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Li G, Shi W, Gao X, Shi X, Feng X, Liang D, Li C, Phillips MR, Hall BJ. Mental health and psychosocial interventions to limit the adverse psychological effects of disasters and emergencies in China: a scoping review. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 45:100580. [PMID: 38699294 PMCID: PMC11064723 DOI: 10.1016/j.lanwpc.2022.100580] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Exposure to disasters and public health emergencies negatively affects mental health. Research documenting the psychosocial responses to these calamities in China increased dramatically after the 2008 Wenchuan earthquake. However, there is no comprehensive assessment of the available literature on China's mental health and psychosocial support (MHPSS) responses to these events. This scoping review systematically maps existing published research and grey literature sources regarding MHPSS to disasters and emergencies in China. We examined relevant literature in English and Chinese from six databases and official websites from Jan 1, 2000, to Aug 13, 2021, and included 77 full-text records in this review. The main types of interventions reported included a) stepped care intervention models, b) individual structured psychotherapy and pharmacotherapy, c) mental health education, d) psychological counselling, and e) government-based policy interventions. Most interventions were evaluated using quantitative methods that assessed the treatment of common mental disorders. The review found that rapid national mobilization, emphasis on resilience-strengthening interventions, and the widespread use of step-care models were essential components of reducing the adverse psychosocial effects of disasters. The review also identified remaining gaps, including a) a lack of integration of disaster-related services with the pre-existing health care system, b) inadequate supervision of MHPSS providers, and c) limited monitoring and evaluation of the services provided. These results show where additional research is needed in China to improve mental health services. It also provides a framework that other countries can adapt when developing and evaluating MHPSS policies and plans in response to disasters.
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Affiliation(s)
- Gen Li
- Center for Global Health Equity, New York University Shanghai, 1555 Century Avenue, Shanghai, China
| | - Wei Shi
- The Institute for Disaster Management and Reconstruction, Sichuan University, No.24 South Section 1, Yihuan Road, Chengdu, China
| | - Xing Gao
- The Institute for Disaster Management and Reconstruction, Sichuan University, No.24 South Section 1, Yihuan Road, Chengdu, China
| | - Xinyi Shi
- The Institute for Disaster Management and Reconstruction, Sichuan University, No.24 South Section 1, Yihuan Road, Chengdu, China
| | - Xiaoyu Feng
- The Institute for Disaster Management and Reconstruction, Sichuan University, No.24 South Section 1, Yihuan Road, Chengdu, China
| | - Di Liang
- School of Public Health, Fudan University, 220 Handan Rd., Shanghai, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wanping Nan Rd., Shanghai, China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai, China
| | - Michael R. Phillips
- Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wanping Nan Rd., Shanghai, China
- Departments of Psychiatry and Epidemiology, Columbia University, New York, NY, USA
| | - Brian J. Hall
- Center for Global Health Equity, New York University Shanghai, 1555 Century Avenue, Shanghai, China
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Stileman HM, Jones CA. Revisiting the debriefing debate: does psychological debriefing reduce PTSD symptomology following work-related trauma? A meta-analysis. Front Psychol 2023; 14:1248924. [PMID: 38204890 PMCID: PMC10779682 DOI: 10.3389/fpsyg.2023.1248924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024] Open
Abstract
Psychological debriefing is an early post-trauma intervention which aims to prevent the development of PTSD and accelerate normal recovery through discussing, validating, and normalising group members responses to trauma. While originally designed in the 1980s for groups of emergency service personnel, the scope of psychological debriefing extended to individual primary victims of trauma. A Cochrane review in 2002 concluded that psychological debriefing was ineffective, yet some authors have argued that many of the studies that informed the Cochrane review did not adhere to key elements of psychological debriefing. This meta-analysis sought to re-examine the effectiveness of psychological debriefing in preventing or reducing PTSD symptoms following work-related trauma. Appropriate studies were selected from three databases (MEDLINE, Embase and PsycINFO). Inclusion criteria was intentionally broad so that features of psychological debriefing that may determine its effectiveness could be explored through a series of subgroup analyses. The overall synthesis did not find consistent evidence that psychological debriefing helps to prevent or reduce PTSD symptoms following work-related trauma. Shortcomings in the methodology and reporting of many of the studies meant that several important subgroup analyses could not be conducted. Further well-designed studies in this field are warranted to ensure that employees exposed to potentially traumatic events receive the effective support they need and deserve.
