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Abstract
Symptom-based self-rating measures were established to detect individuals with posttraumatic stress disorder (PTSD) after specific traumatic events. The aim of the present study was to compare the diagnostic efficiency of the German version of the Trauma Screening Questionnaire (TSQ), the Posttraumatic Diagnostic Scale (PDS), and an 8-item subset of the PDS. Receiver-operating-characteristic analyses are determined in a treatment-seeking outpatient sample (N = 208) with mixed trauma type. The areas under the curve (AUC) for all measures were found to be moderate (AUC = 0.77–0.81); hence, measures did not differ in terms of their discriminatory abilities. Using the favored cutoff points, sensitivity (53–81%) and specificity (71–84%) values were at a level that was only moderate. Considering the high economic burden due to PTSD and the moderate specificity values, a two-stage screening approach might result in only moderate cost-efficiency for treatment-seeking outpatients. In addition, our results support the notion that discriminatory abilities and operating characteristics based on samples with a specific trauma type have to be cross-validated.
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Affiliation(s)
| | - Sören Kliem
- Technical University of Braunschweig, Germany
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52
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Affiliation(s)
- Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Norway and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Miranda Olff
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Norway and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
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Dyb G, Jensen T, Glad KA, Nygaard E, Thoresen S. Early outreach to survivors of the shootings in Norway on the 22nd of July 2011. Eur J Psychotraumatol 2014; 5:23523. [PMID: 25018858 PMCID: PMC4082194 DOI: 10.3402/ejpt.v5.23523] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/12/2014] [Accepted: 03/12/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Under-treatment and unmet needs among survivors have been documented years after terror attacks. Improved early and proactive outreach strategies, including targeted interventions for individuals in need, are required. After the terrorist attacks in Norway on 22 July 2011, a national, proactive outreach strategy was developed and implemented to help those who were directly affected. OBJECTIVES THE AIMS OF THIS STUDY WERE THREEFOLD: (1) to investigate whether the survivors at the island of Utøya had received proactive outreach from the municipalities, (2) to examine the relationships between received health services and the survivors' level of exposure and post-trauma health problems, and (3) to explore the level of unmet needs among survivors 5 months post-terror. METHODS Three hundred and twenty five survivors (M age=19.4, SD=4.6, 47.1% females, response rate 66%) of the 2011 massacre on Utøya Island, Norway, were interviewed face-to-face 4-5 months post-terror. The survivors were asked if they had received proactive outreach from their municipality, and what type of health services they had received. Survivors' level of peri-trauma exposure, loss and injury, posttraumatic stress reactions, symptoms of anxiety and depression, somatic health problems, and sick leave, were assessed. RESULTS Most participants (87%) reported that they had received early and proactive outreach, and most (84%) had a contact person. In addition a majority of the survivors has received support from their general practitioner (63%), or other municipal help services (66%). Specialized mental health services by psychiatrists or psychologists had been provided to 73.1% of the survivors. Survivors who had been referred to specialized mental health services reported higher levels of exposure to trauma, posttraumatic stress reactions, depression and anxiety, and somatic health problems, compared to non-receivers of such services. Forty-three survivors (14%) reported unmet needs for services. CONCLUSION In accordance with the national strategy, the vast majority of the participants in this study had received an early and proactive outreach and targeted responses from specialized mental health services had been provided to survivors in need of more extensive help. However, an important minority of the participants had not been reached as planned. The knowledge from this study may guide professionals and decision makers in planning for future disasters and improve the levels of care.
