Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events

Peter A. Coventry ,Nick Meader,Hollie Melton,Melanie Temple,Holly Dale, Kath Wright, Marylène Cloitre,Thanos Karatzias,Jonathan Bisson, Neil P. Roberts,Jennifer V. E. Brown, Corrado Barbui,
Rachel Churchill,Karina Lovell,Dean McMillan, Simon Gilbody



Complex traumatic events associated with armed conflict, forcible displacement, childhood sexual abuse, and domestic violence are increasingly prevalent. People exposed to complex traumatic events are at risk of not only posttraumatic stress disorder (PTSD) but also other mental health comorbidities. Whereas evidence-based psychological and pharmacological treatments are effective for single-event PTSD, it is not known if people who have experienced complex traumatic events can benefit and tolerate these commonly available treatments. Furthermore, it is not known which components of psychological interventions are most effective for managing PTSD in this population. We performed a systematic review and component network meta-analysis to assess the effectiveness of psychological and pharmacological interventions for managing mental health problems in people exposed to complex traumatic events.


Complex trauma is an increasing threat to global mental health. Complex trauma is defined as exposure to multiple or prolonged traumatic events, typically of an interpersonal nature and from which escape is impossible or difficult. Beyond the prototypical case of childhood sexual abuse, complex-trauma exposure is also common among those who experience intimate partner violence and conflict. Intimate partner violence accounts for 14% of lifetime traumas and is associated with a conditional risk of posttraumatic stress disorder (PTSD) of 11.4%; war-related trauma among military personnel, civilians, and refugees accounts for a further 13.1% of lifetime trauma exposures and is associated with a conditional risk of PTSD of 3.5% [1].


The protocol for this study was registered on PROSPERO (CRD42017055523) and can be found at We followed the PRISMA extension statement for NMAs (S1 Text) [16].


The findings from this systematic review and meta-analysis suggest that collectively, psychological interventions are effective for treating PTSD symptoms, treating symptoms of common mental health problems, and improving sleep across all populations with a history of complex traumatic events. Evidence from non-RCTs generally supported this finding. These positive effects were especially pronounced for interventions with a trauma focus, such as TF-CBT and EMDR, and were observed over the longer term at 6 months and when compared with active controls. Non-trauma-focused interventions were not generally effective for PTSD symptoms, with only weak evidence in favour of IPT.

Citation: Coventry PA, Meader N, Melton H, Temple M, Dale H, Wright K, et al. (2020) Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis. PLoS Med 17(8): e1003262.

Academic Editor: Sarah Bendall, University of Melbourne, AUSTRALIA

Received: March 6, 2020; Accepted: July 15, 2020; Published: August 19, 2020

Copyright: © 2020 Coventry et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data are available from the primary research papers, which are listed in the references.

Funding: Funding was received from the UK National Institute for Health Research (NIHR) Health Technology Assessment programme (ref: 16/11/03) (to PAC) ( The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

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