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Nordström EEL, Kaltiala R, Kristensen P, Thimm JC. Bereaved parents' and siblings' healthcare needs, healthcare utilization, and satisfaction with healthcare services eight years after the 2011 Utøya terror attack. DEATH STUDIES 2024:1-13. [PMID: 39269892 DOI: 10.1080/07481187.2024.2400366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Understanding the healthcare needs of bereaved individuals following terrorism is crucial for organizing healthcare services. This cross-sectional study examined the terror-related healthcare needs, healthcare utilization, and satisfaction with professional healthcare among 122 traumatically bereaved parents and siblings eight years after the 2011 Utøya terrorist attack in Norway. Results showed that over 50% of the participants currently needed help coping with their grief or with mental and somatic symptoms, and only 34% were actively utilizing healthcare related to the terror attack. Furthermore, 68% reported not getting sufficient help, suggesting a treatment gap. One-third rated the professional help and treatment as unsatisfactory, with 28% reporting that they had not received competent help. More somatic and posttraumatic stress symptoms were associated with higher healthcare needs, whilst higher levels of insomnia symptoms were associated with lower healthcare satisfaction. This emphasizes the need to recognize, professionally intervene, and provide competent support for traumatically bereaved individuals.
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Affiliation(s)
| | - Riittakerttu Kaltiala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
- Vanha Vaasa Hospital, Vaasa, Finland
| | - Pål Kristensen
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Jens C Thimm
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
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2
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Pirard P, Motreff Y, Stene LE, Rabet G, Vuillermoz C, Vandentorren S, Baubet T, Messiah A. Initiation of multiple-session psychological care in civilians exposed to the November 2015 Paris terrorist attacks. Arch Public Health 2023; 81:207. [PMID: 38031202 PMCID: PMC10685664 DOI: 10.1186/s13690-023-01206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Terrorist attacks can induce post-traumatic stress disorder (PTSD) and depression, which require multiple-session psychological care (MSPC). This study aims at investigating MSPC initiation and associated factors. METHODS Data were collected from a web-based survey of civilians 8-12 months after their exposure to the November 2015 Paris terrorist attacks. Depression and partial and full PTSD were assessed using the Hospital Anxiety and Depression Scale and the PCL-5 checklist, respectively. Questionnaires collected data on socio-demographic variables, exposure to the attacks, psychological treatment history, social isolation, somatic problems, having received an outreach psychological support (OPS), consultations with a general practitioner, contact with an association for victims, MSPC initiation and, if not, reasons for not having initiated it. Logistic regressions were used to examine factors associated with MSPC initiation. RESULTS Among the 450 respondents, 154 reported having initiated a MSPC after the attacks. Of the 134 who provided the MSPC initiation date, 50% did so during the first month. Among the respondents with at least one of the considered psychological disorders, 53% declared not having initiated yet a MSPC. The primary three reasons for not having initiated a MSPC among people with PTSD were "did not feel the need", "it was not the right time to talk about it", and "not offered". For people with at least one psychological disorder, MSPC initiation was associated with the number of somatic problems, type of exposure (witness, threatened, indirectly exposed), prior psychological treatment, being a woman, being in a relationship, having consulted a psychiatrist or a psychologist, having received an OPS, and being in contact with association for victims. CONCLUSION The organization of adequate psychological care after a terror attack must take into account the need for healthcare that may emerge several months after the attack, and that witnesses seem less likely to receive MSPC than persons directly threatened despite their psychological disorder. Associations for victims and OPS seem to facilitate access to MSPC. Furthermore, our findings highlight the need to train physicians to screen for psychological disorders in persons exposed to terrorist attacks who present with somatic disorders.
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Affiliation(s)
- Philippe Pirard
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France.
- Team MOODS, Inserm-CESP, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Yvon Motreff
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, F75012, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Gabrielle Rabet
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
| | - Cécile Vuillermoz
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, F75012, France
| | - Stéphanie Vandentorren
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
- UMR 1219, Bordeaux Population Health Research Center, PHARes Team, University of Bordeaux, Bordeaux, France
| | - Thierry Baubet
- Université Sorbonne Paris Nord, UTRPP EA 4403, Villetaneuse, France
- AP-HP, Hôpital Avicenne, Bobigny, France
- Resources and Resilience National Centre (CN2R), LilleParis, France
| | - Antoine Messiah
- Team MOODS, Inserm-CESP, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
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3
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Chen Y, Ingram C, Downey V, Roe M, Drummond A, Sripaiboonkij P, Buckley C, Alvarez E, Perrotta C, Buggy C. Employee Mental Health During COVID-19 Adaptation: Observations of Occupational Safety and Health/Human Resource Professionals in Ireland. Int J Public Health 2022; 67:1604720. [PMID: 36016962 PMCID: PMC9396539 DOI: 10.3389/ijph.2022.1604720] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/04/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: This study aims to understand mental health issues among Irish employees arising from COVID-19 adaptation from the perspective of Occupational Safety and Health (OSH) and/or Human Resource (HR) professionals. Methods: Fifteen focus groups including 60 OSH/HR professionals from various sectors were conducted covering four predetermined themes. The data were transcribed verbatim, with transcripts entered into Nvivo for thematic analysis incorporating intercoder reliability testing. Results: The mental health impacts among employees are identified from three stages: pre-adaptation, during adaptation, and post-adaptation. Most issues were reported during the second stage when working conditions dramatically changed to follow emerging COVID-19 policies. The identified mental health support from participating organizations included providing timely and reliable information, Employee Assistance Programme (EAP), informal communication channels, hybrid work schedules and reinforcement of control measures. Conclusion: This study explores the challenges facing employees during the different stages of COVID-19 adaptation and the associated mental health impacts. Gender’s influence on mental health consultations should be considered when planning for public health emergencies, and further research conducted in male dominated industries.
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Affiliation(s)
- Yanbing Chen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- *Correspondence: Yanbing Chen,
| | - Carolyn Ingram
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Vicky Downey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Mark Roe
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Anne Drummond
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Penpatra Sripaiboonkij
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Claire Buckley
- Health Service Executive, Dublin, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Carla Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Conor Buggy
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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4
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Shigemura J, Kurosawa M. Mental health clinic arson attack in Osaka, Japan: An old but new form of mass violence. Disaster Med Public Health Prep 2022; 16:1-2. [PMID: 35801279 DOI: 10.1017/dmp.2022.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jun Shigemura
- Faculty of Health Sciences, Mejiro University, Saitama, Japan
| | - Mie Kurosawa
- Clinical Psychology Center, Musashino University, Tokyo, Japan
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5
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Samnani S, Awal M. Balint in the time of COVID-19: Participant and facilitator experience of virtual Balint groups compared with in-person. Int J Psychiatry Med 2022; 57:269-282. [PMID: 35102772 PMCID: PMC8808131 DOI: 10.1177/00912174211053733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Current literature highlights peer and psychological support as important for staff well-being, to cope in pandemic conditions. AIMS Our organisation increased Balint group provision during unfamiliar challenges of COVID-19. This unique context allowed comparison of multiple new virtual and face-to-face (F2F) Balint experiences. METHOD Following March 2020 lockdown, four existing Balint groups for doctors in psychiatry moved to online, with two new groups established virtually in specific response to the pandemic. All participants and facilitators of these virtual Balint groups were sent a questionnaire to anonymously rate their experience and provide qualitative feedback. RESULTS The response rate was 89% for participants (51 respondents) and 100% for facilitators (5 respondents). Participants found both formats supportive; providing a space to talk, feel heard and validated, helping work feel less stressful. Participant ratings slightly favoured F2F, but some prefer to continue virtually. Facilitators felt virtual attendance was easier, but adherence to conventional Balint group structure and format more difficult. CONCLUSIONS Participant and facilitator responses demonstrate Balint groups, when both F2F and virtual, were experienced as a source of support and connectivity, being valued across different psychiatry grades. Notable virtual benefits seem to be limited to more practical aspects, that is, time, flexibility, logistics and accessibility. There are expressed challenges of virtual Balint; however, some participants still favour this format going forward. Our findings endorse virtual Balint as a welcomed means of emotional well-being, peer support and developing psychotherapeutic competencies during pandemic-related restrictions, with potential to extend beyond COVID-19.
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Affiliation(s)
- Sheliza Samnani
- Birmingham and Solihull Mental Health Foundation Trust (BSMHFT), Birmingham, UK
- Sheliza Samnani, Specialist Psychotherapies Services Birmingham and Solihull Mental Health Foundation Trust (BSMHFT), Birmingham, UK.
| | - Masud Awal
- Birmingham and Solihull Mental Health Foundation Trust (BSMHFT), Birmingham, UK
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6
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Lewis C, Bisson JI. Managing the risk of post-traumatic stress disorder (PTSD): Best practice for prevention, detection and treatment. Acta Psychiatr Scand 2022; 145:113-115. [PMID: 35014031 DOI: 10.1111/acps.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
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7
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Greene T, El-Leithy S, Billings J, Albert I, Birch J, Campbell M, Ehntholt K, Fortune L, Gilbert N, Grey N, Hana L, Kennerley H, Lee D, Lunn S, Murphy D, Robertson M, Wade D, Brewin CR, Bloomfield MAP. Anticipating PTSD in severe COVID survivors: the case for screen-and-treat. Eur J Psychotraumatol 2022; 13:1959707. [PMID: 35096282 PMCID: PMC8797726 DOI: 10.1080/20008198.2021.1959707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. Delayed PTSD diagnosis is associated with poor outcomes. There is a clear case for survivors of severe COVID to be systematically screened for PTSD, and those that develop PTSD should receive timely access to evidence-based treatment for PTSD and other mental health problems by multidisciplinary teams.
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Affiliation(s)
- Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel.,Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Sharif El-Leithy
- Traumatic Stress Service, South West London & St George's Mental Health NHS Trust, London, UK
| | - Jo Billings
- Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Idit Albert
- Centre for Anxiety Disorders and Trauma, South London & Maudsley NHS Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jennifer Birch
- Department of Clinical Psychology and Psychology Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Kim Ehntholt
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK
| | - Lorna Fortune
- Barnet Enfield & Haringey MHT, London, UK.,North Middlesex University Hospital NHS Trust, London, UK
| | | | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Sussex, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Laurinne Hana
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Helen Kennerley
- Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.,Oxford Cognitive Therapy Centre, University of Oxford, Oxford, UK
| | - Deborah Lee
- Berkshire Traumatic Stress Service, Berkshire Foundation NHS Trust, Reading, UK
| | - Sarah Lunn
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK.,Whittington Health NHS Trust, London, UK
| | - Dominic Murphy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mary Robertson
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK
| | - Dorothy Wade
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Michael A P Bloomfield
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK.,Translational Psychiatry Research Group, Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, London, UK.,National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
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8
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Jesuthasan J, Powell RA, Burmester V, Nicholls D. 'We weren't checked in on, nobody spoke to us': an exploratory qualitative analysis of two focus groups on the concerns of ethnic minority NHS staff during COVID-19. BMJ Open 2021; 11:e053396. [PMID: 34972767 PMCID: PMC8720640 DOI: 10.1136/bmjopen-2021-053396] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/29/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To gain exploratory insights into the multifaceted, lived experience impact of COVID-19 on a small sample of ethnic minority healthcare staff to cocreate a module of questions for follow-up online surveys on the well-being of healthcare staff during the pandemic. DESIGN A cross-sectional design using two online focus groups among ethnic minority healthcare workers who worked in care or supportive roles in a hospital, community health or primary care setting for at least 12 months. PARTICIPANTS Thirteen healthcare workers (11 female) aged 26-62 years from diverse ethnic minority backgrounds, 11 working in clinical roles. RESULTS Five primary thematic domains emerged: (1) viral vulnerability, centring around perceived individual risk and vulnerability perceptions; (2) risk assessment, comprising pressures to comply, perception of a tick-box exercise and issues with risk and resource stratification; (3) interpersonal relations in the workplace, highlighting deficient consultation of ethnic minority staff, cultural insensitivity, need for support and collegiate judgement; (4) lived experience of racial inequality, consisting of job insecurity and the exacerbation of systemic racism and its emotional burden; (5) community attitudes, including public prejudice and judgement, and patient appreciation. CONCLUSIONS Our novel study has shown ethnic minority National Health Service (NHS) staff have experienced COVID-19 in a complex, multidimensional manner. Future research with a larger sample should further examine the complexity of these experiences and should enumerate the extent to which these varied thematic experiences are shared among ethnic minority NHS workers so that more empathetic and supportive management and related occupational practices can be instituted.