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Affiliation(s)
- Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tine Jensen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway ; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Kristin Alve Glad
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Egil Nygaard
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway ; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Siri Thoresen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Schreiber MD, Yin R, Omaish M, Broderick JE. Snapshot from Superstorm Sandy: American Red Cross mental health risk surveillance in lower New York State. Ann Emerg Med 2013; 64:59-65. [PMID: 24368053 DOI: 10.1016/j.annemergmed.2013.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 09/18/2013] [Accepted: 11/11/2013] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE Disasters often cause psychological injury, as well as dramatic physical damage. Epidemiologic research has identified a set of disaster experiences and predisposing characteristics that place survivors at risk for post traumatic stress disorder (PTSD), depression, and anxiety. Rapid triage of at-risk survivors could have benefits for individual and population-level outcomes. We examine American Red Cross mental health risk surveillance data collected from October 29 to November 20, 2012, immediately after Hurricane Sandy in 8 lower New York State counties to evaluate the feasibility and utility of collecting these data. METHODS PsySTART, an evidence-based disaster mental health triage tool, was used to record survivor-reported risk factors after each survivor contact. Red Cross disaster mental health volunteers interfaced with survivors at disaster operation sites, including shelters, emergency aid stations, and mobile feeding and community outreach centers. Risk data were called into the operations center each day and reported by county. RESULTS PsySTART risk surveillance data for 18,823 disaster mental health contacts are presented for adults and children. A total of 17,979 risk factors were reported. Overall levels of risk per contact were statistically different (χ(2)(1, N=6,045)=248.1; P<.001) across the 8 counties. Survivors with high levels of risk were found in locations apart from the areas with the greatest physical damage. CONCLUSION Aggregated PsySTART data in Superstorm Sandy indicate substantial population-level impact suggestive of risk for disorders that may persist chronically without treatment. Mental health triage has the potential to improve care of individual disaster survivors, as well as inform disaster management, local health providers, and public health officials.
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Affiliation(s)
- Merritt D Schreiber
- Center for Disaster Medical Sciences, Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, CA
| | - Rob Yin
- Disaster Mental Health, American Red Cross National Headquarters, Washington, DC
| | - Mostafa Omaish
- Center for Disaster Medical Sciences, Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, CA
| | - Joan E Broderick
- Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY.
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55
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Reifels L, Pietrantoni L, Prati G, Kim Y, Kilpatrick DG, Dyb G, Halpern J, Olff M, Brewin CR, O'Donnell M. Lessons learned about psychosocial responses to disaster and mass trauma: an international perspective. Eur J Psychotraumatol 2013; 4:22897. [PMID: 24371515 PMCID: PMC3873118 DOI: 10.3402/ejpt.v4i0.22897] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 11/14/2022] Open
Abstract
At the 13th meeting of the European Society for Traumatic Stress Studies in 2013, a symposium was held that brought together international researchers and clinicians who were involved in psychosocial responses to disaster. A total of six disasters that occurred in five countries were presented and discussed. Lessons learned from these disasters included the need to: (1) tailor the psychosocial response to the specific disaster, (2) provide multi-dimensional psychosocial care, (3) target at-risk population groups, (4) proactively address barriers in access to care, (5) recognise the social dimensions and sources of resilience, (6) extend the roles for mental health professionals, (7) efficiently coordinate and integrate disaster response services, and (8) integrate research and evaluation into disaster response planning.
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Affiliation(s)
- Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | | | - Gabriele Prati
- School of Political Science, University of Bologna, Bologna, Italy
| | - Yoshiharu Kim
- National Center of Neurology and Psychiatry, Department of Adult Mental Health, Tokyo, Japan
| | - Dean G. Kilpatrick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, University of Oslo, Oslo, Norway
| | - James Halpern
- Institute for Disaster Mental Health, State University of New York, New Paltz, NY, USA
| | - Miranda Olff
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Arq Psychotrauma Expert Center, Diemen, The Netherlands
| | - Chris R. Brewin
- Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | - Meaghan O'Donnell
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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56
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Maercker A, Brewin CR, Bryant RA, Cloitre M, van Ommeren M, Jones LM, Humayan A, Kagee A, Llosa AE, Rousseau C, Somasundaram DJ, Souza R, Suzuki Y, Weissbecker I, Wessely SC, First MB, Reed GM. Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World Psychiatry 2013; 12:198-206. [PMID: 24096776 PMCID: PMC3799241 DOI: 10.1002/wps.20057] [Citation(s) in RCA: 424] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The diagnostic concepts of post-traumatic stress disorder (PTSD) and other disorders specifically associated with stress have been intensively discussed among neuro- and social scientists, clinicians, epidemiologists, public health planners and humanitarian aid workers around the world. PTSD and adjustment disorder are among the most widely used diagnoses in mental health care worldwide. This paper describes proposals that aim to maximize clinical utility for the classification and grouping of disorders specifically associated with stress in the forthcoming 11th revision of the International Classification of Diseases (ICD-11). Proposals include a narrower concept for PTSD that does not allow the diagnosis to be made based entirely on non-specific symptoms; a new complex PTSD category that comprises three clusters of intra- and interpersonal symptoms in addition to core PTSD symptoms; a new diagnosis of prolonged grief disorder, used to describe patients that undergo an intensely painful, disabling, and abnormally persistent response to bereavement; a major revision of "adjustment disorder" involving increased specification of symptoms; and a conceptualization of "acute stress reaction" as a normal phenomenon that still may require clinical intervention. These proposals were developed with specific considerations given to clinical utility and global applicability in both low- and high-income countries.
