Psychosocial interventions for posttraumatic stress disorder in low- and middle-income countries: a Bayesian meta-analysis
In brief
Psychosocial therapy reduces PTSD symptoms by over one standard deviation in LMICs
A Bayesian meta-analysis of 55 randomized trials (5,041 adults) found that psychosocial interventions produced a large between-group effect size of about -1.3 standard deviations for PTSD symptoms, with benefits persisting at follow-up and also improving depression and anxiety. Effects were strongest for trauma-focused, face-to-face treatment and older participants, but more high-quality trials are needed, especially in low-income settings.
- Journal
- Psychological medicine (Q1)
- Published
- 17 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Cosima Leithner, Smilla Gerst, Rebeca Niyaz, Luzia Heusler, Yannik Terhorst, Thomas Ehring, et al.
- PMID
- 42750363
- DOI
- 10.1017/S0033291726105807
Why clinicians should know about it
- Picked for Emergency Medicine (top studies of the week, 20 September 2026): Meta‑analysis of PTSD interventions in LMICs
Abstract
Posttraumatic stress disorder (PTSD) is prevalent and debilitating in low- and middle-income countries (LMICs), yet the effectiveness of psychosocial interventions remains poorly synthesized. This study presents the first comprehensive meta-analysis of their effectiveness for adults with PTSD symptoms in LMICs (PROSPERO CRD42024584333). A literature search was conducted using the PTSD Trials Standardized Data Repository. Additional searches were performed through backward citation tracking and in Embase, Medline, PsycINFO, and PTSDpubs using terms for PTSD, nonpharmacological interventions, and randomized controlled trial (RCT) methodology. Trials published from 1 January 1980 to 23 June 2025 were included. Eligible studies were RCTs evaluating psychosocial interventions in LMICs, with participants exhibiting PTSD symptoms. Effect sizes were aggregated using three-level Bayesian random-effects meta-regressions. Study quality was assessed using Cochrane's RoB 2 tool. Fifty-five RCTs, comprising 5,041 participants, were included. At post-assessment, psychosocial interventions yielded large within-group (g = -1.88; 95% credible interval [CrI], -2.25 to -1.51) and between-group (g = -1.31; 95% CrI, -1.66 to -0.95) effects for PTSD symptoms, both sustained at follow-up. Sensitivity analyses confirmed robustness of results across varying prior specifications. For the secondary outcomes of depression and anxiety, medium to large, sustained effects emerged. Treatments were particularly effective when trauma-focused, delivered face-to-face, and administered to older participants. This meta-analysis supports the use of psychosocial interventions for adults with PTSD symptoms in LMICs. Consistent with guidelines from high-income countries, trauma-focused interventions should be prioritized as first-line treatments. More high-quality research on PTSD treatment in LMICs is urgently needed, particularly in low- and lower-middle-income countries.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.