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Affiliation(s)
- Jehanita Jesuthasan
- Department of Brain Sciences, Imperial College London Faculty of Medicine, London, UK
| | - Richard A Powell
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Victoria Burmester
- Department of Brain Sciences, Imperial College London Faculty of Medicine, London, UK
| | - Dasha Nicholls
- Department of Brain Sciences, Imperial College London Faculty of Medicine, London, UK
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9
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Hogan N, Knapp M, McDaid D, Davies M, Brewin CR. Cost-effectiveness of 'screen-and-treat' interventions for post-traumatic stress disorder following major incidents. BMJ Open 2021; 11:e049472. [PMID: 34620659 PMCID: PMC8499281 DOI: 10.1136/bmjopen-2021-049472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening and evidence-based interventions (a 'screen-and-treat' approach), but little is known about its cost-effectiveness. The objective of this paper is to report the first systematic attempt to assess the cost-effectiveness of this approach. METHODS A decision modelling analysis was undertaken to estimate the costs per quality-adjusted life-year (QALY) gained from a screen-and-treat approach compared with treatment-as-usual, the latter involving identification of PTSD by general practitioners and referral to psychological therapy services. Model input variables were drawn from relevant empirical studies in the context of terrorism and the unit costs of health and social care in England. The model was run over a 5-year time horizon for a hypothetical cohort of 1000 exposed adults from the perspective of the National Health Service and Personal Social Services in England. RESULTS The incremental cost per QALY gained was £7931. This would be considered cost-effective 88% of the time at a willingness-to-pay threshold of £20 000 per QALY gained, the threshold associated with the National Institute for Health and Care Excellence in England. Sensitivity analysis confirmed this result was robust. CONCLUSIONS A screen-and-treat approach for identifying and treating PTSD in adults following terrorist attacks appears cost-effective in England compared with treatment-as-usual through conventional primary care routes. Although this finding was in the context of terrorism, the implications might be translatable into other major incident-related scenarios including the current COVID-19 pandemic.
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Affiliation(s)
- Nicole Hogan
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - David McDaid
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | | | - Chris R Brewin
- Clinical Educational & Health Psychology, University College London, London, UK
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10
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Hind D, Allsopp K, Chitsabesan P, French P. The psychosocial response to a terrorist attack at Manchester Arena, 2017: a process evaluation. BMC Psychol 2021; 9:22. [PMID: 33531071 PMCID: PMC7852120 DOI: 10.1186/s40359-021-00527-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/22/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A 2017 terrorist attack in Manchester, UK, affected large numbers of adults and young people. During the response phase (first seven weeks), a multi-sector collaborative co-ordinated a decentralised response. In the subsequent recovery phase they implemented a centralised assertive outreach programme, 'The Resilience Hub', to screen and refer those affected. We present a process evaluation conducted after 1 year. METHODS Case study, involving a logic modelling approach, aggregate routine data, and semi-structured interviews topic guides based on the Inter-Agency Collaboration Framework and May's Normalisation Process Theory. Leaders from health, education and voluntary sectors (n = 21) and frontline Resilience Hub workers (n = 6) were sampled for maximum variation or theoretically, then consented and interviewed. Framework analysis of transcripts was undertaken by two researchers. RESULTS Devolved government, a collaborative culture, and existing clinical networks meant that, in the response phase, a collaboration was quickly established between health and education. All but one leader evaluated the response positively, although they were not involved in pre-disaster statutory planning. However, despite overwhelming positive feedback there were clear difficulties. (1) Some voluntary sector colleagues felt that it took some time for them to be involved. (2) Other VCSE organisations were accused of inappropriate, harmful use of early intervention. (3) The health sector were accused of overlooking those below the threshold for clinical treatment. (4) There was a perception that there were barriers to information sharing across organisations, which was particularly evident in relation to attempts to outreach to first responders and other professionals who may have been affected by the incident. (5) Hub workers encountered barriers to referring people who live outside of Greater Manchester. After 1 year of the recovery phase, 877 children and young people and 2375 adults had completed screening via the Resilience Hub, 79% of whom lived outside Greater Manchester. CONCLUSIONS The psychosocial response to terrorist attacks and other contingencies should be planned and practiced before the event, including reviews of communications, protocols, data sharing procedures and workforce capacity. Further research is needed to understand how the health and voluntary sectors can best collaborate in the wake of future incidents.
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Affiliation(s)
- Daniel Hind
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Kate Allsopp
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Prathiba Chitsabesan
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust, Manchester, UK.,Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, M15 6GX, UK
| | - Paul French
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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11
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Sepehry AA, Lam K, Sheppard M, Guirguis-Younger M, Maglio AS. EMDR for Depression: A Meta-Analysis and Systematic Review. JOURNAL OF EMDR PRACTICE AND RESEARCH 2021. [DOI: 10.1891/emdr-d-20-00038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The literature on the efficacy of eye movement desensitization and reprocessing (EMDR) for treating depression is heterogeneous due to research design, quality issues, and trials methodology. The current meta-analysis seeks to examine EMDR for depression with the aim of answering the aforementioned limitations. Thirty-nine studies were included for analysis after a review of the relevant literature. Univariate meta-regressions were run to examine dose-response and the effect of moderating variables. Subanalysis for primary and secondary depression showed a large, significant, and heterogeneous effect-size estimates, where EMDR significantly improved symptoms of depression in contrast to all control types. At post hoc, data were reexamined and a significant and large, yet heterogeneous, effect-size estimate emerged between the EMDR and control arm after the removal of two outliers [Hedges' g = 0.70, 95% CI =0.50–0.89, p-value < .01, I2 = 70%, K = 37]. This is the first meta-analysis examining for the effect of EMDR comparing to various control modalities on depression with dose-response. We found (a) that studies were balanced at onset in terms of depression severity, and (b) a large and significant effect of EMDR on depression at the end of trials. Additionally, the significance of the aggregate effect-size estimate at the end of trials was unchanged by the intake of psychotropic medications, reported demographic variables, or EMDR methodology.
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12
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Haleemunnissa S, Didel S, Swami MK, Singh K, Vyas V. Children and COVID19: Understanding impact on the growth trajectory of an evolving generation. CHILDREN AND YOUTH SERVICES REVIEW 2021; 120:105754. [PMID: 33281255 PMCID: PMC7695548 DOI: 10.1016/j.childyouth.2020.105754] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 05/05/2023]
Abstract
The COVID19 pandemic has forced the world to be closed in a shell. It has affected large population worldwide, but studies regarding its effect on children very limited. The majority of the children, who may not be able to grasp the entire emergency, are at a bigger risk with other problems lurking behind the attack of SARS-CoV-2 virus. The risk of infection in children was 1.3%, 1.5%, and 1.7% of total confirmed COVID-19 cases in China, Italy and United States respectively which is less compared to 2003 epidemic of severe acute respiratory syndrome (SARS), when 5-7% of the positive cases were children, with no deaths reported while another recent multinational multicentric study from Europe which included 582 PCR (polymerase chain reaction) confirmed children of 0-18 year of age, provide deeper and generalize incite about clinical effects of COVID19 infection in children. According to this study 25% children have some pre-existing illness and 8% required ICU (intensive care unit) admission with 0.69% case fatality among all infected children. Common risk factor for serious illness as per this study are younger age, male sex and pre-existing underlying chronic medical condition. However, we need to be more concerned about possible implications of indirect and parallel psychosocial and mental health damage due to closure of schools, being in confinement and lack of peer interaction due to COVID19 related lockdown and other containment measures. The effects can range from mood swings, depression, anxiety symptoms to Post Traumatic Stress Disorder, while no meaningful impact on COVID19 related mortality reduction is evident with school closure measures. The objective of this paper is to look at both the positive & negative effects in children due to COVID19 related indirect effects following lockdown and other containment measures. There is a need to gear up in advance with psychological strategies to deal with it post the pandemic by involving all stakeholders (parents, teachers, paediatricians, psychologists, psychiatrists, psychiatric social workers, counsellors), proposing an integrated approach to help the children to overcome the pandemic aftermath.
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Affiliation(s)
- S Haleemunnissa
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, India
| | - Siyaram Didel
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Mukesh Kumar Swami
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Varuna Vyas
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
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Pirard P, Baubet T, Motreff Y, Rabet G, Marillier M, Vandentorren S, Vuillermoz C, Stene LE, Messiah A. Use of mental health supports by civilians exposed to the November 2015 terrorist attacks in Paris. BMC Health Serv Res 2020; 20:959. [PMID: 33076901 PMCID: PMC7574168 DOI: 10.1186/s12913-020-05785-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background The use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care. This article focuses on civilians exposed to the November 2015 terrorist attacks in Paris and describes the different combinations of mental health supports (MHSu) used in the following year according to type of exposure and type of mental health disorder (MHD). Methods Santé publique France conducted a web-based survey of civilians 8–11 months after their exposure to the November 2015 terrorist attacks in Paris. All 454 respondents met criterion A of the DSM-5 definition of post-traumatic stress disorder (PTSD). MHD (anxiety, depression, PTSD) were assessed using the PCL-5 checklist and the Hospital Anxiety and Depression Scale. MHSu provided were grouped under outreach psychological support, visits for psychological difficulties to a victims’ or victim support association, consultation with a general practitioner (GP), consultation with a psychiatrist or psychologist (specialist), and initiation of regular mental health treatment (RMHT). Chi-squared tests highlighted differences in MHSu use according to type of exposure (directly threatened, witnessed, indirectly exposed) and MHD. Phi coefficients and joint tabulations were employed to analyse combinations of MHSu use. Results Two-thirds of respondents used MHSu in the months following the attacks. Visits to a specialist and RMHT were more frequent than visits to a GP (respectively, 39, 33, 17%). These were the three MHSu most frequently used among people with PTSD (46,46,23%), with depression (52,39,20%), or with both (56,58, 33%). Witnesses with PTSD were more likely not to have RMHT than those directly threatened (respectively, 65,35%). Outreach support (35%) and visiting an association (16%) were both associated with RMHT (Phi = 0.20 and 0.38, respectively). Very few (1%) respondents initiated RMHT directly. Those who indirectly initiated it (32%) had taken one or more intermediate steps. Visiting a specialist, not a GP, was the most frequent of these steps. Conclusion Our results highlight possibilities for greater coordination of mental health care after exposure to terrorist attacks including involving GP for screening and referral, and associations to promote targeted RMHT. They also indicate that greater efforts should be made to follow witnesses.