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Affiliation(s)
- Harry M. Stileman
- Centre of Applied Psychology, University of Birmingham, Birmingham, United Kingdom
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | - Christopher A. Jones
- Centre of Applied Psychology, University of Birmingham, Birmingham, United Kingdom
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3
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Billings J, Zhan Yuen Wong N, Nicholls H, Burton P, Zosmer M, Albert I, Grey N, El-Leithy S, Murphy D, Tehrani N, Wheatley J, Bloomfield MAP, Greene T. Post-incident psychosocial interventions after a traumatic incident in the workplace: a systematic review of current research evidence and clinical guidance. Eur J Psychotraumatol 2023; 14:2281751. [PMID: 38032045 PMCID: PMC10990448 DOI: 10.1080/20008066.2023.2281751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background: After a traumatic incident in the workplace organisations want to provide support for their employees to prevent PTSD. However, what is safe and effective to offer has not yet been established, despite many organisations offering some form of intervention after a traumatic event.Objective: To systematically review the evidence for post-incident psychosocial interventions offered within one month of a workplace trauma, and to compare the content, effectiveness and acceptability of these interventions. Given the lack of a yet clearly established evidence-base in this field, we sought to examine both published empirical research as well as guidelines published by expert groups working with staff in high-risk roles.Methods: We conducted systematic searches for empirical research across bibliographic databases and searched online for clinical practice guidelines to April 2023. We were also referred to potentially relevant literature by experts in workplace trauma. Both empirical research and clinical guidelines were appraised for their quality.Results: A total of 80 research studies and 11 clinical practice guidelines were included in the review. Interventions included Critical Incident Stress Debriefing (CISD), Critical Incident Stress Management (CISM), unspecified Debriefing, Trauma Risk Management (TRiM), Psychological First Aid (PFA), EMDR, CBT and group counselling. Most research and guidance were of poor quality. The findings of this review do not demonstrate any harm caused by CISD, CISM, PFA, TRiM, EMDR, group counselling or CBT interventions when delivered in a workplace setting. However, they do not conclusively demonstrate benefits of these interventions nor do they establish superiority of any specific intervention. Generic debriefing was associated with some negative outcomes. Current clinical guidelines were inconsistent with the current research evidence base. Nevertheless, interventions were generally valued by workers.Conclusions: Better quality research and guidance is urgently needed, including more detailed exploration of the specific aspects of delivery of post-incident interventions.
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Affiliation(s)
- Jo Billings
- Division of Psychiatry, University College London, London, UK
| | | | - Helen Nicholls
- Division of Psychiatry, University College London, London, UK
| | - Peter Burton
- Division of Psychiatry, University College London, London, UK
| | - Maya Zosmer
- Division of Psychiatry, University College London, London, UK
| | - Idit Albert
- King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nick Grey
- University of Sussex, Falmer, UK
- Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | | | - Dominic Murphy
- King’s College London, London, UK
- Combat Stress, London, UK
| | | | - Jon Wheatley
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Michael A. P. Bloomfield
- Division of Psychiatry, University College London, London, UK
- Camden & Islington NHS Foundation Trust, London, UK
| | - Talya Greene
- Clinical, Educational and Health Psychology, University College London, London, UK
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Semerci M, Uzun S. The effectiveness of post-disaster psychotherapeutic interventions: A systematic review and meta-analysis study. Asian J Psychiatr 2023; 85:103615. [PMID: 37201380 DOI: 10.1016/j.ajp.2023.103615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This study aimed to determine the level of impact of post-disaster psychotherapeutic interventions. MATERIAL METHOD For this systematic review and meta-analysis study, the studies were accessed through the databases of PubMed, Web of Science, EBSCOhost, Google Scholar, and YÖK Thesis Center in July-September 2022 without any year limitation. As a result of the examinations, 27 studies were included in the study. The data were synthesized by meta-analysis and narrative methods. RESULTS According to the results of this systematic review and meta-analysis, post-disaster psychotherapeutic interventions were found to be effective (SMD:-0838, %95 CI: -1,087- 0.588; Z = -6588, p = 0.000, I2 = %95,249). Individuals who have undergone psychotherapeutic interventions experience either no or fewer post-traumatic stress disorder symptoms. The country/continent of the research, the types of psychotherapeutic interventions, the type of disaster, and the measurement tool used influence the effectiveness of the psychotherapeutic interventions. Psychotherapeutic interventions applied especially after earthquakes, one of the types of disasters, were found to be effective. In addition, EMDR, cognitive behavioral therapy, psychotherapy, and exposure method were found to reduce posttraumatic stress disorder symptoms in individuals in the post-disaster period. CONCLUSION Post-disaster psychotherapeutic interventions have positive impacts on people and improve their mental health.
