Literature review on trauma-informed care in primary care settings

In February 2022, the GPMHSC commissioned a rapid literature review to identify evidence of the effectiveness of trauma-informed care in the primary care setting. Evidence is presented for both the effectiveness of implementing trauma-informed care as a model of care in primary practice, and the effectiveness of trauma-specific interventions.

The 'Rapid review on trauma-informed care in primary care settings' consists of three parts:

For the full summary of identified trauma-informed care reviews and primary studies regarding implemetation of trauma-informed care as a model of care, download Part B: Tables

The below is a quick reference summary of identified systematic reviews on trauma-specific interventions*.

*Important note: Health care professional training is required to provide these interventions. The studies included in the reviews were conducted in a range of healthcare settings, not exclusive to primary care, with interventions usually delivered by mental health professionals. This summary presents available systematic review evidence for various interventions, however GPMHSC does not specifically endorse one intervention over another.

Citation	Evidence-base	Population/condition	Intervention/Comparison	Reported outcomes
Overall trauma-focused interventions - adults
PTSD
Jericho 2022²¹	82 RCTs Evidence up to Jan 2020b	PTSD in adults	Interventions: Trauma-focused therapies, including EMDR, PE, CBT, NET, MCT, WET, VRET, BET, TARGET, SIT Comparison: waitlist or other psychotherapies	Network estimates indicated superior efficacy of meta-CT and CPT over other psychotherapies WET and NET were found to be the most tolerable and acceptable treatments WET, IPT and EMDR appear in the superior half of therapies for both efficacy and acceptability
Weber 2021²²	22 RCTs Evidence up to Nov 2019	PTSD in adults	Interventions: psychological treatments for PTSD, including TF-CBT, EMDR, CBT Comparisons: active or passive nonpharmacological controls or other psychological treatments	TF and non-TF interventions yielded large effect size for PTSD severity from pre-test to follow-up Higher effect sizes were observed for civilian compared to military populations and for studies with larger proportions of female participants Medium effect sizes were observed for depressive symptoms
PTSD and comorbid conditions
Grubaugh 2021²⁶	14 studies: 5 RCTs, 8 open trials, 1 within-group controlled trial Evidence up to Mar 2020	PTSD and comorbid severe mental illness	Intervention: PTSD psychotherapy, including CBT, PE, EMDR, brief treatment program	Interventions reduced PTSD symptomatology from pre- to post-treatment, with slightly larger effects observed for PE, EMDR and BTP than CBT. Positive effects were also observed on general psychopathology and psychotic symptoms
Rozek 2021²⁸	33 studies – 23 PTSD-specific, 4 suicide-specific, 6 combined; Evidence up to Jan 2021	PTSD co-occurring with suicidal thoughts and behaviours	Interventions: PTSD-specific - CBT, PE, EMDR, PCT, NET, COPE; combined - DBT-PE, DBT-PTSD; suicide-specific - BCBT, PACT, DBT Comparison: various, some studies did not include comparison or control groups	Interventions appeared to decrease both PTSD and suicide-related symptoms, with most research relating to PTSD treatments, particularly CPT and PE
PTSD related to specific populations/situations
Slade 2021³²	18 studies, including 5 studies on clinical effectiveness of interventions and 13 qualitative studies Evidence up to Oct 2020	Post-traumatic stress following childbirth	Interventions: psychological interventions, including EMDR, TF-CBT, debriefing and expressive writing	All interventions showed some effectiveness reducing post-traumatic stress symptoms however the review authors note that further research is needed to determine true effects
Baas 2020³¹	13 studies, including 3 RCTs. 6 of the studies were for TF-therapy Evidence up to Jun 2019	PTSD during pregnancy	Interventions: various, including TF-CBT, exposure therapy, EMDR	EMDR reduced PTSD symptoms in short term and in follow-up (up to 36 months) (note all EMDR studies were case series) TF-CBT also reduced PTSD symptoms
Complex trauma
Han 2021³⁷	32 studies – 19 RCTs Evidence up to Jun 2019	Trauma in adults in primary care or community setting (not military, refugee or war-related trauma populations or incarcerated populations), most studies focused on child abuse, sexual assault, or domestic violence	Interventions: Trauma-informed interventions, including EMDR, TF-CBT/CBT, mindfulness-based stress reduction program, TREM, general trauma-focused therapy, psychodynamic therapy, stress inoculation therapy, present-focused therapy, CPT	Reports that evidence to support trauma informed interventions for psychological outcomes is inconsistent: 15 studies found trauma-informed interventions led to improvements in 3 main psychological outcomes: PTSD symptoms (11 of 23 studies) depression (9 of 16) anxiety (5 of 10)
Coventry 2020³⁸	116 studies (of which 24 were in community settings, 2 in primary care clinics); 94 RCTs Evidence up to Apr 2017	Complex trauma – subgroups included post-combat deployment veterans, war-related, childhood sexual abuse, refugees, domestic violence	Interventions: psychological and pharmacological interventions; trauma-focused psychological interventions included: TF-CBT and EMDR	Trauma-focused psychological interventions reduced PTSD symptoms more than non-trauma-focused interventions across trauma subgroups, however effects among veterans and war-affected populations were not as strong TF-CBT was consistently associated with the largest effects TF-CBT and EMDR also reduced depressive and anxiety symptoms
Other mental health conditions
Dominguez 2021⁴⁰	11 RCTs Evidence up to Oct 2019	Depression	Interventions: TF therapy, predominately EMDR Comparison: any other psychological and pharmacological treatments including standard care and waitlist	TF treatments (predominately EMDR) reduced depressive symptoms post-treatment, compared to control conditions
Martinez 2021⁴¹	14 studies, including 8 RCTs Evidence up to Oct 2019	Depressive or bipolar disorders in adults exposed to adverse stress early in life Note no studies bipolar disorder patients were identified	Interventions: any intervention (psychological, pharmacological, psychosocial, or a combination) aimed at treating depressive or bipolar disorders in adults with early adverse stress Comparison: various, no control group, no intervention, waitlist, other therapies	Psychological, pharmacological, and combined treatment interventions reduced depressive symptoms in the short- and mid-term Sensitivity analyses suggest psychological or combined treatment interventions had greater effect sizes than pharmacological interventions (although no statistically significant differences)

BET: brief eclectic therapy; BPD: borderline personality disorder; BT: behavioural therapy; CBT: cognitive behavioural therapy; CPT: cognitive processing therapy; CT: cognitive therapy; EMDR: eye movement desensitization and reprocessing; ET: exposure therapy; IPT: interpersonal therapy; IPV: intimate partner violence; MCT: metacognitive therapy; NET: narrative exposure therapy; PCT: present centred therapy; PE: prolonged exposure; PMR: progressive muscle relaxation; PTSD: posttraumatic stress disorder; RCT: randomised controlled trial; SIT: stress inoculation training; SUD: substance use disorder; TARGET: trauma affect regulation: guide for education and therapy; TAU: treatment-as-usual; TF: trauma-focused; VRET: virtual reality exposure therapy; WET: written exposure therapy.

Download Rapid review on trauma-informed care in primary care settings

PTSD

PTSD and comorbid conditions

PTSD related to specific populations/situations

Complex trauma

Other mental health conditions