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Affiliation(s)
- Philippe Pirard
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France. .,Team MOODS, CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Thierry Baubet
- CESP, Inserm, Université Sorbonne Paris Nord, Villetaneuse, France.,APHP, Hôpital Avicenne, Bobigny, France.,Centre National de Ressources et de Résilience (CN2R), Lille/Paris, France
| | - Yvon Motreff
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France.,Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
| | - Gabrielle Rabet
- Support, Data Treatment and Analysis Division, Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Maude Marillier
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France
| | - Stéphanie Vandentorren
- Scientific and International Division, Santé Publique France (The French Public Health Agency), Saint-Maurice, France.,INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ Bordeaux, F-33000, Bordeaux, France
| | - Cécile Vuillermoz
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Antoine Messiah
- Team MOODS, CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
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van Herpen MM, Boeschoten MA, Te Brake H, van der Aa N, Olff M. Mobile Insight in Risk, Resilience, and Online Referral (MIRROR): Psychometric Evaluation of an Online Self-Help Test. J Med Internet Res 2020; 22:e19716. [PMID: 32975521 PMCID: PMC7547397 DOI: 10.2196/19716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Most people who experience a potentially traumatic event (PTE) recover on their own. A small group of individuals develops psychological complaints, but this is often not detected in time or guidance to care is suboptimal. To identify these individuals and encourage them to seek help, a web-based self-help test called Mobile Insight in Risk, Resilience, and Online Referral (MIRROR) was developed. MIRROR takes an innovative approach since it integrates both negative and positive outcomes of PTEs and time since the event and provides direct feedback to the user. OBJECTIVE The goal of this study was to assess MIRROR's use, examine its psychometric properties (factor structure, internal consistency, and convergent and divergent validity), and evaluate how well it classifies respondents into different outcome categories compared with reference measures. METHODS MIRROR was embedded in the website of Victim Support Netherlands so visitors could use it. We compared MIRROR's outcomes to reference measures of PTSD symptoms (PTSD Checklist for DSM-5), depression, anxiety, stress (Depression Anxiety Stress Scale-21), psychological resilience (Resilience Evaluation Scale), and positive mental health (Mental Health Continuum Short Form). RESULTS In 6 months, 1112 respondents completed MIRROR, of whom 663 also completed the reference measures. Results showed good internal consistency (interitem correlations range .24 to .55, corrected item-total correlations range .30 to .54, and Cronbach alpha coefficient range .62 to .68), and convergent and divergent validity (Pearson correlations range -.259 to .665). Exploratory and confirmatory factor analyses (EFA+CFA) yielded a 2-factor model with good model fit (CFA model fit indices: χ219=107.8, P<.001, CFI=.965, TLI=.948, RMSEA=.065), conceptual meaning, and parsimony. MIRROR correctly classified respondents into different outcome categories compared with the reference measures. CONCLUSIONS MIRROR is a valid and reliable self-help test to identify negative (PTSD complaints) and positive outcomes (psychosocial functioning and resilience) of PTEs. MIRROR is an easily accessible online tool that can help people who have experienced a PTE to timely identify psychological complaints and find appropriate support, a tool that might be highly needed in times like the coronavirus pandemic.
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Affiliation(s)
- Merel Marjolein van Herpen
- ARQ Centre of Expertise for the Impact of Disasters and Crises, Diemen, Netherlands
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | - Hans Te Brake
- ARQ Centre of Expertise for the Impact of Disasters and Crises, Diemen, Netherlands
| | | | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam University Medical Center, Amsterdam, Netherlands
- ARQ National Psychotrauma Centre, Diemen, Netherlands
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15
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Greenberg N, Brooks SK, Wessely S, Tracy DK. How might the NHS protect the mental health of health-care workers after the COVID-19 crisis? Lancet Psychiatry 2020; 7:733-734. [PMID: 32473664 PMCID: PMC7255732 DOI: 10.1016/s2215-0366(20)30224-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Neil Greenberg
- The Health Protection Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Samantha K Brooks
- The Health Protection Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK
| | - Simon Wessely
- The Health Protection Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK
| | - Derek K Tracy
- Cognition, Schizophrenia, and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK; Oxleas NHS Foundation Trust, London, UK
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16
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17
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Cole CL, Waterman S, Stott J, Saunders R, Buckman JEJ, Pilling S, Wheatley J. Adapting IAPT services to support frontline NHS staff during the Covid-19 pandemic: the Homerton Covid Psychological Support (HCPS) pathway. COGNITIVE BEHAVIOUR THERAPIST 2020; 13:e12. [PMID: 32454891 PMCID: PMC7235312 DOI: 10.1017/s1754470x20000148] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/07/2022]
Abstract
The Coronavirus (Covid-19) pandemic is exerting unprecedented pressure on NHS Health and Social Care provisions, with frontline staff, such as those of critical care units, encountering vast practical and emotional challenges on a daily basis. Although staff are being supported through organisational provisions, facilitated by those in leadership roles, the emergence of mental health difficulties or the exacerbation of existing ones amongst these members of staff is a cause for concern. Acknowledging this, academics and healthcare professionals alike are calling for psychological support for frontline staff, which not only addresses distress during the initial phases of the outbreak but also over the months, if not years, that follow. Fortunately, mental health services and psychology professional bodies across the United Kingdom have issued guidance to meet these needs. An attempt has been made to translate these sets of guidance into clinical provisions via the recently established Homerton Covid Psychological Support (HCPS) pathway delivered by Talk Changes (Hackney & City IAPT). This article describes the phased, stepped-care and evidence-based approach that has been adopted by the service to support local frontline NHS staff. We wish to share our service design and pathway of care with other Improving Access to Psychological Therapies (IAPT) services who may also seek to support hospital frontline staff within their associated NHS Trusts and in doing so, lay the foundations of a coordinated response. KEY LEARNING AIMS (1)To understand the ways staff can be psychologically and emotionally impacted by working on the frontline of disease outbreaks.(2)To understand the ways in which IAPT services have previously supported populations exposed to crises.(3)To learn ways of delivering psychological support and interventions during a pandemic context based on existing guidance and research.
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Affiliation(s)
- C L Cole
- Centre for Outcomes Research and Effectiveness (CORE), University College London - Research Department of Clinical, Educational and Health Psychology, Gower Street, London, UK
- Talk Changes (City & Hackney IAPT), Homerton University Hospital Foundation Trust, London, UK
| | - S Waterman
- Department of Psychology, Royal Holloway, University of London, Surrey, UK
| | - J Stott
- Centre for Outcomes Research and Effectiveness (CORE), University College London - Research Department of Clinical, Educational and Health Psychology, Gower Street, London, UK
| | - R Saunders
- Centre for Outcomes Research and Effectiveness (CORE), University College London - Research Department of Clinical, Educational and Health Psychology, Gower Street, London, UK
| | - J E J Buckman
- Centre for Outcomes Research and Effectiveness (CORE), University College London - Research Department of Clinical, Educational and Health Psychology, Gower Street, London, UK
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | - S Pilling
- Centre for Outcomes Research and Effectiveness (CORE), University College London - Research Department of Clinical, Educational and Health Psychology, Gower Street, London, UK
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | - J Wheatley
- Talk Changes (City & Hackney IAPT), Homerton University Hospital Foundation Trust, London, UK
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18
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Cyhlarova E, Knapp M, Mays N. Responding to the mental health consequences of the 2015-2016 terrorist attacks in Tunisia, Paris and Brussels: implementation and treatment experiences in the United Kingdom. J Health Serv Res Policy 2019; 25:172-180. [PMID: 31769712 DOI: 10.1177/1355819619878756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore whether the Screen and Treat Programme to support United Kingdom citizens potentially affected by terrorist attacks in Tunisia (2015), Paris (2015) and Brussels (2016) was effective in identifying and referring people to mental health services, to examine the programme's acceptability to users and to understand how agencies involved worked together. METHODS Individuals offered screening by the programme (n = 529) were invited to participate in the study and were sent a questionnaire. Follow-up interviews were conducted with questionnaire respondents who consented and with employees of agencies involved in the programme's planning and delivery. Seventy-seven people affected by the attacks completed questionnaires, 35 of those were also interviewed, and 1 further person only participated in an interview. Eleven people from agencies organizing and delivering the programme and five clinician-managers were also interviewed. RESULTS Most service users said the attacks had a major impact on their lives. Many reported anxiety, depression, difficulty going out or travelling, sleep problems, panic attacks, flashbacks and hyper-vigilance. A third had reduced their working hours and a similar proportion had taken sick leave. Two-thirds sought help from their General Practitioner (GP) before being contacted by the programme, but almost all thought their GP had not been helpful in dealing with post-traumatic stress disorder (PTSD) or referring to appropriate care. Several people were prescribed psychotropic medication; only a few were referred to mental health professionals. Many participants used help offered by organizations external to National Health Service, with mixed experiences. Waiting times for treatment varied from no delay to a few months. Most interviewees thought the programme should have started sooner and provided more information about sources of support. Most users found treatment received via the programme helpful. Professionals involved in organizing and delivering the programme thought that bureaucratic delays in setting it up were key limitations on effectiveness. Clinician interviewees thought an outreach approach was needed to identify at-risk individuals. CONCLUSIONS Users who took part in the programme were satisfied with their treatment, although many thought it should have been offered sooner. Funding and data sharing between agencies were the main barriers to timely contact with affected individuals. Self-referral, GP identification of PTSD and GP referral to appropriate care were regarded as ineffective, suggesting that people affected by similar future incidents should be supported better and assisted more promptly to access treatment.
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Affiliation(s)
- Eva Cyhlarova
- Senior Research Fellow, Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK
| | - Martin Knapp
- Professor of Health and Social Care Policy, Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science; and Policy Innovation and Evaluation Research Unit, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, UK.,Director, NIHR School for Social Care Research, London, UK
| | - Nicholas Mays
- Professor of Health Policy, Director of Policy Innovation and Evaluation Research Unit, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, UK
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19
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Allsopp K, Brewin CR, Barrett A, Williams R, Hind D, Chitsabesan P, French P. Responding to mental health needs after terror attacks. BMJ 2019; 366:l4828. [PMID: 31409609 DOI: 10.1136/bmj.l4828] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Kate Allsopp
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Alan Barrett
- Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Manchester, UK
- School of Health Sciences, University of Salford, Salford, UK
| | - Richard Williams
- Welsh Institute for Health and Social Care, University of South Wales, Pontypridd, UK
| | - Daniel Hind
- School of Health and Related Research, Sheffield, UK
| | - Prathiba Chitsabesan
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Paul French
- Research and Innovation Department, Pennine Care NHS Foundation Trust, Manchester, UK
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
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20
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Mouncey PR, Wade D, Richards-Belle A, Sadique Z, Wulff J, Grieve R, Emerson LM, Brewin CR, Harvey S, Howell D, Hudson N, Khan I, Mythen M, Smyth D, Weinman J, Welch J, Harrison DA, Rowan KM. A nurse-led, preventive, psychological intervention to reduce PTSD symptom severity in critically ill patients: the POPPI feasibility study and cluster RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
High numbers of patients experience severe acute stress in critical care units. Acute stress has been linked to post-critical care psychological morbidity, including post-traumatic stress disorder (PTSD). Previously, a preventive, complex psychological intervention [Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients (POPPI)] was developed by this research team, to be led by nurses, to reduce the development of PTSD symptom severity at 6 months.