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Affiliation(s)
- Murat Semerci
- Department of Nursing, Gümüşhane University Faculty of Health Sciences, Gümüşhane, Turkey
| | - Sevda Uzun
- Department of Nursing, Gümüşhane University Faculty of Health Sciences, Gümüşhane, Turkey.
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5
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Vignaud P, Lavallé L, Brunelin J, Prieto N. Are psychological debriefing groups after a potential traumatic event suitable to prevent the symptoms of PTSD? Psychiatry Res 2022; 311:114503. [PMID: 35287042 DOI: 10.1016/j.psychres.2022.114503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 11/18/2022]
Abstract
Psychological debriefing is a psychotherapeutic approach developed for early intervention in civilians and professionals who have to cope with a potential traumatic event (PTE). Although initial works claimed that this approach may decrease symptoms of posttraumatic stress disorder (PTSD), some studies have concluded that the clinical benefits of psychological debriefing were limited. Several methodological variations could explain the discrepancies observed among studies. Among these variations, how the approach is administered to participants should have importance, and clinical evidence suggests that debriefing groups instead of individuals could have a beneficial clinical effect. We conducted a systematic search of the literature investigating the clinical effects of psychological debriefing groups on PTSD symptoms after a PTE according to the PRISMA guidelines. Among the 790 articles found, 11 met our inclusion criteria. Most of these articles did not support any beneficial effect of psychological debriefing groups on PTSD symptoms. A large number of methodological variations that may influence the outcomes of these studies were observed. Psychological debriefing groups did not seem efficient in alleviating PTSD symptoms. Further studies of high methodological quality are needed to elucidate the effect of psychological debriefing groups on specific PTSD symptoms and on nonspecific symptoms.
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Affiliation(s)
- Philippe Vignaud
- Hospices civils de Lyon, Hôpital Edouard Herriot, Cellule d'urgences médico psychologiques, 69437 Lyon, France; Hospices civils de Lyon, Hôpital Edouard Herriot, Centre régional du Psychotraumatisme Auvergne Rhône Alpes, 69437 Lyon, France.
| | - Layla Lavallé
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Centre de recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, 69437 Lyon, France; Centre Hospitalier Le Vinatier, 69677 Bron, France
| | - Jérôme Brunelin
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Centre de recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, 69437 Lyon, France; Centre Hospitalier Le Vinatier, 69677 Bron, France
| | - Nathalie Prieto
- Hospices civils de Lyon, Hôpital Edouard Herriot, Cellule d'urgences médico psychologiques, 69437 Lyon, France; Hospices civils de Lyon, Hôpital Edouard Herriot, Centre régional du Psychotraumatisme Auvergne Rhône Alpes, 69437 Lyon, France
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6
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Tan L, Petrie K, Deady M, Bryant RA, Harvey SB. Systematic review of first responder post-deployment or post-incident psychosocial interventions. Occup Med (Lond) 2022; 72:160-169. [PMID: 35020931 DOI: 10.1093/occmed/kqab182] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND First responder populations, such as emergency services and the military, report elevated levels of mental health problems. Although post-deployment or post-incident psychosocial support interventions are widely implemented within these services, its effectiveness in preventing the development of mental disorders is unclear. AIMS To systematically assess which, if any, post-deployment or post-incident psychosocial interventions are effective at preventing the development of post-traumatic stress disorder (PTSD) and common mental disorders (CMD) amongst military and emergency service worker (ESW) settings. METHODS A systematic review was conducted by searching four databases for any randomized controlled trials (RCTs) or controlled trials of post-deployment or post-incident interventions. The primary outcomes assessed were differences in symptoms of PTSD and CMD. Study quality was examined using the Downs and Black checklist. Pooled effect sizes and 95% CI were calculated using random-effects modelling for main meta-analyses, planned subgroup and sensitivity analyses. RESULTS From 317 articles, seven RCTs were included in the final meta-analysis. Interventions identified included psychological debriefing, screening, stress education, team-based skills training and a peer-delivered risk assessment. A very small but significant effect was found for team-based skills training in reducing CMD symptoms. Some evidence was also found for team cohesion training in reducing both PTSD and CMD. CONCLUSIONS Limited evidence was found for post-deployment or post-incident psychosocial interventions within military and ESW populations. More high-quality studies, particularly among ESW settings, are urgently needed to determine how to better prevent the development of trauma related disorders after exposure.
