formative evaluation of two evidence-based psychotherapies for PTSD in VA residential treatment programs.” Journal of traumatic stress 26(1): 56-63. |
| Cook 2017 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Cook, J. M., et al. (2017). “The influence of patient readiness on implementation of evidence-based PTSD treatments in Veterans Affairs residential programs.” Psychological Trauma: Theory, Research, Practice, and Policy 9(Suppl 1): 51-58. |
| Cox 2007 | Population outside scope: Studies of people without PTSD | Cox, J., et al. (2007). “Effectiveness of a trauma/grief-focused group intervention: A qualitative study with war-exposed Bosnian adolescents.” International Journal of Group Psychotherapy 57(3): 319-345. |
| De Kleine 2013 | Study design: Quantitative | de Kleine, R. A., et al. (2013). “Pharmacological enhancement of exposure-based treatment in PTSD: A qualitative review.” European Journal of Psychotraumatology Vol 4 2013, ArtID 21626 4. |
| DeVoe 2006 | Study design: Quantitative | DeVoe, E. R., et al. (2006). “Post-9/11 helpseeking by New York City parents on behalf of highly exposed young children.” American Journal of Orthopsychiatry 76(2): 167-175. |
| Dickerson 2002 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Dickerson, S. S., et al. (2002). “Nursing at ground zero: experiences during and after September 11 World Trade Center attack.” The Journal of the New York State Nurses’ Association 33(1): 26-32. |
| Dillahunt-Aspillaga 2015 | Study design: Conference abstract | Dillahunt-Aspillaga, C., et al. (2015). “Health-related quality of life and employment concerns among veterans with PTSD: A qualitative exploration.” Archives of Physical Medicine and Rehabilitation 96 (10): e47-e48. |
| Dondanville 2016 | Study design: Quantitative | Dondanville, K. A., et al. (2016). “Qualitative examination of cognitive change during PTSD treatment for active duty service members.” Behaviour Research and Therapy 79: 1-6. |
| Donisch 2016 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Donisch, K., et al. (2016). “Child welfare, juvenile justice, mental health, and education providers’ conceptualizations of trauma-informed practice.” Child Maltreatment 21(2): 125-134. |
| Elhai 2005 | Non-systematic review | Elhai, J. D., et al. (2005). “Health service use predictors among trauma survivors: A critical review.” Psychological Services 2(1): 3-19. |
| Elsass 2001 | Setting: Non-OECD-country | Elsass, P. (2001). “Individual and collective traumatic memories: A qualitative study of post-traumatic stress disorder symptoms in two Latin American localities.” Transcultural Psychiatry 38(3): 306-316. |
| Fearday 2004 | Non-systematic review | Fearday, F. L. and A. L. Cape (2004). “A Voice for traumatized women: Inclusion and mutual support.” Psychiatric rehabilitation journal 27(3): 258-265. |
| Feczer 2009 | Study design: Case study | Feczer, D. and P. Bjorklund (2009). “Forever changed: Posttraumatic stress disorder in female military veterans, a case report.” Perspectives in Psychiatric Care 45(4): 278-291. |
| Fenech 2015 | Population outside scope: Studies of women with PTSD during pregnancy or in the first year following childbirth | Fenech, G. and G. Thomson (2015). “Defence against trauma: women’s use of defence mechanisms following childbirth-related trauma.” Journal of Reproductive and Infant Psychology 33(3): 268-281. |
| Forneris 2013 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Forneris, C. A., et al. (2013). “Interventions to prevent post-traumatic stress disorder: A systematic review.” American Journal of Preventive Medicine 44(6): 635-650. |
| Fortuna 2009 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Fortuna, L. R., et al. (2009). “A qualitative study of clinicians’ use of the cultural formulation model in assessing posttraumatic stress disorder.” Transcultural Psychiatry 46(3): 429-450. |
| Franco 2007 | Non-systematic review | Franco, M. (2007). “Posttraumatic stress disorder and older women.” Journal of Women and Aging 19(1-2): 103-117. |
| Fu 2007 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Fu, S. S., et al. (2007). “Post-traumatic stress disorder and smoking: A systematic review.” Nicotine and Tobacco Research 9(11): 1071-1084. |