Objectives
The objectives were to (1) standardise and refine the POPPI intervention, and, if feasible, (2) evaluate it in a cluster randomised clinical trial (RCT).
Design
Two designs were used – (1) two feasibility studies to test the delivery and acceptability (to patients and staff) of the intervention, education package and support tools, and to test the trial procedures (i.e. recruitment and retention), and (2) a multicentre, parallel-group, cluster RCT with a baseline period and staggered roll-out of the intervention.
Setting
This study was set in NHS adult, general critical care units.
Participants
The participants were adult patients who were > 48 hours in a critical care unit, receiving level 3 care and able to consent.
Interventions
The intervention comprised three elements – (1) creating a therapeutic environment in critical care, (2) three stress support sessions for patients identified as acutely stressed and (3) a relaxation and recovery programme for patients identified as acutely stressed.
Main outcome measures
Primary outcome – patient-reported symptom severity using the PTSD Symptom Scale – Self Report (PSS-SR) questionnaire (to measure clinical effectiveness) and incremental costs, quality-adjusted life-years (QALYs) and net monetary benefit at 6 months (to measure cost-effectiveness). Secondary outcomes – days alive and free from sedation to day 30; duration of critical care unit stay; PSS-SR score of > 18 points; depression, anxiety and health-related quality of life at 6 months; and lifetime cost-effectiveness.
Results
(1) A total of 127 participants were recruited to the intervention feasibility study from two sites and 86 were recruited to the RCT procedures feasibility study from another two sites. The education package, support tools and intervention were refined. (2) A total of 24 sites were randomised to the intervention or control arms. A total of 1458 participants were recruited. Twelve sites delivered the intervention during the intervention period: > 80% of patients received two or more stress support sessions and all 12 sites achieved the target of > 80% of clinical staff completing the POPPI online training. There was, however, variation in delivery across sites. There was little difference between baseline and intervention periods in the development of PTSD symptom severity (measured by mean PSS-SR score) at 6 months for surviving patients in either the intervention or the control group: treatment effect estimate −0.03, 95% confidence interval (CI) −2.58 to 2.52; p = 0.98. On average, the intervention decreased costs and slightly improved QALYs, leading to a positive incremental net benefit at 6 months (£835, 95% CI −£4322 to £5992), but with considerable statistical uncertainty surrounding these results. There were no significant differences between the groups in any of the secondary outcomes or in the prespecified subgroup analyses.
Limitations
There was a risk of bias because different consent processes were used and as a result of the lack of blinding, which was mitigated as far as possible within the study design. The intervention started later than anticipated. Patients were not routinely monitored for delirium.
Conclusions
Among level 3 patients who stayed > 48 hours in critical care, the delivery of a preventive, complex psychological intervention, led by nurses, did not reduce the development of PTSD symptom severity at 6 months, when compared with usual care.
Future work
Prior to development and evaluation of subsequent psychological interventions, there is much to learn from post hoc analyses of the cluster RCT rich quantitative and qualitative data.
Trial registration
This trial is registered as ISRCTN61088114 and ISRCTN53448131.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 23, No. 30. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Dorothy Wade
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alvin Richards-Belle
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jerome Wulff
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Lydia M Emerson
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, UK
| | - Chris R Brewin
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Harvey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - David Howell
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nicholas Hudson
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Imran Khan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Monty Mythen
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust and University College London, London, UK
| | - Deborah Smyth
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - John Weinman
- Institute of Pharmaceutical Science, King’s College London, London, UK
| | - John Welch
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - David A Harrison
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
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22
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Wulfes N, Del Pozo MA, Buhr-Riehm B, Heinrichs N, Kröger C. Screening for Posttraumatic Stress Disorder in Refugees: Comparison of the Diagnostic Efficiency of Two Self-Rating Measures of Posttraumatic Stress Disorder. J Trauma Stress 2019; 32:148-155. [PMID: 30694568 DOI: 10.1002/jts.22358] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/09/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022]
Abstract
There is a high prevalence of posttraumatic stress disorder (PTSD) in the refugee population. In order to identify affected individuals and offer targeted help, there is an urgent need for easily understandable, reliable, valid, and efficient screening measures. The aim of the present study was to compare the diagnostic efficiency of the Process of Recognition and Orientation of Torture Victims in European Countries to Facilitate Care and Treatment (PROTECT) questionnaire (PQ) to that of the eight-item short-form Posttraumatic Diagnostic Scale (PDS-8) and the Patient Health Questionnaire (PHQ-9). Using structured clinical interviews, the prevalence rates of PTSD and major depression episode (MDE) were assessed in a refugee sample (N = 118), and receiver operating characteristic analyses were determined and compared. Of participants in the sample, 29.7%, 95% CI [22.0%, 38.5%], were diagnosed with PTSD and 33.1%, 95% CI [24.4%, 41.9%], were diagnosed with MDE. The area under the curve (AUC) for all measures was moderate, AUCs = 0.79-0.86; hence, measures did not differ in terms of their discriminatory abilities. Using the favored cutoff points, sensitivity and specificity were 80-97% and 60-70%, respectively. In terms of their discriminatory abilities, none of the investigated measures can be favored more than the others. Thus, for detection of these two disorders, the shorter PQ could be more efficient. Because the high co-occurrence of PTSD and MDE might limit the explanatory power of results in the present study, the findings should be cross-validated in the future.
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Affiliation(s)
- Nele Wulfes
- Department of Psychology, University of Hildesheim, Hildesheim, Germany
| | | | - Brigitte Buhr-Riehm
- Public Health Department Braunschweig, City of Braunschweig, Braunschweig, Germany
| | - Nina Heinrichs
- Department of Psychology, Technical University of Braunschweig, Braunschweig, Germany
| | - Christoph Kröger
- Department of Psychology, University of Hildesheim, Hildesheim, Germany
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23
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The importance of using reflective practice when working with refugees, asylum seekers and survivors of torture within IAPT. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThere is a very high prevalence of post-traumatic stress disorder (PTSD) within refugee populations and survivors of torture. Refugees, asylum seekers and survivors of torture who access IAPT (Improving Access to Psychological Therapies) can present with unique clinical challenges for cognitive behavioural therapy (CBT) therapists. The use of reflective practice can be beneficial particularly when there is added complexity in the client's clinical presentation. The aim of this paper is to provide an overview of how reflective practice can improve clinical work with this patient group and to identify some of the challenges that refugees, asylum seekers and survivors of torture may present with during therapy. The paper sets out how the use of the critical incident analysis model and clinical supervision can assist to develop reflective practice skills and improve the clinical practice of IAPT CBT therapists who work with diverse populations.
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24
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Yoo S, Sim M, Choi J, Jeon K, Shin J, Chung S, Hong SB, Lee SY, Hong SJ. Psychological Responses among Humidifier Disinfectant Disaster Victims and Their Families. J Korean Med Sci 2019; 34:e29. [PMID: 30686951 PMCID: PMC6345639 DOI: 10.3346/jkms.2019.34.e29] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/08/2018] [Indexed: 11/20/2022] Open
Abstract
To substantiate psychological symptoms following humidifier disinfectant (HD) disasters, counseling records of 26 victims and 92 family members of victims (45 were bereaved) were analyzed retrospectively. Among the victims, 34.6% had Clinical Global Impression-Severity scores of over 4, which meant they were moderately ill. While anxiety/fear and depression with respiratory symptoms were frequently observed in victims and family members, chronic psychological distress such as alcohol/smoking abuse and insomnia was relatively high in bereaved family members. In conclusion, it is important to provide mental health support for victims and their families, focusing on the characteristic symptoms of each group as well as monetary compensation.
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Affiliation(s)
- Seonyoung Yoo
- National Center for Trauma, National Center for Mental Health, Seoul, Korea
| | - Minyoung Sim
- National Center for Trauma, National Center for Mental Health, Seoul, Korea
- Department of Stress and Anxiety Disorder, National Center for Mental Health, Seoul, Korea
| | - Jungwon Choi
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Korea
| | - Kyoungsun Jeon
- Department of Stress and Anxiety Disorder, National Center for Mental Health, Seoul, Korea
| | - Jungha Shin
- Department of Stress and Anxiety Disorder, National Center for Mental Health, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Gouweloos-Trines J, Te Brake H, Sijbrandij M, Boelen PA, Brewin CR, Kleber RJ. A longitudinal evaluation of active outreach after an aeroplane crash: screening for post-traumatic stress disorder and depression and assessment of self-reported treatment needs. Eur J Psychotraumatol 2019; 10:1554406. [PMID: 30693072 PMCID: PMC6338285 DOI: 10.1080/20008198.2018.1554406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/06/2018] [Accepted: 11/14/2018] [Indexed: 01/20/2023] Open
Abstract
Background: In 2009, an aeroplane crashed near Amsterdam. To remedy unmet mental health needs, active outreach was used to identify victims at risk for post-traumatic stress disorder (PTSD) and depression. Objective: The active outreach strategy was evaluated by examining the accuracy of screening methods in predicting PTSD and depression, self-reported treatment needs, and the extent to which perceived treatment needs predict trajectories of PTSD. Method: In 112 adult survivors, semi-structured telephone interviews were held at 2 (T1, n = 76), 9 (T2, n = 77) and 44 months (T3, n = 55) after the crash. The Trauma Screening Questionnaire (TSQ) and the Patient Health Questionnaire-2 (PHQ-2) measured symptoms of PTSD and depression, respectively. At T3, a clinical interview assessed PTSD and depression diagnoses. Based on the TSQ scores at the three time-points, participants were grouped into five 'trajectories': resilient (n = 38), chronic (n = 30), recovery (n = 9), delayed onset (n = 9) and relapse (n = 3). Results: The TSQ accurately predicted PTSD at T3 (sensitivity: .75-1.00; specificity: .79-.90). The PHQ-2 showed modest accuracy (sensitivity: .38-.89; specificity: .67-.90). Both measures provided low positive predictive values (TSQ: 0.57; PHQ-2: .50 at T3). A number of participants reported unmet treatment needs (T1: 32.9%; T2: 19.5%; T3: 10.9%). Reporting unmet needs at T2 was more often assigned to a chronic PTSD trajectory compared to reporting no needs (p < .01). Conclusions: The prevalence of unmet needs at 44 months after the crash within a chronic PTSD trajectory indicated that active outreach may be warranted. Nevertheless, although the TSQ was accurate, many participants screening positive did not develop PTSD. This implies that, although active outreach may benefit those with unmet needs, it also has its costs in terms of possible unnecessary clinical assessments.