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Affiliation(s)
- Leona Tan
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia.,School of Psychiatry, University of New South Wales, UNSW Sydney, Kensington, NSW, Australia
| | - Katherine Petrie
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia.,School of Psychiatry, University of New South Wales, UNSW Sydney, Kensington, NSW, Australia
| | - Mark Deady
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, UNSW Sydney, Kensington, NSW, Australia
| | - Samuel B Harvey
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
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7
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He C, Chang S, Lu Y, Zhang H, Zhou H, Guo Y, Gao BL. Effects of Online Psychological Crisis Intervention for Frontline Nurses in COVID-19 Pandemic. Front Psychiatry 2022; 13:937573. [PMID: 35903639 PMCID: PMC9316614 DOI: 10.3389/fpsyt.2022.937573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The psychological problems of frontline nurses in COVID-19 prevention and control are very prominent, and targeted intervention is needed to alleviate them. This study was to assess the impact of online intervention programs on psychological crisis of anxiety, depression levels and physical symptoms among frontline nurses fighting the COVID-19 pandemic. METHODS A three-stage online psychological crisis intervention program was established. The General Anxiety 7 (GAD-7) assessment, Patient Health Questionnaire-9 (PHQ-9), and the Self-rating Somatic Symptom Scale (SSS) were used to evaluate the effect of intervention on the day before entering isolation wards (Time 1), the first day after leaving the isolation ward (Time 2), and at the end of the intervention (Time 3). RESULTS Sixty-two nurses completed the study, including 59 female (95.2%) and three male nurses (4.8%) with an age range of 23-49 (mean 33.37 ± 6.01). A significant (P < 0.01) difference existed in the scores of GAD-7, PHQ-9, and SSS at different intervention periods. The GAD-7 score was significantly (P < 0.001) lower at the end of quarantine period (time 3) than that before entering the isolation wards (time 1) or after leaving the isolation wards (time 2), the PHQ-9 score was significantly (P = 0.016) lower at the end of quarantine period (time 3) than that after leaving the isolation wards (time 2), and the SSS score was significantly (P < 0.001) lower at the end of quarantine period (time 3) than that before entering the isolation wards (time 1) or after leaving the isolation wards (time 2). CONCLUSION The three-stage online intervention program based on the psychological crisis can be effective in reducing negative emotions and somatic symptoms and improving the mental health of frontline nurses in prevention and control of the COVID-19 epidemic. It may provide an empirical basis for psychological crisis intervention of frontline medical staff when facing public health emergencies.
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Affiliation(s)
- Chunyan He
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Shuying Chang
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Ying Lu
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Hongmei Zhang
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Haining Zhou
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Yunfei Guo
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Bu-Lang Gao
- Henan Provincial People's Hospital, Zhengzhou, China
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Figueroa RA, Cortés PF, Marín H, Vergés A, Gillibrand R, Repetto P. The ABCDE psychological first aid intervention decreases early PTSD symptoms but does not prevent it: results of a randomized-controlled trial. Eur J Psychotraumatol 2022; 13:2031829. [PMID: 35251529 PMCID: PMC8890535 DOI: 10.1080/20008198.2022.2031829] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Early Psychological First Aid (PFA) has been widely recommended for preventing posttraumatic stress disorder (PTSD). However, its lack of empirical evidence of safety and effectiveness has been criticized. OBJECTIVES To assess the effectiveness of PFA-ABCDE, an original PFA protocol, for preventing PTSD one month after the intervention and decreasing PTSD symptoms at one and six months of follow up. METHODS We assessed the eligibility of 1,140 adult survivors of recent trauma (≤ 72 hours) consulting five emergency departments in Chile. Two hundred twenty-one were randomized to receive either PFA-ABCDE (active listening, breathing retraining, categorization of needs, referral to ancillary services, and psychoeducation) or only psychoeducation. We used the Composite International Diagnostic Interview (CIDI) to assess PTSD diagnosis. The Posttraumatic Checklist (PCL), the Beck Depression Inventory-II (BDI-II), and a 0-10 points analogue visual scale were used to assess PTSD symptoms, depressive symptoms, and immediate distress relief after the intervention. RESULTS We found no difference between the experimental and control groups in the frequency of PTSD one month after the intervention (PFA-ABCDE = 23/76 [30.3%], psychoeducation = 18/75 [24.0%], adjusted odds ratio = 1.39, 95% confidence interval = 0.63-3.07, p = .408). Immediately after the intervention, participants who received PFA-ABCDE reported greater distress relief (PFA-ABCDE mean = 9.06, psychoeducation mean = 8.55, Cohen's d = 0.30, p = .038). Fewer PTSD symptoms were reported by those who received PFA-ABCDE one month after the intervention (PFA-ABCDE mean = 36.26, psychoeducation mean = 43.62, Cohen's d = 0.42, p = .033). We found no difference in depressive symptoms at one-month follow up (p = .713) nor in PTSD symptoms six months after the intervention (p = .986). CONCLUSIONS PFA-ABCDE does not prevent PTSD diagnosis, but it provides immediate distress relief and decreases PTSD symptoms in the short term.
