Long-term outcomes of psychological treatment for posttraumatic stress disorder: a systematic review and meta-analysis.

Several types of psychological treatment for posttraumatic stress disorder (PTSD) are considered well established and effective, but evidence of their long-term efficacy is limited. This systematic review and meta-analysis aimed to investigate the long-term outcomes across psychological treatments for PTSD. MEDLINE, Cochrane Library, PTSDpubs, PsycINFO, PSYNDEX, and related articles were searched for randomized controlled trials with at least 12 months of follow-up. Twenty-two studies (N = 2638) met inclusion criteria, and 43 comparisons of cognitive behavioral therapy (CBT) were available at follow-up. Active treatments for PTSD yielded large effect sizes from pretest to follow-up and a small controlled effect size compared with non-directive control groups at follow-up. Trauma-focused treatment (TFT) and non-TFT showed large improvements from pretest to follow-up, and effect sizes did not significantly differ from each other. Active treatments for comorbid depressive symptoms revealed small to medium effect sizes at follow-up, and improved PTSD and depressive symptoms remained stable from treatment end to follow-up. Military personnel, low proportion of female patients, and self-rated PTSD measures were associated with decreased effect sizes for PTSD at follow-up. The findings suggest that CBT for PTSD is efficacious in the long term. Future studies are needed to determine the lasting efficacy of other psychological treatments and to confirm benefits beyond 12-month follow-up.

A systematic review and meta-analysis of transdiagnostic cognitive behavioural therapies for emotional disorders.

Transdiagnostic cognitive behavioural psychotherapy (TD-CBT) may facilitate the treatment of emotional disorders. Here we investigate short- and long-term efficacy of TD-CBT for emotional disorders in individual, group and internet-based settings in randomized controlled trials (PROSPERO CRD42019141512). Two independent reviewers screened results from PubMed, MEDLINE, PsycINFO, Google Scholar, medRxiv and OSF Preprints published between January 2000 and June 2023, selected studies for inclusion, extracted data and evaluated risk of bias (Cochrane risk-of-bias tool 2.0). Absolute efficacy from pre- to posttreatment and relative efficacy between TD-CBT and control treatments were investigated with random-effects models. Of 56 identified studies, 53 (6,705 participants) were included in the meta-analysis. TD-CBT had larger effects on depression (g = 0.74, 95% CI = 0.57-0.92, P < 0.001) and anxiety (g = 0.77, 95% CI = 0.56-0.97, P < 0.001) than did controls. Across treatment formats, TD-CBT was superior to waitlist and treatment-as-usual. TD-CBT showed comparable effects to disorder-specific CBT and was superior to other active treatments for depression but not for anxiety. Different treatment formats showed comparable effects. TD-CBT was superior to controls at 3, 6 and 12 months but not at 24 months follow-up. Studies were heterogeneous in design and methodological quality. This review and meta-analysis strengthens the evidence for TD-CBT as an efficacious treatment for emotional disorders in different settings.

Mental health across two years of the COVID-19 pandemic: a 5-wave longitudinal study in Germany.

The COVID-19 pandemic has been negatively associated with mental health. However, little is known about the temporal dynamics of mental health in the longer term of the pandemic. We aimed to investigate symptom levels and changes of depression, anxiety, posttraumatic stress, and loneliness spanning two years of the pandemic; and to examine associated risk factors. This five-wave, longitudinal online study from May 2020 to April 2022 included 636 adults (Mage = 39.5 years, SD = 16.11; 84.1% female) from the German general population who completed the international COVID-19 Mental Health Survey. Symptoms of anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire-9; PHQ-9), posttraumatic stress (PTSD Checklist for DSM-5; PCL-5), and loneliness ("Do you feel lonely?") were assessed using mixed-effects models. Associations with anxiety and depressive symptoms were examined with having children, student status, financial worries, contamination fear, and loneliness. PHQ-9, GAD-7, PCL-5, and loneliness scores overall decreased throughout the two-year period of the pandemic but exhibited an increase during two national lockdowns. Controlled for significant associations with female gender and younger age, increased PHQ-9 and GAD-7 scores were associated with contamination fear, financial worries, and loneliness. No associations were found with having children and student status. Symptoms of depression, anxiety, posttraumatic stress, and loneliness decreased over time but varied along with the dynamics of the pandemic. Longitudinal monitoring of mental health in vulnerable subgroups is required, especially those of younger age, females, and the financially insecure.

Mental Health and Loneliness in University Students During the COVID-19 Pandemic in Germany: A Longitudinal Study.

The COVID-19 pandemic and its preventive measures had adverse consequences for mental health. However, knowledge of mental health trajectories across the pandemic is limited. This study investigated the mental health levels and changes among university students during the pandemic and lockdown in Germany, as well as their associated factors. We surveyed students' mental health (N = 363, 68% female) with the patient health questionnaire (PHQ-8) and the generalized anxiety disorder scale (GAD-7) during the first easing phase (July 2020; time 1) and the second lockdown (November 2020; time 2). Cut-off scores from the GAD-7 and PHQ-8 were used to determine clinically relevant symptoms and to define trajectory groups. Sociodemographic and pandemic-related data were assessed (e.g., coping with academic life, social contacts) as well as loneliness, stress, repetitive negative thinking, quality of life, and perceived social support. Paired t-test, multiple regression, and repeated-measures ANOVA were applied. Means and prevalence rates for symptoms of depression (38.8%) and anxiety (25.6%) did not differ between time 1 and time 2, and most students were asymptomatic on the PHQ-8 (44.4%) and the GAD-7 (56.3%) across the pandemic. Feelings of loneliness significantly increased from time 1 to time 2, d = -0.30, [-0.47, -0.13], with higher symptom levels in symptomatic groups at time 2 and greater increases in the asymptomatic groups. Levels of stress, repetitive negative thinking, quality of life, and social support did not differ during the pandemic. At time 1, loneliness and repetitive negative thinking were associated with anxiety and depressive symptoms. Anxiety and depressive symptoms were prevalent among students, and increased levels of loneliness during the pandemic were associated with elevated symptoms and differing trajectories. Further research using representative and larger samples should determine the long-term impact of the pandemic on mental health and loneliness to identify vulnerable students and offer adequate support.