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Affiliation(s)
- Juul Gouweloos-Trines
- Knowledge Center Impact, Arq Psychotrauma Expert Group, Diemen, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Hans Te Brake
- Knowledge Center Impact, Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Free University of Amsterdam, Amsterdam, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rolf J Kleber
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
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Durodié B, Wainwright D. Terrorism and post-traumatic stress disorder: a historical review. Lancet Psychiatry 2019; 6:61-71. [PMID: 30342864 PMCID: PMC9939936 DOI: 10.1016/s2215-0366(18)30335-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/26/2022]
Abstract
Terror is a psychological state. Historically, most studies of terrorism focused on its societal purpose and structural consequences rather than mental health effects. That emphasis began to change shortly before the Sept 11, 2001, terrorist attacks. A vast expansion of research into post-traumatic stress disorder accompanied revisions to the classification of mental health disorders. The effect of terrorist incidents on those people now deemed vulnerable, both directly and indirectly, was actively sought. However, a review of more than 400 research articles (mostly published after Sept 11) on the association between terrorism and mental health reached the largely overlooked conclusion that terrorism is not terrorising-at least not in a way that causes a greater than expected frequency of post-traumatic stress disorder than other traumatic events. This conclusion is surprising given the emphasis on the psychological effects of terrorism in political discourse, media commentary, contemporary culture, and academic inquiry. Authorities might prefer to encourage an interpretation of terrorist incidents that highlights fortitude and courage rather than psychological vulnerability.
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Affiliation(s)
- Bill Durodié
- Department of Politics, Languages, and International Studies, University of Bath, Bath, UK.
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27
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Gobin M, Rubin GJ, Albert I, Beck A, Danese A, Greenberg N, Grey N, Smith P, Oliver I. Outcomes of Mental Health Screening for United Kingdom Nationals Affected by the 2015-2016 Terrorist Attacks in Tunisia, Paris, and Brussels. J Trauma Stress 2018; 31:471-479. [PMID: 30084509 DOI: 10.1002/jts.22317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/04/2018] [Accepted: 04/13/2018] [Indexed: 11/11/2022]
Abstract
Following several terrorist attacks in 2015 and 2016, a national program was set up to identify and support residents of England whose mental health had been affected. We report the outcomes of the program's screening and assessment components. Questionnaires and information about the program were mailed to 483 people and 49 families known to the police. Individuals who screened positive on an assessment for posttraumatic stress disorder, anxiety, depression, increased smoking, or problematic alcohol consumption were offered clinical assessment and referred to an appropriate National Health Service (NHS) service, if required. Of the 195 eligible people who returned our questionnaires, 179 (91.8%) screened positive on one or more measure. Following clinical assessment, 78 adults and three children were referred for treatment. The program was broadly successful in facilitating access to services. However, most people who had been directly exposed to the attacks did not participate and data protection issues limited communication with those who were affected. Further discussion of data protection concerns may help future programs operate more efficiently.
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Affiliation(s)
- Maya Gobin
- Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | - G James Rubin
- Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Idit Albert
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Alison Beck
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Andrea Danese
- Social, Genetic, and Developmental Psychiatry Centre, King's College, London, United Kingdom.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,National and Specialist CAMHS Trauma and Anxiety Clinic, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Hove, United Kingdom.,Department of Psychology, University of Sussex, Brighton, United Kingdom
| | - Patrick Smith
- Department of Psychology, King's College London, London, United Kingdom
| | - Isabel Oliver
- Field Epidemiology Service, Public Health England, Bristol, United Kingdom
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28
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Reed GM, Sharan P, Rebello TJ, Keeley JW, Elena Medina-Mora M, Gureje O, Luis Ayuso-Mateos J, Kanba S, Khoury B, Kogan CS, Krasnov VN, Maj M, de Jesus Mari J, Stein DJ, Zhao M, Akiyama T, Andrews HF, Asevedo E, Cheour M, Domínguez-Martínez T, El-Khoury J, Fiorillo A, Grenier J, Gupta N, Kola L, Kulygina M, Leal-Leturia I, Luciano M, Lusu B, Nicolas J, Martínez-López I, Matsumoto C, Umukoro Onofa L, Paterniti S, Purnima S, Robles R, Sahu MK, Sibeko G, Zhong N, First MB, Gaebel W, Lovell AM, Maruta T, Roberts MC, Pike KM. The ICD-11 developmental field study of reliability of diagnoses of high-burden mental disorders: results among adult patients in mental health settings of 13 countries. World Psychiatry 2018; 17:174-186. [PMID: 29856568 PMCID: PMC5980511 DOI: 10.1002/wps.20524] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11). The present study assessed inter-diagnostician reliability of mental disorders accounting for the greatest proportion of global disease burden and the highest levels of service utilization - schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear-related disorders, and disorders specifically associated with stress - among adult patients presenting for treatment at 28 participating centers in 13 countries. A concurrent joint-rater design was used, focusing specifically on whether two clinicians, relying on the same clinical information, agreed on the diagnosis when separately applying the ICD-11 diagnostic guidelines. A total of 1,806 patients were assessed by 339 clinicians in the local language. Intraclass kappa coefficients for diagnoses weighted by site and study prevalence ranged from 0.45 (dysthymic disorder) to 0.88 (social anxiety disorder) and would be considered moderate to almost perfect for all diagnoses. Overall, the reliability of the ICD-11 diagnostic guidelines was superior to that previously reported for equivalent ICD-10 guidelines. These data provide support for the suitability of the ICD-11 diagnostic guidelines for implementation at a global level. The findings will inform further revision of the ICD-11 diagnostic guidelines prior to their publication and the development of programs to support professional training and implementation of the ICD-11 by WHO member states.
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Affiliation(s)
- Geoffrey M Reed
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Tahilia J Rebello
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Nigeria
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid, IIS-P and Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka City, Japan
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Valery N Krasnov
- Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Min Zhao
- Shanghai Mental Health Center and Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | | | - Howard F Andrews
- New York State Psychiatric Institute, New York, NY, USA
- Departments of Biostatistics and Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Elson Asevedo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Majda Cheour
- Department of Psychiatry, Tunis Al Manar University and Al Razi Hospital, Tunis, Tunisia
| | - Tecelli Domínguez-Martínez
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
- Cátedras CONACYT, National Council for Science and Technology, Mexico City, Mexico
| | - Joseph El-Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jean Grenier
- Institut du Savoir Montfort - Hôpital Montfort & Université d'Ottawa, Ottawa, Ontario, Canada
| | - Nitin Gupta
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Lola Kola
- Department of Psychiatry, University of Ibadan, Nigeria
| | - Maya Kulygina
- Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Itziar Leal-Leturia
- Department of Psychiatry, Universidad Autonoma de Madrid, IIS-P and Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Bulumko Lusu
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | | | - I Martínez-López
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | - Sabrina Paterniti
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, and Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Shivani Purnima
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Manoj K Sahu
- Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, India
| | - Goodman Sibeko
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Na Zhong
- Shanghai Mental Health Center and Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Anne M Lovell
- Institut National de la Santé et de la Recherche Médicale U988, Paris, France
| | - Toshimasa Maruta
- Health Management Center, Seitoku University, Matsudo City, Japan
| | - Michael C Roberts
- Office of Graduate Studies and Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Kathleen M Pike
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
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29
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Daffey-Moore E. Why is building psychological resilience relevant to UK Service personnel in order to improve military mental health? BMJ Mil Health 2018; 166:89-94. [DOI: 10.1136/jramc-2018-000962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 11/04/2022]
Abstract
This article will aim to give an overview of stress and resilience, briefly exploring current definitions. It will try to identify why psychological resilience is relevant in the military context and suggest why the UK military could be exploring data from other countries and welfare bodies to enhance their own stress management policies in order to improve military mental health. The MOD (Ministry of Defence) understands their duty of care and has developed a clear strategic intent to tackle the increasing numbers of personnel developing mental health issues. While all three Services currently have in place comprehensive predeployment and postdeployment strategies to signpost individuals, there is a lack of psychological fitness training. Examining resilience in the civilian sector has identified the relevance for individuals to be psychologically resilient in any context. The skills and techniques of the Special Forces are now becoming popular in the business world to increase resilience in individuals and their organisations. The MOD could improve military mental health through relevant strategies aimed at building resilience.
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Rubin GJ, Webster R, Rubin AN, Amlot R, Grey N, Greenberg N. Public attitudes in England towards the sharing of personal data following a mass casualty incident: a cross-sectional study. BMJ Open 2018; 8:e022852. [PMID: 29780033 PMCID: PMC5961558 DOI: 10.1136/bmjopen-2018-022852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To assess public attitudes towards data sharing to facilitate a mental health screening programme for people caught up in a mass casualty incident. DESIGN Two, identical, cross-sectional, online surveys, using quotas to ensure demographic representativeness of people aged 18-65 years in England. Participants were randomly allocated to consider a scenario in which they witness a terrorism-related radiation incident or mass shooting, after which a police officer records their contact details. SETTING Participants were drawn from an online panel maintained by a market research company. Surveys were conducted before and immediately after a series of terrorist attacks and a large tower block fire occurred in England. PARTICIPANTS One thousand people aged 18-65 years participated in each survey. MAIN OUTCOME MEASURES Three questions asking participants if it would be acceptable for police to share their contact details, without asking first, with 'a health-related government organisation, so they can send you a questionnaire to find out if you might benefit from extra care or support', 'a specialist NHS team, to provide you with information about ways to get support for any physical or mental health issues' and 'your GP, so they can check how you are doing'. RESULTS A minority of participants reported that it would be definitely not acceptable for their details to be shared with the government organisation (n=259, 13.0%), the National Health Service (NHS) (n=141, 7.1%) and their general practitioner (GP) (n=166, 8.3%). There was a small, but significant increase in acceptability for the radiation incident compared with the mass shooting. No major differences were observed between the preincident and postincident surveys. CONCLUSIONS Although most people believe it is acceptable for their details to be shared in order to facilitate a mental health response to a major incident, care must be taken to communicate with those affected about how their information will be used.
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Affiliation(s)
- G James Rubin
- Department of Psychological Medicine, King's College London, London, UK
| | - Rebecca Webster
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Richard Amlot
- Behavioural Science Emergency Response Department Science and Technology (ERD S&T), Health Protection Directorate, Public Health England, Porton Down, UK
| | - Nick Grey
- Mood and Anxiety Clinical Academic Group, Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, London, UK
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31
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Alvarez-Monjarás M, Bucay-Harari L. Modelo de tamizaje, atención y monitoreo de la salud mental para adultos en casos de desastre. SALUD PUBLICA DE MEXICO 2018. [DOI: 10.21149/9340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Los desastres afectan a todos los miembros de una comunidad;sin embargo, no todos reaccionan de la misma forma. Por ello, resulta esencial identificar quiénes requieren intervenciones especializadas, así como establecer mecanismos de referencia y atención adecuados para los diferentes servicios de salud mental. Los autores sintetizan recomendaciones de intervenciones basadas en evidencia para informar los esfuerzos de atención a la salud mental para poblaciones expuestas a desastres, específicamente respecto al proceso de tamizaje, referencia y atención psicológica. Asimismo, proponen un modelo comprensivo y de acción coordinada, que utilice los servicios e infraestructura ya existentes, con el objetivo de incentivar tanto la colaboración interinstitucional a futuro, como una mayor profesionalización de la saludmental pública en México.