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Affiliation(s)
- Rodrigo Andrés Figueroa
- Trauma & Dissociation Unit, Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Research Center for Integrated Natural Disaster Management (Cigiden), Santiago, Chile, CONICYT/FONDAP/1511007
| | - Paula Francisca Cortés
- Research Center for Integrated Natural Disaster Management (Cigiden), Santiago, Chile, CONICYT/FONDAP/1511007
| | - Humberto Marín
- Research Center for Integrated Natural Disaster Management (Cigiden), Santiago, Chile, CONICYT/FONDAP/1511007
| | - Alvaro Vergés
- Research Center for Integrated Natural Disaster Management (Cigiden), Santiago, Chile, CONICYT/FONDAP/1511007.,Escuela de Psicología, Pontificia Universidad Católica de Chile, Macul, Chile
| | - Rodrigo Gillibrand
- Hospital Del Trabajador, Asociación Chilena de Seguridad, Providencia, Chile
| | - Paula Repetto
- Research Center for Integrated Natural Disaster Management (Cigiden), Santiago, Chile, CONICYT/FONDAP/1511007.,Escuela de Psicología, Pontificia Universidad Católica de Chile, Macul, Chile
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9
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Bisson JI, Wright LA, Jones KA, Lewis C, Phelps AJ, Sijbrandij M, Varker T, Roberts NP. Preventing the onset of post traumatic stress disorder. Clin Psychol Rev 2021; 86:102004. [PMID: 33857763 DOI: 10.1016/j.cpr.2021.102004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/25/2021] [Accepted: 02/26/2021] [Indexed: 12/15/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a common mental health condition that requires exposure to a traumatic event. This provides unique opportunities for prevention that are not available for other disorders. The aim of this review was to undertake a systematic review and evaluation of randomized controlled trials (RCTs) of interventions designed to prevent PTSD in adults. Searches involving Cochrane, Embase, Medline, PsycINFO, PILOTS and Pubmed databases were undertaken to identify RCTs of pre-incident preparedness and post-incident interventions until May 2019. Six pre-incident and 69 post-incident trials were identified that could be included in meta-analyses. The overall quality of the evidence was low. There was emerging evidence that some interventions may be helpful but an absence of evidence for any intervention that can be strongly recommended for universal, selected or indicated prevention before or within the first three months of a traumatic event. The strongest results were found for cognitive-behavioural therapy with a trauma focus (CBT-T) in individuals with a diagnosis of acute stress disorder which supports calls to detect and treat individuals with significant symptoms rather than providing blanket preventative interventions. Further research is required to optimally configure existing interventions with some evidence of effect and to develop novel interventions to address this major public health issue.
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Affiliation(s)
- Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom.
| | - Laurence Astill Wright
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom
| | - Kimberley A Jones
- Phoenix Australia- Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom
| | - Andrea J Phelps
- Phoenix Australia- Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, the Netherlands
| | - Tracey Varker
- Phoenix Australia- Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Victoria, Australia
| | - Neil P Roberts
- Psychology and Psychological Therapies Directorate, Cardiff & Vale University Health Board, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom
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10
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Richins MT, Gauntlett L, Tehrani N, Hesketh I, Weston D, Carter H, Amlôt R. Early Post-trauma Interventions in Organizations: A Scoping Review. Front Psychol 2020; 11:1176. [PMID: 32670143 PMCID: PMC7330139 DOI: 10.3389/fpsyg.2020.01176] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/06/2020] [Indexed: 12/02/2022] Open
Abstract
Background In some organizations, traumatic events via direct or indirect exposure are routine experiences. The National Institute for Health and Care Excellence reviews (2005; 2018) of post-traumatic stress disorder management in primary and secondary care did not address early interventions for trauma within emergency response organizations. Aims This scoping review was designed to identify research which evaluates the use of early interventions in emergency and other high-risk organizations following exposure to primary or secondary trauma and to report on the effectiveness of the early intervention models in common use. Methods A scoping review was conducted to examine early interventions for workers exposed to trauma, including emergency response, military, and humanitarian aid. Relevant data were extracted from the included studies and the outcomes were assessed using meta-ethnography. Results Fifty studies of mixed quality met the inclusion criteria for this review. A synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they are delivered in a manner that (a) respects distinct organizational culture, (b) is supported by organizations and senior management, and (c) harnesses existing social cohesion and peer support systems within teams. Conclusion This review demonstrates that early interventions support emergency responders following exposure to trauma when these are tailored to the needs of the population, are supported by the host organization, and harness existing social cohesion and peer support processes within a team or unit. A number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organizations were made.