| Fulton 2015 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Fulton, J. J., et al. (2015). “The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: A meta-analysis.” Journal of Anxiety Disorders 31: 98-107. |
| Furuta 2012 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Furuta, M., et al. (2012). “A systematic review of the relationship between severe maternal morbidity and post-traumatic stress disorder.” BMC Pregnancy and Childbirth 12 (no pagination)(125). |
| Gadagbui 2003 | Study design: Case study | Gadagbui, G. Y. (2003). “Traumatic life experience: Case studies.” IFE Psychologia: An International Journal 11(1): 100-116. |
| Greene 2016 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Greene, T., et al. (2016). “Prevalence, Detection and Correlates of PTSD in the Primary Care Setting: A Systematic Review.” Journal of Clinical Psychology in Medical Settings 23(2): 160-180. |
| Haun 2016 | Study design: Not a first-hand account of experience | Haun, J. N., et al. (2016). “Qualitative inquiry explores health-related quality of life of female veterans with post-traumatic stress disorder.” Military medicine 181(11): e1470-e1475. |
| Howgego 2005 | Study design: Quantitative | Howgego, I. M., et al. (2005). “Posttraumatic stress disorder: an exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health.” BMC Psychiatry 5 (no pagination)(21). |
| Johnson 2011 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Johnson, K. and J. M. Luna (2011). “Working toward resilience: a retrospective report of actions taken in support of a New York school crisis team following 9/11.” International Journal of Emergency Mental Health 13(2): 81-90. |
| Kaier 2014 | Study design: Quantitative study | Kaier, E., et al. (2014). “Associations between PTSD and healthcare utilization among OEF/OIF veterans with hazardous alcohol use.” Traumatology 20(3): 142-149. |
| Kaltman 2014 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Kaltman, S., et al. (2014). “Preferences for trauma-related mental health services among Latina immigrants from Central America, South America, and Mexico.” Psychological Trauma: Theory, Research, Practice, and Policy 6(1): 83-91. |
| Kaltman 2014 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Kaltman, S., et al. (2014). “Preferences for trauma-related mental health services among Latina immigrants from Central America, South America, and Mexico.” Psychological Trauma: Theory, Research, Practice, and Policy 6(1): 83-91. |
| Kane 2016 | Setting: Non-OECD-country | Kane, J. C., et al. (2016). “Challenges for the implementation of World Health Organization guidelines for acute stress, PTSD, and bereavement: a qualitative study in Uganda.” Implementation science : IS 11: 36. |
| Kantor 2017 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Kantor, V., et al. (2017). “Perceived barriers and facilitators of mental health service utilization in adult trauma survivors: A systematic review.” Clinical Psychology Review 52: 52-68. |
| Kar 2011 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Kar, N. (2011). “Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: A review.” Neuropsychiatric Disease and Treatment 7(1): 167-181. |
| Karraa 2011 | Population outside scope: Studies of women with PTSD during pregnancy or in the first year following childbirth | Karraa, W., et al. (2011). “Post traumatic stress disorder secondary to childbirth: Birth doulas, prevention, and potential partnerships.” Archives of Women’s Mental Health 14: S70-S71. |
| Lobb 2014 | Population outside scope: Studies of people with traumatic grief | Lobb, E. A., et al. (2014). “Signs of post-traumatic stress disorder in caregivers following an expected death: A qualitative study.” Palliative Medicine 28 (6): 736-737. |
| Lu 2017 | Population outside scope: Studies of people with psychosis as a coexisting condition | Lu, W., et al. (2017). “Posttraumatic reactions to psychosis: A qualitative analysis.” Frontiers in Psychiatry 8 (JUL) (no pagination)(129). |
| Manguno-Mire 2007 | Study design: Quantitative | Manguno-Mire, G., et al. (2007). “Psychological distress and burden among female partners of combat veterans with PTSD.” Journal of Nervous and Mental Disease 195(2): 144-151. |