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Richards-Belle A, Mouncey PR, Wade D, Brewin CR, Emerson LM, Grieve R, Harrison DA, Harvey S, Howell D, Mythen M, Sadique Z, Smyth D, Weinman J, Welch J, Rowan KM. Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients (POPPI): protocol for a cluster-randomised clinical trial of a complex intervention. BMJ Open 2018; 8:e020908. [PMID: 29439083 PMCID: PMC5879925 DOI: 10.1136/bmjopen-2017-020908] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Acute psychological stress, as well as unusual experiences including hallucinations and delusions, are common in critical care unit patients and have been linked to post-critical care psychological morbidity such as post-traumatic stress disorder (PTSD), depression and anxiety. Little high-quality research has been conducted to evaluate psychological interventions that could alleviate longer-term psychological morbidity in the critical care unit setting. Our research team developed and piloted a nurse-led psychological intervention, aimed at reducing patient-reported PTSD symptom severity and other adverse psychological outcomes at 6 months, for evaluation in the POPPI trial. METHODS AND ANALYSIS This is a multicentre, parallel group, cluster-randomised clinical trial with a staggered roll-out of the intervention. The trial is being carried out at 24 (12 intervention, 12 control) NHS adult, general, critical care units in the UK and is evaluating the clinical effectiveness and cost-effectiveness of a nurse-led preventative psychological intervention in reducing patient-reported PTSD symptom severity and other psychological morbidity at 6 months. All sites deliver usual care for 5 months (baseline period). Intervention group sites are then trained to carry out the POPPI intervention, and transition to delivering the intervention for the rest of the recruitment period. Control group sites deliver usual care for the duration of the recruitment period. The trial also includes a process evaluation conducted independently of the trial team. ETHICS AND DISSEMINATION This protocol was reviewed and approved by the National Research Ethics Service South Central - Oxford B Research Ethics Committee (reference: 15/SC/0287). The first patient was recruited in September 2015 and results will be disseminated in 2018. The results will be presented at national and international conferences and published in peer reviewed medical journals. TRIAL REGISTRATION NUMBER ISRCTN53448131; Pre-results.
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Affiliation(s)
- Alvin Richards-Belle
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Dorothy Wade
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chris R Brewin
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Lydia M Emerson
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David A Harrison
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Sheila Harvey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - David Howell
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Monty Mythen
- NIHR Biomedical Research Centre, University College London/University College London Hospitals, Institute of Sport Exercise and Health (ISEH), London, UK
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Deborah Smyth
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - John Weinman
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - John Welch
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
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Haga JM, Thoresen S, Stene LE, Wentzel-Larsen T, Dyb G. Healthcare to parents of young terrorism survivors: a registry-based study in Norway. BMJ Open 2017; 7:e018358. [PMID: 29273662 PMCID: PMC5778306 DOI: 10.1136/bmjopen-2017-018358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess changes in parents' short-term and long-term primary and specialised healthcare consumption following a terrorist attack threatening the lives of their children. DESIGN Registry-based study comparing parental healthcare service consumption in the 3 years before and the 3 years after a terrorist attack. SETTING The aftermath of the Utøya terrorist attack. The regular, publicly funded, universal healthcare system in Norway. INTERVENTION Parents learning of a terrorist attack on their adolescent and young adult children. PARTICIPANTS Mothers (n=226) and fathers (n=141) of a total of 263 survivors of the Utøya terrorist attack (54.6% of all survivors 13-33 years, n=482). MAIN OUTCOME MEASURES We report primary and specialised somatic and mental healthcare service consumption in the early (0-6 months) and delayed (>6-36 months) aftermath of the attack, both in terms of frequency of services consumed (assessed by age-adjusted negative binomial hurdle regression) and proportions of mothers and fathers provided for (mean semiannual values). The predisaster and postdisaster rates were compared by rate ratios (RRs), and 95% CI were generated through bootstrap replications. RESULTS Frequency of primary healthcare service consumption increased significantly in both mothers and fathers in the early aftermath of the attack (mothers: RR=1.97, 95% CI 1.76 to 2.23; fathers: RR=1.73, 95% CI 1.36 to 2.29) and remained significantly elevated throughout the delayed aftermath. In the specialised mental healthcare services, a significant increase in the frequency of service consumption was observed in mothers only (early: RR=7.00, 95% CI 3.86 to 19.02; delayed: RR=3.20, 95% CI 1.49 to 9.49). In specialised somatic healthcare, no significant change was found. CONCLUSION Following terrorist attacks, healthcare providers must prepare for increased healthcare needs in survivors and their close family members, such as parents. Needs may present shortly after the attack and require long-term follow-up.
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Affiliation(s)
- Jon Magnus Haga
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siri Thoresen
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Lise Eilin Stene
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Greenberg N, Wessely S. Mental health interventions for people involved in disasters: what not to do. World Psychiatry 2017; 16:249-250. [PMID: 28941097 PMCID: PMC5608849 DOI: 10.1002/wps.20445] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Neil Greenberg
- King's Centre for Military Health Research, King's College LondonLondonUK
| | - Simon Wessely
- King's Centre for Military Health Research, King's College LondonLondonUK
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Brewin CR, Cloitre M, Hyland P, Shevlin M, Maercker A, Bryant RA, Humayun A, Jones LM, Kagee A, Rousseau C, Somasundaram D, Suzuki Y, Wessely S, van Ommeren M, Reed GM. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev 2017; 58:1-15. [PMID: 29029837 DOI: 10.1016/j.cpr.2017.09.001] [Citation(s) in RCA: 327] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/18/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022]
Abstract
The World Health Organization's proposals for posttraumatic stress disorder (PTSD) in the 11th edition of the International Classification of Diseases, scheduled for release in 2018, involve a very brief set of symptoms and a distinction between two sibling disorders, PTSD and Complex PTSD. This review of studies conducted to test the validity and implications of the diagnostic proposals generally supports the proposed 3-factor structure of PTSD symptoms, the 6-factor structure of Complex PTSD symptoms, and the distinction between PTSD and Complex PTSD. Estimates derived from DSM-based items suggest the likely prevalence of ICD-11 PTSD in adults is lower than ICD-10 PTSD and lower than DSM-IV or DSM-5 PTSD, but this may change with the development of items that directly measure the ICD-11 re-experiencing requirement. Preliminary evidence suggests the prevalence of ICD-11 PTSD in community samples of children and adolescents is similar to DSM-IV and DSM-5. ICD-11 PTSD detects some individuals with significant impairment who would not receive a diagnosis under DSM-IV or DSM-5. ICD-11 CPTSD identifies a distinct group who have more often experienced multiple and sustained traumas and have greater functional impairment than those with PTSD.
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Affiliation(s)
- Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Marylène Cloitre
- Division of Dissemination and Training, National Center for PTSD, Menlo Park, CA, USA
| | - Philip Hyland
- School of Business, National College of Ireland, Dublin, Ireland
| | - Mark Shevlin
- School of Psychology, University of Ulster, Coleraine, North Ireland
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology, University of Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Lynne M Jones
- FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Cécile Rousseau
- Department of Psychiatry, McGill University Health Center, Montreal, Canada
| | | | - Yuriko Suzuki
- National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | | | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland; Global Mental Health Program, Columbia University Medical Center, New York, NY, USA
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van der Meer CAI, Bakker A, Schrieken BAL, Hoofwijk MC, Olff M. Screening for trauma-related symptoms via a smartphone app: The validity of Smart Assessment on your Mobile in referred police officers. Int J Methods Psychiatr Res 2017; 26:e1579. [PMID: 28948699 PMCID: PMC5639363 DOI: 10.1002/mpr.1579] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 06/09/2017] [Accepted: 06/26/2017] [Indexed: 01/04/2023] Open
Abstract
To facilitate easily accessible screening for trauma-related symptoms, a web-based application called Smart Assessment on your Mobile (SAM) was developed. In this study, we examined whether SAM was able to accurately identify posttraumatic stress disorder (PTSD) and depression in adults. Eighty-nine referred police officers completed SAM, containing the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (PCL-5) and the Depression Anxiety and Stress Scale (DASS-21), on their own device prior to a diagnostic interview where the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and Structured Clinical Interview for DSM-IV (SCID-I/P) were administered. Results showed a substantial agreement between SAM and the diagnostic interview in the assessment of PTSD and depression. An optimal trade-off between sensitivity (89%) and specificity (68%) levels was found at a cut-off score of 31 on the PTSD Checklist for DSM-5 (area under the curve = 0.845, 95% CI [0.765, 0.925], diagnostic odds ratio = 15.97). This is one of the first studies to support the validity and reliability of a mobile screener following trauma. SAM may facilitate screening for trauma-related symptoms on a large scale and could be a first step in a stepped-care model for trauma survivors to help identify individuals who need further diagnostics and care.
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Affiliation(s)
| | - Anne Bakker
- Academic Medical Centre, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Miranda Olff
- Academic Medical Centre, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
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Haga JM, Stene LE, Thoresen S, Wentzel-Larsen T, Dyb G. Does posttraumatic stress predict frequency of general practitioner visits in parents of terrorism survivors? A longitudinal study. Eur J Psychotraumatol 2017; 8:1389206. [PMID: 29379587 PMCID: PMC5784312 DOI: 10.1080/20008198.2017.1389206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/22/2017] [Indexed: 12/05/2022] Open
Abstract
Background: Life threat to children may induce severe posttraumatic stress reactions (PTSR) in parents. Troubled mothers and fathers may turn to their general practitioner (GP) for help. Objective: This study investigated frequency of GP visits in mothers and fathers of adolescent and young adult terrorism survivors related to their own PTSR and PTSR in their surviving children. Method: Self-reported early PTSR (4-5 months post-disaster) in 196 mothers, 113 fathers and 240 survivors of the 2011 Utøya terrorist attack were linked to parents' three years pre- and post-disaster primary healthcare data from a national reimbursement claims database. Frequency of parents' GP visits was regressed on parent and child PTSR, first separately, then in combination, and finally by including an interaction. Negative binominal regressions, adjusted for parents' pre-disaster GP visits and socio-demography, were performed separately for mothers and fathers and for the early (<6 months) and delayed (6-36 months) aftermath of the terrorist attack. Results: Parents' early PTSR were significantly associated with higher early frequency of GP visits in mothers (rate ratio, RR = 1.31, 95%CI 1.09-1.56) and fathers (RR = 1.40, 95%CI 1.03-1.91). In the delayed aftermath, early PTSR were significantly associated with higher frequency of GP visits in mothers only (RR = 1.21, 95%CI 1.04-1.41). Early PTSR in children were not significantly associated with an overall increase in GP visits. On the contrary, in mothers, child PTSR predicted significant decrease in GP visits the delayed aftermath (RR = 0.83, 95%CI 0.71-0.97). Conclusions: Our study suggests that GPs may play an important role in identifying and providing for parents' post-disaster healthcare needs. GPs need to be aware that distressed individuals are likely to approach them following disasters and must prepare for both short- and long-term healthcare needs.