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Affiliation(s)
- Matt T Richins
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Louis Gauntlett
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Noreen Tehrani
- Crisis, Disaster, and Trauma Section, British Psychological Society (Member of Standing Committee EFPA), Leicester, United Kingdom
| | - Ian Hesketh
- Alliance Manchester Business School, University of Manchester, Manchester, United Kingdom
| | - Dale Weston
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Holly Carter
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
| | - Richard Amlôt
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection and Medical Directorate, Public Health England, London, United Kingdom
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11
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Establishing the Effectiveness of Interventions Provided to First Responders to Prevent and/or Treat Mental Health Effects of Response to a Disaster: A Systematic Review. Disaster Med Public Health Prep 2020; 15:115-126. [PMID: 33870882 DOI: 10.1017/dmp.2019.140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This review systematically explores the current available evidence on the effectiveness of interventions provided to first responders to prevent and/or treat the mental health effects of responding to a disaster. METHODS A systematic review of Medline, Scopus, PsycINFO, and gray literature was conducted. Studies describing the effectiveness of interventions provided to first responders to prevent and/or treat the mental health effects of responding to a disaster were included. Quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and the Critical Appraisal Skills Programme (CASP) checklist. RESULTS Manuscripts totaling 3869 met the initial search criteria; 25 studies met the criteria for in-depth analysis, including 22 quantitative and 3 qualitative studies; 6 were performed in low- and middle-income countries (LMICs); 18 studies evaluated a psychological intervention; of these, 13 found positive impact, 4 found no impact, and 1 demonstrated worsened symptoms after the intervention. Pre-event trainings decreased psychiatric symptoms in each of the 3 studies evaluating its effectiveness. CONCLUSIONS This review demonstrates that there are likely effective interventions to both prevent and treat psychiatric symptoms in first responders in high-, medium-, and low-income countries.
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Tai YM, Lin MW, Tsai CW, Hsu CC, Kao LC, Yang SN. Critical incident stress debriefing for frontline military rescuers in a helicopter crash disaster in Taiwan: A preliminary report. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_14_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Posttraumatic stress disorder following the 2008 Wenchuan earthquake: A 10-year systematic review among highly exposed populations in China. J Affect Disord 2019; 243:327-339. [PMID: 30261448 DOI: 10.1016/j.jad.2018.09.047] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/27/2018] [Accepted: 09/15/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The 2008 Wenchuan earthquake was unprecedented in Chinese history both in terms of the magnitude of the quake itself and the scale of human suffering. Following the disaster, researchers reported on a wide range of mental health outcomes, especially posttraumatic stress disorder (PTSD). In this review, we assess the cumulative body of research evidence about PTSD across the first 10 years following the earthquake. METHODS We searched the literature in the PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) databases (from May 2008 to February 2018) using Wenchuan earthquake and PTSD as keywords. RESULTS We selected 58 relevant studies. Published findings from the selected period suggested a substantial burden of PTSD on highly exposed survivors. Studies have found that symptoms of PTSD have been associated with a range of risk factors, including sociodemographic factors, trauma exposure characteristics, post-disaster cognitive and emotional states, and social support. Studies have explored the factor structure of PTSD in the affected Chinese population, and researchers have developed a Chinese self-report measure of PTSD symptoms. Several treatments for PTSD have been evaluated, including some indigenous intervention methods. LIMITATIONS Only a relatively small number of the studies used longitudinal assessments, and the consistency and effectiveness of measurement tools for PTSD require further exploration. More rigorous investigations of the effectiveness of interventions for the prevention and treatment of PTSD are needed. CONCLUSION The 10-year body of literature is important for the future deployment of disaster relief and an increased understanding of PTSD in China.
