Factors Contributing to PTSD Treatment Dropout in Veterans Returning From the Wars in Iraq and Afghanistan: A Systematic Review

Public Significance Statement This article provides a synthesis of factors contributing to treatment dropout from trauma-focused treatments among post-9/11 veterans. Trauma-focused treatments consistently yield high rates of treatment noncompletion, particularly among this cohort of veterans. The current review identified several consistent findings contributing to treatment dropout including: younger age (<35 years old), co-occurring substance use, and multiple life roles. Veterans with these characteristics might benefit from additional efforts at treatment engagement to reduce dropout or may require more innovative approaches to increase treatment engagement. Although treatment effectiveness among evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) has been well established, treatment dropout among veterans continues to be a concern within these treatments. Due to the uniqueness of the Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) veteran cohort, this article reviewed the literature examining factors contributing to treatment dropout from EBPs for PTSD among OEF/OIF/OND veterans. We conducted a systematic review of the published literature using PsycINFO, PubMed, and PTSDpubs with a restriction on year of publication beginning in 2007, following the first VA national initiative to roll-out EBPs for PTSD, through May 1st, 2020. Articles were retained if treatment dropout for EBPs was examined among OEF/OIF/OND veterans with PTSD, which yielded a total of 26 manuscripts. Common themes associated with treatment dropout were identified, including demographic, psychological, cognitive, practical, and treatment-related factors. Specifically, younger age, concurrent substance use, and practical concerns (e.g., balancing multiple life roles) emerged as factors that consistently contributed to treatment dropout. Other findings were mixed (e.g., pretreatment symptom severity and presence of traumatic brain injury). While factors contributing to dropout are complex and interact uniquely for each veteran, improved understanding of these factors in combination with innovative strategies for treating OEF/OIF/OND veterans utilizing EBPs is needed to enhance treatment engagement, retention, and outcomes. Implications for these factors are discussed.