| Michalopoulos 2017 | Setting: Non-OECD-country | Michalopoulos, L. T., et al. (2017). “Life at the River is a Living Hell:” a qualitative study of trauma, mental health, substance use and HIV risk behavior among female fish traders from the Kafue Flatlands in Zambia.” BMC Women’s Health 17(1): 15. |
| Middleton 2012 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Middleton, K. and C. D. Craig (2012). “A systematic literature review of PTSD among female veterans from 1990 to 2010.” Social Work in Mental Health 10(3): 233-252. |
| Murphy 2014 | Population outside scope: Studies of soldiers on active service | Murphy, D., et al. (2014). “Exploring positive pathways to care for members of the UK Armed Forces receiving treatment for PTSD: a qualitative study.” European Journal of Psychotraumatology Vol 5 2014, ArtID 21759 5. |
| Murphy 2015 | Non-systematic review | Murphy, D. and W. Busuttil (2015). “PTSD, stigma and barriers to help-seeking within the UK Armed Forces.” Journal of the Royal Army Medical Corps 161(4): 322-326. |
| Nicholl 2004 | Non-systematic review | Nicholl, C. and A. Thompson (2004). “The psychological treatment of Post Traumatic Stress Disorder (PTSD) in adult refugees: A review of the current state of psychological therapies.” Journal of Mental Health 13(4): 351-362. |
| Nicholls 2007 | Population outside scope: Studies of women with PTSD during pregnancy or in the first year following childbirth | Nicholls, K. and S. Ayers (2007). “Childbirth-related post-traumatic stress disorder in couples: A qualitative study.” British journal of health psychology 12(4): 491-509. |
| Norris 2001 | Outcomes: Experiences of disorder or care with no explicit implications for management, planning and/or delivery of care | Norris, F. H., et al. (2001). “A qualitative analysis of posttraumatic stress among Mexican victims of disaster.” Journal of traumatic stress 14(4): 741-756. |
| Ogilvie 2015 | Population outside scope: Studies of people without PTSD | Ogilvie, R., et al. (2015). “Young peoples’ experience and self-management in the six months following major injury: A qualitative study.” Injury 46(9): 1841-1847. |
| Okey 2000 | Outcomes: Experiences of disorder or care with no explicit implications for management, planning and/or delivery of care | Okey, J. L., et al. (2000). “The central relationship patterns of male veterans with posttraumatic stress disorder: A descriptive study.” Psychotherapy 37(2): 171-179. |
| Olthuis 2016 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Olthuis, J. V., et al. (2016). “Distance-delivered interventions for PTSD: A systematic review and meta-analysis.” Journal of Anxiety Disorders 44: 9-26. |
| Osei-Bonsu 2014 | Population outside scope: Studies of people without PTSD | Osei-Bonsu, P. E., et al. (2014). “The role of coping in depression treatment utilization for VA primary care patients.” Patient Education & Counseling 94(3): 396-402. |
| Otto 2006 | Non-systematic review | Otto, M. W. and D. E. Hinton (2006). “Modifying Exposure-Based CBT for Cambodian Refugees with Posttraumatic Stress Disorder.” Cognitive and Behavioral Practice 13(4): 261-270. |
| Palinkas 2004 | Outcomes: Experiences of disorder or care with no explicit implications for management, planning and/or delivery of care | Palinkas, L. A., et al. (2004). “The San Diego East County school shootings: a qualitative study of community-level post-traumatic stress.” Prehospital and disaster medicine : the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 19(1): 113-121. |
| Palmer 2017 | Outcomes: Experiences of disorder or care with no explicit implications for management, planning and/or delivery of care | Palmer, E., et al. (2017). “Experience of post-traumatic growth in UK veterans with PTSD: a qualitative study.” Journal of the Royal Army Medical Corps 163(3): 171-176. |
| Powell 2016 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Powell, T. M. and T. Bui (2016). “Supporting social and emotional skills after a disaster: Findings from a mixed methods study.” School Mental Health 8(1): 106-119. |
