The role of executive function in posttraumatic stress disorder: A systematic review

Background: Although posttraumatic stress disorder (PTSD) has been associated with disturbances in verbal memory, studies examining executive functioning in PTSD show mixed results. Methods: A systematic review and meta-analysis were performed to compare executive functioning in patients with current PTSD and controls without any psychiatric disorder. Standard mean differences (SMD) in executive functioning scores were calculated using random-effects models. Covariates were added to examine whether differences exist between subgroups. Results: Across 18 studies, 1080 subjects were included. In comparison with 431 exposed controls and 227 healthy controls, 422 people with PTSD showed significantly impaired executive functioning. Subgroup analyses revealed more pronounced differences between PTSD patients and exposed controls than healthy controls. Male gender, higher age, war trauma, and higher severity of co-morbid depressive symptoms were related to poorer executive functioning in PTSD patients compared to exposed controls. Limitations: Due to insufficient data and heterogeneity, not all subgroup differences or characteristics could be taken into account. Conclusions: Overall, PTSD patients were found to show impaired executive functioning. Future research should further elucidate the subgroup effects and focus on clinical implications with regard to daily functioning and treatment outcome.