Background: Despite the established efficacy of psychological
therapies for
post-traumatic stress disorder (
PTSD) there has been little systematic exploration of dropout rates. Objective: To ascertain rates of dropout across different modalities of psychological
therapy for
PTSD and to explore potential sources of heterogeneity. Method: A systematic review of dropout rates from randomized controlled trials (RCTs) of psychological
therapies was conducted. The pooled rate of dropout from psychological
therapies was estimated and reasons for heterogeneity explored using meta-regression. Results:: The pooled rate of dropout from RCTs of psychological
therapies for
PTSD was 16% (95% CI 14-18%). There was evidence of substantial heterogeneity across studies. We found evidence that psychological
therapies with a
trauma-focus were significantly associated with greater dropout. There was no evidence of greater dropout from
therapies delivered in a group format; from studies that recruited participants from clinical services rather than via advertisements; that included only military personnel/veterans; that were limited to participants traumatized by
sexual traumas; that included a higher proportion of female participants; or from studies with a lower proportion of participants who were university educated. Conclusions: Dropout rates from recommended psychological
therapies for
PTSD are high and this appears to be particularly true of interventions with a
trauma focus. There is a need to further explore the reasons for dropout and to look at ways of increasing treatment retention.