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Affiliation(s)
- Andreas Maercker
- Department of Psychology, Division of Psychopathology, University of ZurichSwitzerland
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
| | - Richard A Bryant
- School of Psychology, University of New South WalesSydney, Australia
| | - Marylene Cloitre
- Division of Dissemination and Training, National Center for PTSDMenlo Park, CA, USA
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health OrganizationGeneva, Switzerland
| | - Lynne M Jones
- FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard UniversityCambridge, MA, USA
| | - Asma Humayan
- Institute of PsychiatryBenazir Bhutto Hospital, Murree Road, Rawalpindi, Pakistan
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch UniversityStellenbosch, South Africa
| | | | - Cécile Rousseau
- Department of Psychiatry, McGill University Health CenterMontréal, Canada
| | - Daya J Somasundaram
- University of JaffnaSri Lanka,Glenside Mental Health ServicesGlenside, South Australia, Australia
| | - Renato Souza
- International Committee of the Red CrossGeneva, Switzerland
| | - Yuriko Suzuki
- National Center of Neurology and Psychiatry, National Institute of Mental HealthTokyo, Japan
| | | | | | - Michael B First
- Department of Psychiatry, Columbia University Medical CenterNew York, NY, USA
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health OrganizationGeneva, Switzerland
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57
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Ehlers A, Grey N, Wild J, Stott R, Liness S, Deale A, Handley R, Albert I, Cullen D, Hackmann A, Manley J, McManus F, Brady F, Salkovskis P, Clark DM. Implementation of cognitive therapy for PTSD in routine clinical care: effectiveness and moderators of outcome in a consecutive sample. Behav Res Ther 2013; 51:742-52. [PMID: 24076408 PMCID: PMC3897916 DOI: 10.1016/j.brat.2013.08.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/26/2013] [Accepted: 08/26/2013] [Indexed: 11/28/2022]
Abstract
Objective Trauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area. Method A consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects. Results CT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience. Conclusions The results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas. Cognitive Therapy for PTSD can be effectively implemented in routine clinical care. The intent-to-treat analysis showed very large treatment effects. Patients found the treatment acceptable, and the majority showed clinically significant change. Few patient characteristics moderated treatment outcome. Inexperienced therapists had more dropouts.
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Affiliation(s)
- Anke Ehlers
- Department of Experimental Psychology, University of Oxford, South Parks Road, Oxford OX1 3UD, UK; Oxford Cognitive Health Clinical Research Facility, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK.
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58
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Abstract
The 7 July 2005 bombings in London caused heightened levels of distress among some in the general community. This distress was most notable in Muslims and members of ethnic minority groups. These effects were transient for most. An estimated 30% of those who were more affected by the attacks, including victims and witnesses, developed psychiatric disorders as a result. An outreach program was set up to screen those who were exposed to potentially traumatic events and to offer them evidence-based treatment. This article discusses what lessons might be learned from studies of the general community and the screen-and-treat approach.