| Preez 2008 | Study design: Quantatitive | Perez, S. and D. M. Johnson (2008). “PTSD compromises battered women’s future safety.” Journal of interpersonal violence 23(5): 635-651. |
| Rahill 2015 | Setting: Non-OECD-country | Rahill, G. J., et al. (2015). “Symptoms of PTSD in a sample of female victims of sexual violence in post-earthquake Haiti.” Journal of Affective Disorders 173: 232-238. |
| Rees 2015 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Rees, C. S. and E. Maclaine (2015). “A systematic review of videoconference-delivered psychological treatment for anxiety disorders.” Australian Psychologist 50(4): 259-264. |
| Roberts 2008 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Roberts, N. P., et al. (2008). “Multiple session early psychological intervention to prevent and treat post-traumatic stress disorder.” Cochrane Database of Systematic Reviews (1) (no pagination)(CD006869). |
| Rosenberg 2001 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Rosenberg, S. D., et al. (2001). “Developing effective treatments for posttraumatic disorders among people with severe mental illness.” Psychiatric Services 52(11): 1453-1461. |
| Runnals 2014 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Runnals, J. J., et al. (2014). “Systematic review of women veterans’ mental health.” Womens Health Issues 24(5): 485-502 |
| Ruzek 2009 | Non-systematic review | Ruzek, J. I. and R. C. Rosen (2009). “Disseminating evidence-based treatments for PTSD in organizational settings: A high priority focus area.” Behaviour Research and Therapy 47(11): 980-989. |
| Saban 2010 | Non-systematic review | Saban, K. L., et al. (2010). “Measures of psychological stress and physical health in family caregivers of stroke survivors: a literature review.” The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses 42(3): 128-138. |
| Salzmann-Erikson 2017 | Outcomes: Experiences of disorder or care with no explicit implications for management, planning and/or delivery of care | Salzmann-Erikson, M. and D. Hicdurmaz (2017). “Use of social media among individuals who suffer from post-traumatic stress: A qualitative analysis of narratives.” Qualitative health research 27(2): 285-294. |
| Samuelson 2014 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Samuelson, K. W., et al. (2014). “Web-based PTSD training for primary care providers: a pilot study.” Psychological Services 11(2): 153-161. |
| Sanderson 2013 | Population outside scope: Studies of people with traumatic grief | Sanderson, C., et al. (2013). “Signs of post-traumatic stress disorder in caregivers following an expected death: A qualitative study.” Palliative Medicine 27(7): 625-631. |
| Sayer 2009 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Sayer, N. A., Friedemann-Sanchez, G., Spoont, M., Murdoch, M., Parker, L. E., Chiros, C., & Rosenheck, R. (2009). A qualitative study of determinants of PTSD treatment initiation in veterans. Psychiatry, 72(3), 238-255. |
| Sayer 2011 | Outcomes: Experiences of disorder or care with no explicit implications for management, planning and/or delivery of care | Sayer, N. A., et al. (2011). “A qualitative study of U.S. veterans’ reasons for seeking Department of Veterans Affairs disability benefits for posttraumatic stress disorder.” Journal of traumatic stress 24(6): 699-707. |
| Schiltz 2014 | Non-English language paper | Schiltz, L., et al. (2014). “Great precariousness, psycho-trauma, narcissistic suffering: Results of action-research based on an integrated quantitative and qualitative research methodology. [French].” Annales Medico-Psychologiques 172(7): 513-518. |
| Schuman 2015 | Outcomes: Experiences of disorder or care with no explicit implications for management, planning and/or delivery of care | Schumm, J. A., et al. (2015). “Veteran satisfaction and treatment preferences in response to a posttraumatic stress disorder specialty clinic orientation group.” Behaviour Research and Therapy 69: 75-82. |
| Schuman 2016 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Schuman, D. (2016). “Veterans’ Experiences using Complementary and Alternative Medicine for Posttraumatic Stress: A Qualitative Interpretive Meta-Synthesis.” Social work in public health 31(2): 83-97. |