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Affiliation(s)
- Jon Magnus Haga
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lise Eilin Stene
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway.,Department of Social Paediatrics, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Siri Thoresen
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway.,Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Stene LE, Wentzel-Larsen T, Dyb G. Healthcare Needs, Experiences and Satisfaction after Terrorism: A Longitudinal Study of Survivors from the Utøya Attack. Front Psychol 2016; 7:1809. [PMID: 27933008 PMCID: PMC5121283 DOI: 10.3389/fpsyg.2016.01809] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 11/02/2016] [Indexed: 11/13/2022] Open
Abstract
Background: Public health outreach programs have been developed in order to ensure that needs are met after disasters. However, little is known about survivors' experiences with post-terror healthcare. In the present study, our objectives were to (1) describe survivors' experiences with post-terror healthcare, (2) identify factors associated with reports of unmet healthcare needs, and (3) examine the relationship between socio-demographic characteristics, healthcare experiences and satisfaction. Methods: Our study comprised three waves of semi-structured interviews with 261/490 (53%) survivors of the Utøya mass shooting. We applied Pearson's chi-squared tests (categorical variables) and independent t-tests (continuous variables) to compare survivors by whether or not they reported higher perceived needs than received help for psychological reactions and physical health problems, respectively. Ordinal regression analyses were applied to examine whether socio-demographic characteristics and healthcare experiences were associated with dissatisfaction. Results: Altogether 127 (49%) survivors reported very high/high help needs for psychological reactions, and 43 (17%) for attack-related physical health problems. Unmet healthcare needs were associated with higher levels of posttraumatic stress, psychological distress, somatic symptoms and less social support. Survivors with immigrant backgrounds and injured survivors who were not admitted to hospital reported unmet needs for physical health problems more often. After adjustments for socio-demographic characteristics, immigrant origin was associated with dissatisfaction with post-terror healthcare. After additionally adjusting for healthcare experiences, poor rating of the overall organization and accessibility of healthcare remained significantly associated with dissatisfaction. Conclusions: Most survivors were satisfied with the post-terror healthcare they received, yet our findings indicate that increased attention to the physical health of non-hospitalized terrorism survivors is required. Furthermore, in future outreach, particular attention should be paid to the healthcare needs of survivors with immigrant background.
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Affiliation(s)
- Lise E Stene
- Norwegian Centre for Violence and Traumatic Stress Studies Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress StudiesOslo, Norway; Centre for Child and Adolescent Mental Health, Eastern and Southern NorwayOslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress StudiesOslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of OsloOslo, Norway
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Psychometric Properties of Disaster Event Reaction Items From the Crisis Counseling Individual/Family Encounter Log. Disaster Med Public Health Prep 2016; 10:822-831. [PMID: 27515401 DOI: 10.1017/dmp.2016.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this article was to examine the psychometric properties of the Crisis Counseling Assistance and Training Program (CCP) data collection instrument, the Individual/Family Encounter Log (IFEL). Data collected from disaster survivors included how they reacted to events in emotional, behavioral, physical, and cognitive domains. These domains are based on conceptual categorization of event reactions and allow CCP staff to provide survivors with referrals to appropriate behavioral health support resources, if warranted. METHODS This study explored the factor structure of these survey items to determine how best to use the available information as a screen of disaster-related behavioral health indicators. Specifically, our first research question explored and confirmed the optimal factor structure of the event reaction items, and our second question examined whether the new factor structure was similar across disaster types: hurricanes, tornadoes, floods, and wildfires. Using a factor analytic technique, we tested whether our event reaction outcomes achieved consistent and reliable measurement across different disaster situations. Finally, we assessed how the new subscales were correlated with the type of risk to which CCP disaster survivors were exposed. RESULTS Our analyses revealed 3 factors: (1) depressive-like, (2) anxiety-like, and (3) somatic. In addition, we found that these factors were coherent for hurricanes, floods, and wildfires, although the basic factor structure was not equivalent for tornadoes. CONCLUSION Implications for use of the IFEL in disaster preparedness, response, and recovery are discussed. (Disaster Med Public Health Preparedness. 2016;10:822-831).
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Wiström ED, Stene LE, Dyb G. Etter Utøya-angrepet – hvem fikk tidlig hjelp? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1223-6. [DOI: 10.4045/tidsskr.15.0691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Haga JM, Stene LE, Wentzel-Larsen T, Thoresen S, Dyb G. Early postdisaster health outreach to modern families: a cross-sectional study. BMJ Open 2015; 5:e009402. [PMID: 26681694 PMCID: PMC4691779 DOI: 10.1136/bmjopen-2015-009402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/07/2015] [Accepted: 10/21/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This study investigated whether the early outreach programme following the Utøya massacre reached out to the parents of the young survivors. Additionally, we explored whether specialised mental healthcare services were provided to parents presenting elevated levels of PTSD and depression reactions. DESIGN Cross-sectional survey, face-to-face interviews and questionnaires. SETTING Norway, aftermath of the Utøya massacre, 4-7 months postdisaster. BACKGROUND Following the Utøya massacre, proactive early outreach programmes were launched in all municipalities that were affected, facilitating access to appropriate healthcare services. PARTICIPANTS A total of 453 parents of the Utøya survivors aged 13-33 years took part. Overall, 59.8% of the survivors were represented by one or more parent in our study. MAIN OUTCOME MEASURES Engagement with the proactive early outreach programme (psychosocial crisis teams and contact persons in the municipalities), utilisation of healthcare services (general practitioner and specialised mental healthcare services) and mental distress (UCLA PTSD-RI and HSCL-8). RESULTS A majority of the participants reported contact with the proactive early outreach programme (crisis team, 73.9%; and contact person, 73.0%). Failure of outreach to parents was significantly associated with non-intact family structure (crisis team: OR 1.69, 95% CI 1.05 to 2.72, p=0.032) and non-Norwegian origin (crisis team: OR 2.39, 95% CI 1.14 to 4.98, p=0.021). Gender of the parent was not significantly associated with failure of the outreach programme (p ≥ 0.075). Provision of specialised mental healthcare services was significantly associated with higher levels of PTSD (OR 2.08, 95% CI 1.55 to 2.79, p<0.001) and depression (OR 2.42, 95% CI 1.71 to 3.43, p<0.001) and not with the sociodemography (p ≥ 0.122). CONCLUSIONS Proactive early outreach strategies may be helpful in identifying healthcare needs and facilitating access to the required services in a population struck by disaster. Our findings prompt increased attention to the complexity of family structures in reaching out universally to modern families following a disaster.
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Affiliation(s)
- Jon Magnus Haga
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Lise Eilin Stene
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Department of Social Pediatrics, Women and Children's Division, Oslo University Hospital, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Siri Thoresen
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
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Affiliation(s)
- Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Sarah Cosgrove
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Neil P Robert
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
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Impact of the Boston Marathon Bombing and Its Aftermath on Refugees and Survivors of Torture. J Immigr Minor Health 2015; 18:764-770. [PMID: 26289501 DOI: 10.1007/s10903-015-0263-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
On April 15, 2013, Boston residents and guests gathered for the Boston Marathon. Two explosives at the finish line killed three people and injured hundreds of others. As part of our clinical encounters, patients of the Boston Center for Refugee Health & Human Rights were asked about the marathon bombing. We were concerned about the high level of armed security as many of our patients had been detained in their countries of origin. Eighty patients seen between April 16 and July 7, 2013 were asked about their experience of the Boston Marathon bombing and its aftermath. A retrospective chart review was undertaken and data analyzed using Atlas.ti & SPSS. Approximately 86 % of those interviewed were reminded of their past trauma. The following themes emerged: triggering and trauma related symptoms, content specific cognitive schemas, recognition of the universality of violence, fears of discrimination, issues surrounding safety, and specific concerns of Muslims.
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Systematic Consensus Building on Disaster Mental Health Services After the Great East Japan Earthquake by Phase. Disaster Med Public Health Prep 2015; 9:359-66. [PMID: 25905559 DOI: 10.1017/dmp.2015.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We intended to build consensus on appropriate disaster mental health services among professionals working in the area affected by the Great East Japan Earthquake. METHODS We focused on the first 3 months after the disaster, divided into 3 phases: immediate aftermath, acute phase, and midphase. We adopted the Delphi process and asked our survey participants (n=115) to rate the appropriateness of specific mental health services in each phase and comment on them. We repeated this process 3 times, giving participants feedback on the results of the previous round. Through this process, we determined the criterion for positive consensus for each item as having the agreement of more than 80% of the participants. RESULTS We found that the importance of acute psychiatric care and prescribing regular medication for psychiatric patients gained positive consensus in the immediate aftermath and acute phase. Counseling and psychoeducation after traumatic events or provision of information gained consensus in the acute phase and midphase, and screening of mental distress gained consensus in the midphase. CONCLUSIONS Higher priority was given to continuous psychiatric services in the immediate aftermath and mental health activities in later phases.
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Stene LE, Dyb G. Health service utilization after terrorism: a longitudinal study of survivors of the 2011 Utøya attack in Norway. BMC Health Serv Res 2015; 15:158. [PMID: 25890344 PMCID: PMC4457986 DOI: 10.1186/s12913-015-0811-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 03/23/2015] [Indexed: 12/04/2022] Open
Abstract
Background For effective organization of health services after terror attacks, it is vital to gain insight into survivors’ health service utilization. Following the 2011 Utøya mass shooting in Norway, a proactive outreach programme was launched to prevent unmet help needs. All survivors received health services during the first five months, yet an important minority were not proactively followed-up. This study assessed the prevalence of health service utilization and factors associated with mental health service utilization among the survivors 5–15 months after the attack. Methods The study comprised data from interviews using standardised questionnaires performed 4–5 (T1) and 14–15 (T2) months after the attack. Altogether 281 of 490 (57.3%) survivors answered questions on health service utilization at T2 and were included in this study. Users and non-users of mental health services were compared using Pearson Chi Square tests (categorical variables) and independent t-tests (continuous variables). Multivariate logistic regression analyses were conducted to examine the relationship between mental health service utilization at T2 and early (model 1) and concurrent (model 2) posttraumatic stress reactions, mental distress and somatic symptoms. Both models were adjusted for age, gender and predisaster utilization of mental health services. Results Altogether 267 (95.0%) of 281 survivors reported contact with health services at T2, including 254 (90.4%) with ≥1 types of primary care services; and 192 (68.3%) with mental health services. In bivariate analyses, mental health service utilization was associated with female gender, injuries, PTSD, mental distress, somatic symptoms, and sleep problems. After multivariate adjustments for early symptom levels (model 1), only mental distress remained significantly associated with mental health service utilization at T2 (OR 2.8, 95% CI 1.2-6.8). In the analysis adjusting for concurrent symptom levels (model 2), only somatic symptoms were associated with mental health service utilization (OR 4.4, 95% CI 1.8-10.8). Conclusions The high utilization of both primary and secondary health services among young survivors 5–15 months after the attack underscores the importance of allocating resources to meet the increased demand for services over a longer time period. The results further highlight the need to address somatic symptoms in disaster survivors who receive mental health services. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0811-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Gullhaugveien 1-3, NO-0484, Oslo, Norway.