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Brooks SK, Dunn R, Amlôt R, Greenberg N, Rubin GJ. Training and post-disaster interventions for the psychological impacts on disaster-exposed employees: a systematic review. J Ment Health 2018:1-25. [PMID: 29447058 DOI: 10.1080/09638237.2018.1437610] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/15/2017] [Accepted: 01/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND When organisations are exposed to traumatic situations, such as disasters, often staff are not prepared for the potential psychological impact which can negatively affect their wellbeing. AIMS To conduct a systematic review of the literature on psychological interventions aimed at improving staff wellbeing during or after disasters. METHOD Four electronic literature databases were searched. Reference lists of relevant articles were hand-searched. RESULTS Fifteen articles were included. Five studies suggested that pre-disaster skills training and disaster education can improve employee confidence. Ten studies on post-disaster interventions revealed mixed findings on the effectiveness of psychological debriefing and limited evidence for cognitive behavioural therapy, psychoeducation and meditation. CONCLUSIONS Pre-disaster training and education can improve employees' confidence in their ability to cope with disasters. The routine use of post-disaster psychological debriefings is not supported; further research is needed to determine if debriefing interventions could be useful in some circumstances. Further research is needed to provide more evidence on the potential positive effects of cognitive behavioural therapy, psychoeducation and meditation. More experimental studies on psychological disaster interventions are needed.
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Affiliation(s)
- Samantha K Brooks
- a Department of Psychological Medicine , King's College London , London , UK , and
| | - Rebecca Dunn
- a Department of Psychological Medicine , King's College London , London , UK , and
| | - Richard Amlôt
- b Emergency Response Department Science and Technology, Health Protection Directorate, Public Health England , Salisbury , UK
| | - Neil Greenberg
- a Department of Psychological Medicine , King's College London , London , UK , and
| | - G James Rubin
- a Department of Psychological Medicine , King's College London , London , UK , and
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Guglielmi D, Vignoli M, Camellini L, Florini MC, Brunetti M, Depolo M. When helpers need help: A case study on the 2012 earthquakes in Italy. Work 2017; 58:185-191. [PMID: 29036863 DOI: 10.3233/wor-172616] [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: 11/15/2022] Open
Abstract
BACKGROUND After two strong earthquakes in the Emilia region in Italy, many HCWs had to deal with the psychological consequences of the aftershocks. OBJECTIVE The aims of this case study were a) to describe the psychosocial condition of the HCWs affected by the earthquake; b) to present an intervention immediately after the earthquake on HCWs in a post-disaster situation using a mixed-method approach. METHODS A mixed-method study was conducted collecting qualitative data (during Group Counselling sessions) and quantitative data (through questionnaires). RESULTS The results suggested that the impact of the earthquake was very strong, as more than 80% perceived at least a severe impact event capable of altering their ability to function; most of the thoughts and feelings were related to death and fear. CONCLUSIONS This study adds knowledge about how to plan interventions aiming to help those workers at both individual and organisational level.
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Affiliation(s)
- Dina Guglielmi
- Department of Education Studies, University of Bologna, Bologna, Italy
| | - Michela Vignoli
- Department of Education Studies, University of Bologna, Bologna, Italy
| | | | | | | | - Marco Depolo
- Department of Psychology, University of Bologna, Bologna, Italy
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Hong C, Efferth T. Systematic Review on Post-Traumatic Stress Disorder Among Survivors of the Wenchuan Earthquake. TRAUMA, VIOLENCE & ABUSE 2016; 17:542-561. [PMID: 26028651 DOI: 10.1177/1524838015585313] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Post-traumatic stress disorder (PTSD) widely occurs among victims or witness of disasters. With flashbacks, hyperarousal, and avoidance being the typical symptoms, PTSD became a focus of psychological research. The earthquake in Wenchuan, China, on May 12, 2008, was without precedent in magnitude and aftermath and caused huge damage, which drew scientists' attention to mental health of the survivors. We conducted a systematic overview by collecting published articles from the PubMed database and classifying them into five points: epidemiology, neuropathology, biochemistry, genetics and epigenetics, and treatment. The large body of research during the past 6 years showed that adolescents and adults were among the most studied populations with high prevalence rates for PTSD. Genomic and transcriptomic studies focusing on gene × environment studies as well as epigenetics are still rare, although a few available data showed great potential to better understand the pathophysiology of PTSD as multifactorial disease. Phytotherapy with Chinese herbs and acupuncture are rarely reported as of yet, although the first published data indicated promising therapy effects. Future studies should focus on the following points: (1) The affected populations under observation should be better defined concerning individual risk factor, time of observation, spatial movement, and individual disease courses of patients. (2) The role of social support for prevalence rates of PTSD should be observed in more detail. (3) Efficacy and safety of Chinese medicine should be studied to find potential interventions and effective treatments of PTSD.