| Self-Brown 2016 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Self-Brown, S., et al. (2016). “Impact of caregiver factors on youth service utilization of trauma-focused cognitive behavioral therapy in a community setting.” Journal of Child and Family Studies 25(6): 1871-1879. |
| Seng 2002 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Seng, J. S., et al. (2002). “Abuse-related posttraumatic stress and desired maternity care practices: Women’s perspective.” Journal of Midwifery and Women’s Health 47(5): 360-370. |
| Seng 2004 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Seng, J. S., et al. (2004). “Abuse-related post-traumatic stress during the childbearing year.” Journal of Advanced Nursing 46(6): 604-613. |
| Sharif 2015 | Setting: Non-OECD-country | Sharif Nia, H., et al. (2015). “The experience of death anxiety in Iranian war veterans: a phenomenology study.” Death studies 39(1-5): 281-287. |
| Sheen 2016 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Sheen, K., et al. (2016). “The experience and impact of traumatic perinatal event experiences in midwives: A qualitative investigation.” International journal of nursing studies 53: 61-72. |
| Sijbrandij 2016 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Sijbrandij, M., et al. (2016). “Effectiveness of Internet-Delivered Cognitive Behavioral Therapy for Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis.” Depression and Anxiety 33(9): 783-791. |
| Simmons 2015 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Simmons, C. A., et al. (2015). “Real-world barriers to assessing and treating mental health problems with IPV survivors: A qualitative study.” Journal of interpersonal violence 30(12): 2067-2086. |
| Somer 2015 | Setting: Non-OECD-country | Somer, E. and Y. Ataria (2015). “Adverse outcome of continuous traumatic stress: A qualitative inquiry.” International Journal of Stress Management 22(3): 287-305. |
| Spangaro 2016 | Population outside scope: Studies of people without PTSD | Spangaro, J., et al. (2016). “Deciding to tell: Qualitative configurational analysis of decisions to disclose experience of intimate partner violence in antenatal care.” Social Science and Medicine 154: 45-53. |
| Sprang 2013 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Sprang, G. and M. Silman (2013). “Posttraumatic stress disorder in parents and youth after health-related disasters.” Disaster Medicine and Public Health Preparedness 7(1): 105-110. |
| Stewart 2017 | Study design: Case study | Stewart, R. W., et al. (2017). “Addressing barriers to care among Hispanic youth: Telehealth delivery of trauma-focused cognitive behavior therapy.” the Behavior Therapist 40(3): 112-118. |
| Stige 2013 | Population outside scope: Studies of people without PTSD | Stige, S. H., et al. (2013). “Stories from the road of recovery-How adult, female survivors of childhood trauma experience ways to positive change.” Nordic Psychology 65(1): 3-18. |
| Suffoletta-Maierle 2003 | Non-systematic review | Suffoletta-Maierle, S., et al. (2003). “Trauma-related mental health needs and service utilization among female veterans.” Journal of Psychiatric Practice 9(5): 367-375. |
| Sundin 2011 | Study design: Conference abstract | Sundin, E. C. (2011). “Homelessness and experiences of psychological trauma in the western world: A research review and a qualitative study.” European Psychiatry. Conference: 19th European Congress of Psychiatry, EPA 26 |
| Taylor 2004 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | Taylor, T. L. and C. M. Chemtob (2004). “Efficacy of treatment for child and adolescent traumatic stress.” Archives of Pediatrics and Adolescent Medicine 158(8): 786-791. |
| Ting 2006 | Population outside scope: Studies of experience from perspective of health/social care professional/practitioner | Ting, L., et al. (2006). “Dealing with the aftermath: A qualitative analysis of mental health social workers’ reactions after a client suicide.” Social Work 51(4): 329-341. |
| Todahl 2014 | Population outside scope: Studies of people without PTSD | Todahl, J. L., et al. (2014). “Trauma healing: A mixed methods study of personal and community-based healing.” Journal of Aggression, Maltreatment & Trauma 23(6): 611-632. |