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Affiliation(s)
- G James Rubin
- King's College London, Department of Psychological Medicine, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
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59
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Sijbrandij M, Reitsma JB, Roberts NP, Engelhard IM, Olff M, Sonneveld LP, Bisson JI. Self-report screening instruments for post-traumatic stress disorder (PTSD) in survivors of traumatic experiences. Hippokratia 2013. [DOI: 10.1002/14651858.cd010575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marit Sijbrandij
- VU University; Clinical Psychology; Van den Boechorststraat 1 Amsterdam Netherlands 1081 BT
| | - Johannes B Reitsma
- University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care; PO Box 85500 Utrecht Netherlands 3508 GA Utrecht
| | - Neil P Roberts
- Cardiff and Vale University Health Board; Traumatic Stress Service; Monmouth House, University Hospital of Wales Heath Park Cardiff UK CF14 4XW
| | - Iris M Engelhard
- Utrecht University; Clinical and Health Psychology; Heidelberglaan 1 Utrecht Netherlands 3584 TC
| | - Miranda Olff
- Academic Medical Center; Psychiatry; Meibergdreef 5 Amsterdam Netherlands 1105 AZ
| | - Liza P Sonneveld
- University of Amsterdam; Academic Medical Centre; Meibergdreef 5 Amsterdam Netherlands 1105 AZ
| | - Jonathan I Bisson
- Cardiff and Vale University Health Board; Department of Research and Development; Radnor House, University Hospital of Wales Heath Park Cardiff UK CF14 4XW
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Kleim B, Grey N, Wild J, Nussbeck FW, Stott R, Hackmann A, Clark DM, Ehlers A. Cognitive change predicts symptom reduction with cognitive therapy for posttraumatic stress disorder. J Consult Clin Psychol 2013; 81:383-93. [PMID: 23276122 PMCID: PMC3665307 DOI: 10.1037/a0031290] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 10/10/2012] [Accepted: 11/13/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a growing body of evidence for the effectiveness of trauma-focused cognitive behavior therapy (TF-CBT) for posttraumatic stress disorder (PTSD), but few studies to date have investigated the mechanisms by which TF-CBT leads to therapeutic change. Models of PTSD suggest that a core treatment mechanism is the change in dysfunctional appraisals of the trauma and its aftermath. If this is the case, then changes in appraisals should predict a change in symptoms. The present study investigated whether cognitive change precedes symptom change in Cognitive Therapy for PTSD, a version of TF-CBT. METHOD The study analyzed weekly cognitive and symptom measures from 268 PTSD patients who received a course of Cognitive Therapy for PTSD, using bivariate latent growth modeling. RESULTS Results showed that (a) dysfunctional trauma-related appraisals and PTSD symptoms both decreased significantly over the course of treatment, (b) changes in appraisals and symptoms were correlated, and (c) weekly change in appraisals significantly predicted subsequent reduction in symptom scores (both corrected for the general decrease over the course of therapy). Changes in PTSD symptom severity did not predict subsequent changes in appraisals. CONCLUSIONS The study provided preliminary evidence for the temporal precedence of a reduction in negative trauma-related appraisals in symptom reduction during trauma-focused CBT for PTSD. This supports the role of change in appraisals as an active therapeutic mechanism.
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Affiliation(s)
- Birgit Kleim
- Department of Psychology, King’s College London, London, England, and Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Nick Grey
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust and King’s College London
| | - Jennifer Wild
- David M. Clark, and Anke Ehlers, Department of Experimental Psychology, University of Oxford, Oxford, and Department of Psychology, Institute of Psychiatry, King’s College London
| | | | | | - Ann Hackmann
- Department of Psychiatry, University of Oxford and Department of Psychology, Institute of Psychiatry, King’s College London
| | - David M. Clark
- David M. Clark, and Anke Ehlers, Department of Experimental Psychology, University of Oxford, Oxford, and Department of Psychology, Institute of Psychiatry, King’s College London
| | - Anke Ehlers
- David M. Clark, and Anke Ehlers, Department of Experimental Psychology, University of Oxford, Oxford, and Department of Psychology, Institute of Psychiatry, King’s College London
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Stevens GJ, Dunsmore JC, Agho KE, Taylor MR, Jones AL, Van Ritten JJ, Raphael B. Long‐term health and wellbeing of people affected by the 2002 Bali bombing. Med J Aust 2013; 198:273-7. [DOI: 10.5694/mja12.11480] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/07/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Garry J Stevens
- School of Medicine, University of Western Sydney, Sydney, NSW
| | - Julie C Dunsmore
- Health Promotion Department, Northern Sydney Local Health District, Sydney, NSW
- National Association for Loss & Grief (NSW), Sydney, NSW
| | - Kingsley E Agho
- School of Medicine, University of Western Sydney, Sydney, NSW
| | | | - Alison L Jones
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW
| | - Jason J Van Ritten
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW
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Abstract
The immediate patterns of injury from explosions are well documented, from both military and civil experience. However, few studies have focused on less immediately apparent health consequences and latent effects of explosions in survivors, emergency responders and the surrounding community. This review aimed to analyze the risks to health following an explosion in a civil setting. A comprehensive review of the open literature was conducted, and data on 10 relevant military, civilian and industrial events were collected. Events were selected according to availability of published studies and involvement of large numbers of people injured. In addition, structured interviews with experts in the field were conducted, and existing national guidelines reviewed. The review revealed significant and potentially long-term health implications affecting various body systems and psychological well-being following exposure to an explosion. An awareness of the short- and long-term health effects of explosions is essential in screening for blast injuries, and identifying latent pathologies that could otherwise be overlooked in stressful situations with other visually distracting injuries and, often, mass casualties. Such knowledge would guide responsible medical staff in implementing early appropriate interventions to reduce the burden of long-term sequelae. Effective planning and response strategies would ensure accessibility of appropriate health care resources and evidence-based information in the aftermath of an explosion.
