Efficacy of community interventions for posttraumatic stress disorder symptoms: a Bayesian network meta-analysis of randomized controlled trials

Abstract

Communities play a crucial role in addressing trauma-related stress. Broadly, community interventions include both evidence-based psychotherapies delivered in community-relevant settings, such as cognitive processing therapy (CPT), prolonged exposure (PE), and cognitive behavioral therapy (CBT), and community-tailored approaches adapted to local resources and service needs, such as Common Elements Treatment Approaches (CETA), community psychoeducation, and care management. Although an increasing number of studies have examined community interventions for posttraumatic stress disorder (PTSD) symptoms, debates persist, and systematic evidence remains limited. This study conducted a network meta-analysis (NMA) to assess and compare the effectiveness of community interventions for PTSD symptoms. Randomized controlled trials (RCTs) were included if they examined community interventions for PTSD symptoms among trauma-exposed community populations. Studies were identified through Web of Science, Embase, PubMed, PsycINFO, Scopus, Wanfang, and CINAHL. Risk of bias was assessed using the Cochrane Risk of Bias Tool, and data were synthesized using Bayesian NMA with random-effects models. Thirty-six RCTs involving 5,350 participants and 16 intervention types were included. The primary outcomes were immediate post-treatment and follow-up PTSD symptoms within 6 months; secondary outcomes included immediate depression and anxiety symptoms, and treatment attrition. PE (SMD = 1.69, 95% CrI [1.14, 2.24]) and CPT (SMD = 1.23, 95% CrI [0.81, 1.67]) showed relatively strong immediate effects on PTSD symptoms in community settings. When combined into a single node, community-tailored interventions showed a significant moderate immediate effect (SMD = 0.52, 95% CrI [0.34, 0.71]). When modeled separately, community-tailored psychological interventions, care management, psychoeducation, and CETA also showed significant moderate effects, with SMDs ranging from 0.48 to 0.59. Trauma-focused interventions, particularly PE and CPT, appeared to show relatively strong effects in reducing PTSD symptoms in community settings, suggesting the potential value of approaches that incorporate cognitive restructuring and structured engagement with trauma-related cues. Community-tailored approaches showed some evidence of immediate benefit and may provide feasible, accessible support for trauma-affected populations, especially where specialist resources are limited. This NMA provides comparative evidence to guide the selection, adaptation, and delivery of PTSD interventions in community settings. PROSPERO registration number: CRD42023396053.