A systematic review and meta-analysis of e-Mental Health interventions to treat symptoms of post-traumatic stress

Background: Post-traumatic stress disorder (PTSD) is a stress disorder characterised by unwanted intrusive re-experiencing of an acutely distressing, often life-threatening, event, combined with symptoms of hyper-arousal, avoidance as well as negative thoughts and feelings. Evidence-based psychological interventions have been developed to treat these symptoms and reduce distress, the majority of which were designed to be delivered face-to-face with trained therapists. However, new developments in the use of technology to supplement and extend healthcare have led to the creation of e-Mental Health interventions. Objective: To assess the scope and efficacy of e-Mental Health interventions to treat symptoms of PTSD. Methods: The following databases were systematically searched to identify randomised controlled trials of e-Mental Health interventions to treat symptoms of PTSD as measured by standardised and validated scales: The Cochrane Library, MEDLINE, EMBASE and PsycINFO (in March 2015 and repeated in November 2016). Results: A total of 39 studies were found during the systematic review and 33 (n = 3832) were eligible for meta-analysis. The results of the primary meta-analysis revealed a significant improvement in PTSD symptoms, in favour of the active intervention group (SMD = -0.35, 95% CI: -0.45, -0.25, p < 0.001, I2 = 81%). Several sensitivity and sub-group analyses were performed suggesting that improvements in PTSD symptoms remained in favour of the active intervention group independent of the comparison condition, the type of Cognitive Behavioural Therapy-based intervention and the level of guidance provided. Conclusions: This review demonstrates an emerging evidence-base supporting e-Mental Health to treat symptoms of PTSD.