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63
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Post-disaster psychosocial services across Europe: the TENTS project. Soc Sci Med 2012; 75:1708-14. [PMID: 22835920 DOI: 10.1016/j.socscimed.2012.06.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 05/08/2012] [Accepted: 06/17/2012] [Indexed: 11/23/2022]
Abstract
At present post-disaster activities and plans seem to vary widely. An adequate estimation of the availability of post-disaster psychosocial services across Europe is needed in order to compare them with recently developed evidence-informed psychosocial care guidelines. Here we report on the results of a cross-sectional web-based survey completed in 2008 by two hundred and eighty-six representatives of organizations involved in psychosocial responses to trauma and disaster from thirty-three different countries across Europe. The survey addressed planning and delivery of psychosocial care after disaster, methods of screening and diagnosis, types of interventions used, and other aspects of psychosocial care after trauma. The findings showed that planning and delivery of psychosocial care was inconsistent across Europe. Countries in East Europe seemed to have less central coordination of the post-disaster psychosocial response and fewer post-disaster guidelines that were integrated into specific disaster or contingency plans. Several forms of psychological debriefing, for which there is no evidence of efficacy to date, were still used in several areas particularly in North Europe. East European countries delivered evidence-based interventions for PTSD less frequently, whilst in South- and South-Eastern European countries anxiety suppressing medication such as benzodiazepines were prescribed more frequently to disaster victims than in other areas. Countries across Europe are currently providing sub-optimal psychosocial care for disaster victims. This short report shows that there is an urgent need for some countries to abandon non-effective interventions and others to develop more evidence based and effective services to facilitate the care of those involved in future disasters.
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Griffiths RD. Sedation, delirium and psychological distress: let's not be deluded. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:109. [PMID: 22340142 PMCID: PMC3396256 DOI: 10.1186/cc11176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
New ways of approaching sedation and analgesia are being considered in our endeavour to improve our management of the ventilated patient. Long-term psychological problems are not insignificant and before we can assume benefit or harm of any new approach we must not delude ourselves by using sampling methods that can miss those patients most at risk.
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Affiliation(s)
- Richard D Griffiths
- Musculoskeletal Biology, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3GA, UK.
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65
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Kar N. Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatr Dis Treat 2011; 7:167-81. [PMID: 21552319 PMCID: PMC3083990 DOI: 10.2147/ndt.s10389] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic nature. Cognitive behavioral therapy (CBT) has been used in the management of PTSD for many years. This paper reviews the effectiveness of CBT for the treatment of PTSD following various types of trauma, its potential to prevent PTSD, methods used in CBT, and reflects on the mechanisms of action of CBT in PTSD. METHODS Electronic databases, including PubMed, were searched for articles on CBT and PTSD. Manual searches were conducted for cross-references in the relevant journal sites. RESULTS The current literature reveals robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD following a range of traumatic experiences in adults, children, and adolescents. However, nonresponse to CBT by PTSD can be as high as 50%, contributed to by various factors, including comorbidity and the nature of the study population. CBT has been validated and used across many cultures, and has been used successfully by community therapists following brief training in individual and group settings. There has been effective use of Internet-based CBT in PTSD. CBT has been found to have a preventive role in some studies, but evidence for definitive recommendations is inadequate. The effect of CBT has been mediated mostly by the change in maladaptive cognitive distortions associated with PTSD. Many studies also report physiological, functional neuroimaging, and electroencephalographic changes correlating with response to CBT. CONCLUSION There is scope for further research on implementation of CBT following major disasters, its preventive potential following various traumas, and the neuropsychological mechanisms of action.
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Affiliation(s)
- Nilamadhab Kar
- Department of Psychiatry, Wolverhampton City Primary Care Trust, Wolverhampton, UK
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