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Gullhaugveien 1-3, NO-0484, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Shapiro E, Laub B. Early EMDR Intervention Following a Community Critical Incident: A Randomized Clinical Trial. JOURNAL OF EMDR PRACTICE AND RESEARCH 2015. [DOI: 10.1891/1933-3196.9.1.17] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the efficacy of early eye movement desensitization and reprocessing (EMDR) intervention using the EMDR recent traumatic episode protocol (R-TEP) after a traumatic community event whereby a missile hit a building in a crowded area of a town. In a waitlist/delayed treatment parallel-group randomized controlled trial, 17 survivors with posttraumatic distress were treated with EMDR therapy using the R-TEP protocol. Volunteer EMDR practitioners conducted treatment on 2 consecutive days. Participants were randomly allocated to either immediate or waitlist/delayed treatment conditions. Assessments with Impact of Event Scale-Revised (IES-R) and the Patient Health Questionnaire (PHQ-9) brief depression inventory took place at pre- and posttreatment and at 3 months follow-up. At 1 week posttreatment, the scores of the immediate treatment group were significantly improved on the IES-R compared to the waitlist/delayed treatment group, who showed no improvement prior to their treatment. At 3 months follow-up, results on the IES-R were maintained and there was a significant improvement on PHQ-9 scores. This pilot study provides preliminary evidence, supporting the efficacy of EMDR R-TEP for reducing posttrauma stress among civilian victims of hostility, and shows that this model of intervention briefly augmenting local mental health services following large-scale traumatic incidents, using an EMDR intervention on 2 consecutive days may be effective.
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Morina N, van Emmerik AAP, Andrews B, Brewin CR. Comparison of DSM-IV and proposed ICD-11 formulations of PTSD among civilian survivors of war and war veterans. J Trauma Stress 2014; 27:647-54. [PMID: 25418442 DOI: 10.1002/jts.21969] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 07/22/2014] [Accepted: 08/04/2014] [Indexed: 11/10/2022]
Abstract
The World Health Organization recently proposed a reformulation of posttraumatic stress disorder (PTSD) for the 11(th) edition of the International Classification of Diseases (ICD-11), employing only 6 symptoms. The aim of this study was to investigate the impact of this reformulation of PTSD as compared to criteria according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994) on the prevalence of current PTSD as well as comorbid major depressive episode and anxiety disorders other than PTSD. Study 1 involved previously collected interviews with 560 Kosovar civilian war survivors; Study 2 employed a previously collected sample of 142 British war veterans. Results revealed no change in the diagnostic status under the criteria proposed for ICD-11 in 87.5% of civilian war survivors and 91.5% of war veterans. Participants who only met the newly proposed criteria showed lower rates of comorbid major depressive episode than participants who only met DSM-IV criteria (13.6% vs. 43.8% respectively). Rates of comorbid anxiety disorders did not significantly differ between participants who lost or gained a PTSD diagnosis under the proposed criteria.
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Affiliation(s)
- Nexhmedin Morina
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Close RM, Maguire H, Etherington G, Brewin CR, Fong K, Saliba V, Barker RM, Leonardi GS. Preparedness for a major incident: creation of an epidemiology protocol for a health protection register in England. ENVIRONMENT INTERNATIONAL 2014; 72:75-82. [PMID: 24928282 DOI: 10.1016/j.envint.2014.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 04/29/2014] [Accepted: 05/01/2014] [Indexed: 06/03/2023]
Abstract
Large incidents and natural disasters are on the increase globally. They can have a major impact lasting many years or decades; and can affect large groups of people including those that are more susceptible to adverse consequences. Following a major incident, it may be considered necessary to establish a register of those people affected by the incident to provide appropriate advice on relevant immediate and longer-term public health interventions that may be required, provide reassurance to the public that their care is paramount, to reassure the worried well to avoid them inappropriately overwhelming local services, and to facilitate epidemiological investigations. Arrangements for the prompt follow-up of populations after large incidents or disasters have been agreed in England and a protocol for establishing a register of individuals potentially affected by a large incident has been developed. It is important for countries to have a protocol for implementing a health register if the circumstances require one to be in place, and are supported by Public Health Authorities. Health registers facilitate the initial descriptive epidemiology of exposure and provide the opportunity of carrying out long term analytical studies on the affected population. Such epidemiological studies provide a greater understanding of the impact that a large incident can have on health, which in turn helps in the planning of health care provision. Registers can also assist more directly in providing access to individuals in need of physical and mental health interventions. The challenge that still remains is to formally pilot the register in the field and refine it based on that experience.
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Affiliation(s)
- R M Close
- Department of Epidemiology, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK; Field Epidemiology Training Programme (FETP), Public Health England, UK; European Programme for Intervention Epidemiology Training, ECDC, Stockholm, Sweden.
| | - H Maguire
- European Programme for Intervention Epidemiology Training, ECDC, Stockholm, Sweden; Field Epidemiology Services, Public Health England, Victoria, London, UK
| | - G Etherington
- Department of Toxicology, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK
| | - C R Brewin
- Department of Psychology, University College London, UK
| | - K Fong
- Department of Emergency Medicine, University College Hospital, London, UK
| | - V Saliba
- North East & North Central London Health Protection Team, Public Health England, London, UK
| | - R M Barker
- Emergency Response Department, Public Health England, UK
| | - G S Leonardi
- Department of Epidemiology, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK; London School of Hygiene and Tropical Medicine, London, UK
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Welch AE, Debchoudhury I, Jordan HT, Petrsoric LJ, Farfel MR, Cone JE. Translating research into action: An evaluation of the World Trade Center Health Registry's Treatment Referral Program. DISASTER HEALTH 2014; 2:97-105. [PMID: 28229004 DOI: 10.4161/dish.28219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/09/2014] [Accepted: 02/13/2014] [Indexed: 11/19/2022]
Abstract
This manuscript describes the design, implementation and evaluation of the World Trade Center (WTC) Health Registry's Treatment Referral Program (TRP), created to respond to enrollees' self-reported 9/11-related physical and mental health needs and promote the use of WTC-specific health care. In 2009-2011, the TRP conducted personalized outreach, including an individualized educational mailing and telephone follow-up to 7,518 selected enrollees who resided in New York City, did not participate in rescue/recovery work, and reported symptoms of 9/11-related physical conditions or posttraumatic stress disorder (PTSD) on their most recently completed Registry survey. TRP staff spoke with enrollees to address barriers to care and schedule appointments at the WTC Environmental Health Center for those eligible. We assessed three nested outcomes: TRP participation (e.g., contact with TRP staff), scheduling appointments, and keeping scheduled appointments. A total of 1,232 (16.4%) eligible enrollees participated in the TRP; 32% of them scheduled a first-time appointment. We reached 84% of participants who scheduled appointments; 79.4% reported having kept the appointment. Scheduling an appointment, but not keeping it, was associated with self-reported unmet health care need, PTSD, and poor functioning (≥14 days of poor physical or mental health in the past 30 days) (P < 0.05). Neither scheduling nor keeping an appointment was associated with demographic characteristics. Successful outreach to disaster-exposed populations may require a sustained effort that employs a variety of methods in order to encourage and facilitate use of post-disaster services. Findings from this evaluation can inform outreach to the population exposed to 9/11 being conducted by other organizations.
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Affiliation(s)
- Alice E Welch
- New York City Department of Health and Mental Hygiene ; Queens, NY USA
| | | | - Hannah T Jordan
- New York City Department of Health and Mental Hygiene ; Queens, NY USA
| | - Lysa J Petrsoric
- New York City Department of Health and Mental Hygiene ; Queens, NY USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene ; Queens, NY USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene ; Queens, NY USA
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Bryant RA, Waters E, Gibbs L, Gallagher HC, Pattison P, Lusher D, MacDougall C, Harms L, Block K, Snowdon E, Sinnott V, Ireton G, Richardson J, Forbes D. Psychological outcomes following the Victorian Black Saturday bushfires. Aust N Z J Psychiatry 2014; 48:634-43. [PMID: 24852323 DOI: 10.1177/0004867414534476] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to map the prevalence and predictors of psychological outcomes in affected communities 3-4 years after the Black Saturday bushfires in the state of Victoria, Australia. METHODS Baseline assessment of a longitudinal cohort study in high-, medium-, and low-affected communities in Victoria. Participants included 1017 residents of high-, medium-, and low-affected fire communities. Participants were surveyed by means of a telephone and web-based interview between December 2011 and January 2013. The survey included measures of fire-related post-traumatic stress disorder (PTSD) and general PTSD from other traumatic events, major depressive episode, alcohol use, and general psychological distress. RESULTS The majority of respondents in the high- (77.3%), medium- (81.3%), and low-affected (84.9%) communities reported no psychological distress on the K6 screening scale. More participants in the high-affected communities (15.6%) reported probable PTSD linked to the bushfires than medium- (7.2%) and low-affected (1.0%) communities (odds ratio (OR): 4.57, 95% confidence interval (CI): 2.61-8.00, p = 0.000). Similar patterns were observed for depression (12.9%, 8.8%, 6.3%, respectively) (OR: 1.83, 95% CI: 1.17-2.85, p = 0.008) and severe psychological distress (9.8%, 5.0%, 4.9%, respectively) (OR: 2.08, 95% CI: 1.23-3.55, p = 0.007). All communities reported elevated rates of heavy drinking (24.7%, 18.7%, 19.6%, respectively); however, these were higher in the high-affected communities (OR: 1.39, 95% CI: 1.01-1.89, p = 0.04). Severe psychological distress was predicted by fear for one's life in the bushfires, death of someone close to them in the bushfires, and subsequent stressors. One-third of those with severe psychological distress did not receive mental health assistance in the previous month. CONCLUSIONS Several years following the Black Saturday bushfires the majority of affected people demonstrated resilience without indications of psychological distress. A significant minority of people in the high-affected communities reported persistent PTSD, depression, and psychological distress, indicating the need for promotion of the use of health and complementary services, community-based initiatives, and family and other informal supports, to target these persistent problems.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia Emergency Services, Australian Red Cross, Melbourne, Australia
| | - Elizabeth Waters
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Lisa Gibbs
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - H Colin Gallagher
- School of Psychological Sciences, University of Melbourne, Australia
| | - Philippa Pattison
- School of Psychological Sciences, University of Melbourne, Australia
| | - Dean Lusher
- Swinburne Business School, Swinburne University of Technology, Melbourne, Australia
| | - Colin MacDougall
- Southgate Institute for Health, Society and Equity, Flinders University, Melbourne, Australia
| | - Louise Harms
- Department of Social Work, Department of Health (Victoria), Melbourne, Australia
| | - Karen Block
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Elyse Snowdon
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Vikki Sinnott
- Southgate Institute for Health, Society and Equity, Flinders University, Melbourne, Australia
| | - Greg Ireton
- Health and Human Services Emergency Management, Department of Human Services (Victoria), Melbourne, Australia
| | - John Richardson
- Emergency Services, Australian Red Cross, Melbourne, Australia
| | - David Forbes
- Australian Centre for Posttraumatic Mental Health, University of Melbourne, Australia
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