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Maloney LM, Hoffman J, Peralta E, Princi R, Thode HC, DiDonato C, LaBarbera A, Williams S. Informal Peer Support and Intentional Acts of Kindness May Attenuate the Impact of Work-Related Stressors on Compassion Satisfaction, Secondary Traumatic Stress, and Burnout of Emergency Medical Services Clinicians. Air Med J 2024; 43:333-339. [PMID: 38897697 DOI: 10.1016/j.amj.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Emergency medical services (EMS) Code Lavender was developed to support EMS clinicians after stressful events via consistent recognition of events, informal peer support, and intentional acts of kindness. This study evaluated changes in burnout screening tool responses of EMS clinicians in response to program implementation and the coincidental start of coronavirus disease 2019. METHODS Anonymous surveys with demographic questions and 2 burnout screening tools were distributed before program implementation (spring 2020) and 20 months later (fall 2021). Analysis included t-tests, Fisher exact tests, and multivariable linear regression. RESULTS Seventy-seven preprogram (59% response rate) and 108 intraprogram (88% response rate) survey responses were included. No changes existed between preprogram and intraprogram responses across all subscale scores. Sex was associated with depersonalization subscale scores, with men having scores 1.53 (95% confidence interval [CI] 0.11-2.95) higher than women. Compared with emergency medical technicians, paramedics had higher compassion satisfaction (OR 3.50; 95% CI 1.79-5.70) and personal accomplishment scores (OR 2.40; 95% CI 1.08-3.71). Transport nurses had higher personal accomplishment (OR 3.29; 95% CI 1.18-5.40), depersonalization (OR 3.73; 95% CI 1.19-6.26), and rates of burnout symptoms (OR 0.54; 95% CI 0.09-0.98) than emergency medical technicians. CONCLUSION The organizational commitment, peer support, and authentic leadership of EMS Code Lavender may attenuate work-related stressors among EMS clinicians.
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Affiliation(s)
- Lauren M Maloney
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY.
| | - Jason Hoffman
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Edder Peralta
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Rudolph Princi
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Henry C Thode
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Christopher DiDonato
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Anthony LaBarbera
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Sarah Williams
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
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2
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Maloney LM, Hoffman J, Peralta E, Princi R, Thode HC, Tomlin M, DiDonato C, LaBarbera A, Lambert E, King J, Johnson DG, Edouard S, Williams S. Supporting Emergency Medical Services Clinicians Through Acute and Sustained Crises With Informal Peer Support and Intentional Acts of Kindness: The Emergency Medical Services Code Lavender Program. Air Med J 2024; 43:313-320. [PMID: 38897694 DOI: 10.1016/j.amj.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/26/2024] [Accepted: 02/14/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Given the recommendations against the use of critical incident stress debriefing, the emergency medical services (EMS) Code Lavender program was created as a mechanism to consistently recognize and reach out to EMS clinicians after acute crisis events, offer nonintrusive informal peer support and acts of kindness, and provide stepwise support via mental health professionals as needed. The study aimed to assess program utilization and evaluate the program's impact on EMS clinicians' perceptions of support and resources available to them after an acute crisis event. METHODS Anonymous surveys were distributed before program implementation and 18 months later. Program utilization was tracked using REDCap (Vanderbilt University, Nashville, TN). Fisher exact tests and logistic regression were used to analyze the survey results. RESULTS Within 30 months, 87 referrals were made. Seventy-seven preprogram (59% response rate) and 104 intraprogram (88% response rate) surveys were collected. There were no differences between respondents by sex or role. There were significant improvements in knowing where to go for help (from 40% to 85%, P < .001) and willingness to seek help if needed (from 40% to 59%, P = .02). CONCLUSION The implementation of an EMS Code Lavender program led to significant increases in EMS clinician self-reported knowledge of where to go and willingness to seek help after acute crisis events.
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Affiliation(s)
- Lauren M Maloney
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY.
| | - Jason Hoffman
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Edder Peralta
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Rudolph Princi
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Henry C Thode
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Mark Tomlin
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Christopher DiDonato
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Anthony LaBarbera
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Erin Lambert
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - James King
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Daniel G Johnson
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Shawn Edouard
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Sarah Williams
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY
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3
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Park SM, Lee JY, Choi JS, Jung HY. A prospective study on EEG default mode network associated with subsequent posttraumatic stress disorder following sexual assault. J Psychiatr Res 2024; 174:181-191. [PMID: 38642455 DOI: 10.1016/j.jpsychires.2024.04.009] [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: 01/23/2024] [Revised: 03/06/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Abstract
This study aimed to explore the predictors of posttraumatic stress disorder (PTSD) in women who have recently experienced sexual assault, by examining psychological and neurophysiological factors using a prospective design with resting-state electroencephalogram (EEG) functional connectivity. The study enrolled 33 women who had been recently traumatized by sexual assault and conducted assessments within a month of the trauma. These survivors were evaluated for PTSD three months later and were classified into two groups: PTSD positive (n = 12) and PTSD negative (n = 21). They were compared to two control groups comprising women who had not experienced any extremely traumatic events: 25 with depression and 25 healthy controls. The evaluation focused on resting-state EEG functional connectivity within default mode network (DMN) using small-worldness (SW), based on graph theory. We also assessed self-reported levels of depression, anxiety, anger, and executive functions. The findings indicated that survivors who developed PTSD three months post-trauma exhibited higher anxiety levels and reduced DMN SW in the beta 3 frequency, compared to those who did not develop PTSD. Contrary to expectations, survivors without PTSD showed decreased executive functioning and lower prefrontal centrality compared to those with PTSD. This study underscores the importance of early assessment and intervention for sexual assault survivors at risk of developing PTSD.