| Torchalla 2015 | Population outside scope: Studies of women with PTSD during pregnancy or in the first year following childbirth | Torchalla, I., et al. (2015). “Like a lots happened with my whole childhood”: Violence, trauma, and addiction in pregnant and postpartum women from Vancouver’s Downtown Eastside.” Harm Reduction Journal. 12. |
| Turchik 2013 | Population outside scope: Studies of people without PTSD | Turchik, J. A., et al. (2013). “Perceived barriers to care and provider gender preferences among veteran men who have experienced military sexual trauma: A qualitative analysis.” Psychological Services 10(2): 213-222. |
| van den Berk-Clark 2014 | Systematic review with no new useable data and any meta-synthesis results not appropriate to extract | van den Berk-Clark, C. and D. P. S. Wolf (2017). “Mental health help seeking among traumatized individuals: A systematic review of studies assessing the role of substance use and abuse.” Trauma, Violence, & Abuse 18(1): 106-116. |
| Vasterling 2000 | Outcomes: Experiences of disorder or care with no explicit implications for management, planning and/or delivery of care | Vasterling, J. J., et al. (2000). “Qualitative block design analysis in posttraumatic stress disorder.” Assessment 7(3): 217-226. |
| Venkatraju 2013 | Setting: Non-OECD-country | Venkatraju, B. and S. Prasad (2013). “Psychosocial trauma of diagnosis: A qualitative study on rural TB patients’ experiences in Nalgonda District, Andhra Pradesh.” Indian Journal of Tuberculosis 60(3): 162-167. |
| Whealin 2017 | Setting: Non-OECD-country | Whealin, J. M., et al. (2017). “Factors impacting rural Pacific Island veterans’ access to care: A qualitative examination.” Psychological Services 14(3): 279-288. |
| Wilson 2012 | Outcomes: Experiences of disorder or care with no explicit implications for management, planning and/or delivery of care | Wilson, N., d’Ardenne, P., Scott, C., Fine, H., & Priebe, S. (2012). Survivors of the london bombings with PTSD: A qualitative study of their accounts during CBT treatment. Traumatology, 18(2), 75-84. |
| Wilson 2015 | Population outside scope: Studies of people without PTSD | Wilson, J. M., et al. (2015). “Bringing trauma-informed practice to domestic violence programs: A qualitative analysis of current approaches.” American Journal of Orthopsychiatry 85(6): 586-599. |
| Woollett 2017 | Setting: Non-OECD-country | Woollett, N., et al. (2017). “Revealing the impact of loss: Exploring mental health through the use of drawing/writing with HIV positive adolescents in Johannesburg.” Children and Youth Services Review 77: 197-207. |
| Young 2011 | Setting: Non-OECD-country | Young, C. (2011). “Understanding HIV-related posttraumatic stress disorder in South Africa: A review and conceptual framework.” African Journal of AIDS Research 10(2): 138-148. |
| Zinzow 2007 | Non-systematic review | Zinzow, H. M., et al. (2007). “Trauma among female veterans: A critical review.” Trauma, Violence, and Abuse 8(4): 384-400. |
| Zinzow 2013 | Population outside scope: Studies of soldiers on active service | Zinzow, H. M., et al. (2013). “Barriers and facilitators of mental health treatment seeking among active-duty army personnel.” Military Psychology 25(5): 514-535. |
| Zoellner 2003 | Population outside scope: <80% of the study’s participants are eligible for the review and disaggregated data cannot be obtained | Zoellner, L. A., et al. (2003). “Treatment choice for PTSD.” Behaviour Research and Therapy 41(8): 879-886. |
Economic studies
No economic studies were reviewed at full text and excluded from this review.
Appendix L. Research recommendations
Research recommendations for “For adults, children and young people with clinically important post-traumatic stress symptoms, what factors should be taken into account in order to provide access to care, optimal care and coordination of care?”
No research recommendations were made for this review question.
Final
Evidence reviews
Evidence reviews
These evidence reviews were developed by the National Guideline Alliance hosted by the Royal College of Obstetricians and Gynaecologists
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.
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