Psychosocial interventions for adult survivors and responders exposed to mass casualty events: A systematic review and network meta-analysis
In brief
Trauma-focused therapies ranked among the strongest options after mass-casualty events
Across 54 studies involving 10,721 adults, exposure therapy and cognitive behavioral therapy outperformed inactive controls for post-traumatic stress, depression, and anxiety; both also showed benefits against active controls for some outcomes. Early eye movement desensitization and reprocessing ranked highest for post-traumatic stress, but limited head-to-head and long-term evidence leaves the best choice and durability of benefits uncertain.
- Journal
- Journal of traumatic stress (Q1)
- Published
- 22 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Mark J Macgowan, Catalina Canizares, Maryam Rafieifar, Julio Sánchez-Meca, José A López López
- PMID
- 42908503
- DOI
- 10.1002/jts.70128
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 24 October 2026): Comparative evidence for PTSD, depression, and anxiety interventions after mass-casualty
Abstract
This systematic review and network meta-analysis evaluated and ranked psychosocial interventions for reducing posttraumatic stress disorder (PTSD), depression, and anxiety among adults exposed to mass casualty events (MCEs). English- and Spanish-language databases were searched for randomized and nonrandomized trials comparing interventions with inactive (e.g., waitlist) or active (e.g., treatment-as-usual) controls. Primary outcomes were posttreatment symptoms of PTSD, depression, and anxiety. Risk of bias was assessed (Cochrane Risk of Bias 2, ROBINS-I), and random-effects network meta-analyses were conducted using standardized mean differences (SMDs), with ranking based on P-scores. Primary analyses excluded studies with a high or serious risk of bias. Fifty-four studies (N = 10,721) across 25 countries met the inclusion criteria. Compared with inactive controls, large effects for PTSD were observed for early eye movement desensitization and reprocessing (E-EMDR), SMD = 2.48; exposure therapy, SMD = 1.60; and cognitive behavioral therapy (CBT), SMD = 1.40, with E-EMDR and CBT remaining significant versus active controls, SMDs = 2.36 and 1.28, respectively. For depression, exposure therapy, SMD = 1.36; interpersonal psychotherapy, SMD = 1.15; mind-body practices, SMD = 1.01; CBT, SMD = 0.85; and integrative therapies, SMD = 0.67, outperformed inactive controls, with exposure therapy, mind-body practices, and CBT remaining significant versus active controls. For anxiety, exposure therapy, CBT, and integrative therapies outperformed both control types, with less precise estimates. Exposure and CBT ranked highly across outcomes; E-EMDR ranked highest for PTSD. The findings support prioritizing trauma-focused interventions following MCEs while highlighting the need for additional comparative and long-term research.
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.