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Affiliation(s)
- Su Mi Park
- Department of Counseling Psychology, Hannam University, Daejoen, Republic of Korea.
| | - Jun-Young Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jung-Seok Choi
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hee Yeon Jung
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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4
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Raphael B. Crowds and Other Collectives: Complexities of Human Behaviors in Mass Emergencies. Psychiatry 2023; 86:300-306. [PMID: 38149709 DOI: 10.1080/00332747.2023.2289816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
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5
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Satchell J, Craston T, Drennan VM, Billings J, Serfaty M. Psychological Distress and Interventions for Older Victims of Crime: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:3493-3512. [PMID: 36329564 PMCID: PMC10594850 DOI: 10.1177/15248380221130354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We aimed to conduct the first systematic narrative review and quality appraisal of existing evidence on the psychological consequences of crime in older victims in the community and psychological interventions. We searched five databases to identify all peer-reviewed literature published in English on psychological impact and/or interventions for older crime victims and quality appraised these using the Mixed-Methods Appraisal Tool, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (Prospero: CRD42019140137). Evidence from included studies were narratively synthesized, along with their strengths and limitations. We found 20 studies on psychological distress in older victims, four of which included interventions. From these, we identified 30 different impacts including symptoms of anxiety, depression, post-traumatic stress disorder, emotions including humiliation and self-blame, and behavioral changes. Only feasibility interventions have been published, although promising results were reported for cognitive-behavioral informed treatments for depression and anxiety. Studies were wide-ranging in aims, crimes included, and outcomes used. Recommendations for improving the evidence-base and to raise the profile of this neglected population have been provided.
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6
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Jahnke SA, Watson P, Leto F, Jitnarin N, Kaipust CM, Hollerbach BS, Haddock CK, Poston WSC, Gist R. Evaluation of the Implementation of the NFFF Stress First Aid Intervention in Career Fire Departments: A Cluster Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7067. [PMID: 37998298 PMCID: PMC10671183 DOI: 10.3390/ijerph20227067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023]
Abstract
Firefighting is inherently dangerous, though recently concerns have shifted from traditional fireground injuries (burns and asphyxiation) to a focus on mental and behavioral health. Although firefighters are remarkably resilient, research suggests many suffer negative psychological consequences from repeated exposures to trauma. While the Stress First Aid (SFA) model has gained increased attention and adoption among fire departments as a model for behavioral health training, it has not been formally evaluated. This cluster randomized controlled trial used a crossover design comparing the immediate SFA group to delayed SFA control to test the impact of the SFA on firefighters' mental and behavioral health changes after 10-12 months (n = 400; Mage = 37.6, 4.8% women). A convenience sample of 79 firefighters (Mage = 41.4; 8.7% women) provided evaluations on one or more of the training modules. Participants reported satisfaction with all training components (Peer team training 97.6%, Online SFA 94.9%, Curbside Manner 88.4%, After Action Review 89.4%) and reported success in changing personnel's perception of their department's ability to respond to behavioral health issues (SFA M = 3.93, Control 3.50; t = 2.52, p = 0.042). Future work should focus on additional resources and training to augment existing efforts to help departments continue their efforts.
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Affiliation(s)
- Sara A. Jahnke
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - Patricia Watson
- National Center for PTSD, White River Junction, VT 05009, USA;
| | - Frank Leto
- FDNY, Counseling Services Unit, Fort Totten, NY 10314, USA;
| | - Nattinee Jitnarin
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - Christopher M. Kaipust
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - Brittany S. Hollerbach
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - Christopher K. Haddock
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - W. S. Carlos Poston
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA; (S.A.J.); (N.J.); (C.M.K.); (C.K.H.); (W.S.C.P.)
