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The role of psychological support interventions in trauma patients on mental health outcomes

A systematic review and meta-analysis

Pham, Christopher H. MD; Fang, Mike PhD; Nager, Jacqueline MS; Matsushima, Kazuhide MD; Inaba, Kenji MD; Kuza, Catherine M. MD

Journal of Trauma and Acute Care Surgery: August 2019 - Volume 87 - Issue 2 - p 463–482
doi: 10.1097/TA.0000000000002371

BACKGROUND The recovery and rehabilitation of trauma survivors may be long and challenging. Patients may be prone to psychiatric disorders, cognitive impairments, and decreased quality of life. The objective of this review was to determine whether there is a role for psychological interventions in reducing the incidence and severity of psychiatric sequelae in trauma survivors.

METHODS MEDLINE, PubMed, SCOPUS, and Google Scholar were searched for published articles. We searched for articles published between 1990 and 2018 with adult subjects, and limited our search to articles published in English. Randomized controlled trials that evaluated various psychiatric interventions in trauma patients on the effects of psychiatric outcomes were included for analysis. The articles were independently reviewed for eligibility by two different reviewers. A meta-analysis was performed on nine studies with similar interventions, outcomes measured, and patient populations.

RESULTS Nine hundred thirty-four articles were identified [830 articles identified through database search, and 107 through article references]. Sixty-nine full-text articles were reviewed for eligibility. Of these, 33 were included for qualitative analysis. Thirteen studies evaluating the effect of cognitive behavioral therapy (CBT)-based interventions on the severity of posttraumatic stress disorder (PTSD), anxiety, and depression symptoms underwent meta-analysis. While CBT-treated patients experienced clinically significant decreases in symptom severity, there were no statistically significant differences between treatment and control groups at follow-up for PTSD, anxiety, and depression.

CONCLUSION Compared with usual care, CBT-based interventions may not be effective in decreasing or preventing PTSD, anxiety, or depression symptoms in trauma survivors.

LEVEL OF EVIDENCE Systematic Review, level III.

From the Department of Anesthesiology (C.H.P., J.N., C.M.K.), Division of Plastic and Reconstructive Surgery, Department of Surgery (C.H.P.), Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Population and Quantitative Health Sciences (M.F.), Case Western Reserve University School of Medicine, Cleveland, Ohio; and Department of Surgery (K.M., K.I.), Keck School of Medicine of the University of Southern California, Los Angeles, California.

Submitted: February 12, 2019, Revised: April 10, 2019, Accepted: May 5, 2019, Published online: May 28, 2019.

Address for reprints: Catherine M. Kuza, MD, Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Suite 3600, 1450 San Pablo St, Los Angeles, CA 90033; email:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Online date: May 30, 2019

© 2019 Lippincott Williams & Wilkins, Inc.