Concerns about a systematic review of mediators of PTSD treatments: A commentary on Alpert and colleagues (2023)

• Published in: Clinical psychology review 2023-12, Vol.106, p.102323-102323, Article 102323
• Main Author: Sonis, Jeffrey
• Format: Article
• Language: English
• Subjects: Humans; Mediation; Posttraumatic stress disorder; PTSD; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Systematic Reviews as Topic
• ISSN: 0272-7358; 1873-7811
• DOI: 10.1016/j.cpr.2023.102323

The systematic review by Alpert and colleagues (Clinical Psychology Reviews, https://doi.org/10.1016/j.cpr.2023.102300) suggests methodological standards for mediation analysis and evaluates the evidence for mediation of PTSD treatment effects in published research. Although the article articulates important methodological guidelines related to timing of treatment, mediator, and outcome, it fails to incorporate the insights of causal mediation analysis into the methodological standards. In particular, the systematic review does not recognize the limitations of using time, rather than PTSD treatment type, in mediation analyses and does not include an assessment of the potential impact of uncontrolled confounding between the mediator and the outcome in the included studies. The conclusions about mediators of PTSD treatments from this systematic review should be considered carefully. •The systematic review by Alpert and colleagues has important limitations.•The most important limitation is that causal mediation analysis was not considered.•Many articles included time not treatment type in the mediation analyses.•The systematic review also did not assess mediator-outcome confounding.•The systematic review included mediators based only on statistical significance.