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Affiliation(s)
- Chunlan Hong
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
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Kang P, Lv Y, Hao L, Tang B, Liu Z, Liu X, Liu Y, Zhang L. Psychological consequences and quality of life among medical rescuers who responded to the 2010 Yushu earthquake: A neglected problem. Psychiatry Res 2015; 230:517-23. [PMID: 26476590 DOI: 10.1016/j.psychres.2015.09.047] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 07/16/2015] [Accepted: 09/29/2015] [Indexed: 10/23/2022]
Abstract
A comprehensive study was conducted 8 months after the 2010 Yushu earthquake to assess the prevalence of posttraumatic stress disorder (PTSD) among medical rescuers and the rescuers' quality of life. Additionally, the study examines differences between local and supporting forces, as well as the relationship between PTSD and lower quality of life (QoL), and the risk factors for both. A total of 338 rescuers (including 123 local rescuers and 215 supporting ones) were randomly selected from Yushu County (the epicenter) and Xining City using multistage systematic sampling. Two standardized instruments, the PTSD Checklist-Civilian Version (PCL-C) and the Chinese version of the WHOQOL-BREF, were used to evaluate the prevalence of PTSD and obtain the rescuers' QoL. Being between 40 and 50 years old, a nurse, Tibetan, having been in serious danger or having received mental health training before this earthquake were significantly and independently associated with PTSD symptoms. Compared with supporting rescuers, local rescuers were more likely to develop PTSD and to report a lower QoL. Additional mental health services and training should be available to at-risk medical rescuers and groups to ensure they are adequately prepared for relief efforts and to maintain their mental health after assistance in disaster relief.
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Affiliation(s)
- Peng Kang
- Department of Military Health Management, College of Military Health Management, Second Military Medical University, Shanghai 200433, China
| | - Yipeng Lv
- Department of Military Health Management, College of Military Health Management, Second Military Medical University, Shanghai 200433, China
| | - Lu Hao
- Office of Teaching and Training, Division of Graduate, Second Military Medical University, Shanghai 200433, China
| | - Bihan Tang
- Department of Military Health Management, College of Military Health Management, Second Military Medical University, Shanghai 200433, China
| | - Zhipeng Liu
- Department of Military Health Management, College of Military Health Management, Second Military Medical University, Shanghai 200433, China
| | - Xu Liu
- Department of Military Health Management, College of Military Health Management, Second Military Medical University, Shanghai 200433, China
| | - Yuan Liu
- Department of Military Health Management, College of Military Health Management, Second Military Medical University, Shanghai 200433, China
| | - Lulu Zhang
- Department of Military Health Management, College of Military Health Management, Second Military Medical University, Shanghai 200433, China.
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Brooks SK, Dunn R, Sage CAM, Amlôt R, Greenberg N, Rubin GJ. Risk and resilience factors affecting the psychological wellbeing of individuals deployed in humanitarian relief roles after a disaster. J Ment Health 2015; 24:385-413. [PMID: 26452755 DOI: 10.3109/09638237.2015.1057334] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND When disasters occur, humanitarian relief workers frequently deploy to assist in rescue/recovery efforts. AIMS To conduct a systematic review of factors affecting the psychological wellbeing of disaster relief workers and identify recommendations for interventions. METHOD We searched MEDLINE®, Embase, PsycINFO® and Web of Science for relevant studies, supplemented by hand searches. We performed thematic analysis on their results to identify factors predicting wellbeing. RESULTS Sixty-one publications were included. Key themes were: pre-deployment factors (preparedness/training); peri-deployment factors (deployment length/timing; traumatic exposure; emotional involvement; leadership; inter-agency cooperation; support; role; demands and workload; safety/equipment; self-doubt/guilt; coping strategies) and post-deployment factors (support; media; personal and professional growth). CONCLUSIONS As well as role-specific stressors, many occupational stressors not specific to humanitarian relief (e.g. poor leadership, poor support) present a significant health hazard to relief workers. Humanitarian organisations should prioritise strengthening relationships between team members and supervisors, and dealing effectively with non-role-specific stressors, to improve the psychological resilience of their workforce.
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Affiliation(s)
- Samantha K Brooks
- a Department of Psychological Medicine , King's College London , London , UK and
| | - Rebecca Dunn
- a Department of Psychological Medicine , King's College London , London , UK and
| | - Clara A M Sage
- a Department of Psychological Medicine , King's College London , London , UK and
| | - Richard Amlôt
- b Emergency Response Department, Health Protection Directorate, Public Health England, Microbial Risk Assessment and Behavioural Science, Porton Down , Salisbury , Wilts , UK
| | - Neil Greenberg
- a Department of Psychological Medicine , King's College London , London , UK and
| | - G James Rubin
- a Department of Psychological Medicine , King's College London , London , UK and
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