| | - Richard Gist
- KCMO Fire Department, Kansas City, MO 64106, USA;
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7
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Mortimer AR, Mortimer RB. Psychological First Aid for Wilderness Trauma: Interventions for Expedition or Search and Rescue Team Members. Wilderness Environ Med 2023; 34:346-353. [PMID: 37105845 DOI: 10.1016/j.wem.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 04/29/2023]
Abstract
When exposed to actual or threatened death or serious injury in austere settings, expedition members are at risk of acute stress reactions, as are search and rescue members involved with extricating the patient. Acute stress reactions are a normal response to significant trauma and commonly resolve on their own. If they do not, they can lead to post-traumatic stress disorder (PTSD), a set of persistent symptoms that cause significant effects on the person's life. Medication has a limited preventive role in the field for treatment of stress partly because so few are trained to administer it. Contrastingly, psychological first aid can be performed by lay team members with minimal training. Psychological first aid consists of interventions attempting to encourage feelings of safety, calm, self-efficacy, connection, and hope. These are interventions that provide guidance to not make the situation emotionally worse and might have a preventive effect on later development of PTSD. They are valuable in the field not only for the patient but also for affected team members as well as for search and rescue team members who may be indirectly affected by the trauma and experience repercussions later.
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Affiliation(s)
- Amanda R Mortimer
- Department of Psychology, California State University, Fresno, Fresno, CA
| | - Roger B Mortimer
- Fresno Medical Education Program, Department of Family Medicine, University of California, San Francisco, San Francisco, CA.
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8
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Strudwick J, Gayed A, Deady M, Haffar S, Mobbs S, Malik A, Akhtar A, Braund T, Bryant RA, Harvey SB. Workplace mental health screening: a systematic review and meta-analysis. Occup Environ Med 2023; 80:469-484. [PMID: 37321849 PMCID: PMC10423530 DOI: 10.1136/oemed-2022-108608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/30/2023] [Indexed: 06/17/2023]
Abstract
Workplaces are an important location for population mental health interventions. Screening to detect employees at risk of or experiencing mental ill health is increasingly common. This systematic review and meta-analysis examined the efficacy of workplace mental health screening programmes on employee mental health, work outcomes, user satisfaction, positive mental health, quality of life, help-seeking and adverse effects. PubMed, PsycINFO, EMBASE, CENTRAL, Global Index Medicus, Global Health and SciELO were searched (database inception-10 November 2022) and results screened by two independent reviewers. Controlled trials evaluating screening of workers' mental health as related to their employment were included. Random effects meta-analysis was performed to calculate pooled effect sizes for each outcome of interest. Grading of Recommendations Assessment, Development and Evaluation was conducted to evaluate the certainty of findings. Of the 12 328 records screened, 11 were included. These reported 8 independent trials collectively assessing 2940 employees. Results indicated screening followed by advice or referral was ineffective in improving employee mental health symptoms (n=3; d=-0.07 (95% CI -0.29 to 0.15)). Screening followed by facilitated access to treatment interventions demonstrated a small improvement in mental health (n=4; d=-0.22 (95% CI -0.42 to -0.02)). Limited effects were observed for other outcomes. Certainty ranged from low to very low. The evidence supporting workplace mental health screening programmes is limited and available data suggest mental health screening alone does not improve worker mental health. Substantial variation in the implementation of screening was observed. Further research disentangling the independent effect of screening alongside the efficacy of other interventions to prevent mental ill health at work is required.
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Affiliation(s)
- Jessica Strudwick
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
| | - Aimee Gayed
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Mark Deady
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Sam Haffar
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
| | - Sophia Mobbs
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
| | - Aiysha Malik
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Taylor Braund
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Samuel B Harvey
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
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9
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Cornelius T, Mendieta M, Cumella RM, Lopez Veneros D, Tincher IM, Agarwal S, Kronish I. Family-authored ICU diaries to reduce fear in patients experiencing a cardiac arrest (FAID fear): A pilot randomized controlled trial. PLoS One 2023; 18:e0288436. [PMID: 37498834 PMCID: PMC10373992 DOI: 10.1371/journal.pone.0288436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023] Open
Abstract
Survivors of cardiac arrest (CA) and their family members often experience significant fear-based distress (cardiac fear; i.e., fear about the CA survivor's heart). Fear-based distress after CA is associated with higher rates of cardiac event recurrence and mortality in CA survivors. As posited in Dyadic Disruption Theory (DDT), cardiac fear in family members may contribute to the development of distress in CA survivors via socially-based mechanisms. Thus, interventions to reduce family distress may improve CA survivors' outcomes. ICU diaries are easy to implement and scalable and show promise for reducing distress after CA but are primarily targeted towards survivors. The primary aim of the Family-Authored ICU Diaries to reduce Fear in Patients Experiencing a CA (FAID Fear) pilot randomized controlled trial was to test feasibility of an ICU diary intervention targeted towards family member distress alone. Family members of patients hospitalized after CA (N = 16) were randomized 2:1 to receive the FAID Fear intervention or usual care. Intervention participants were provided brief instructions and were asked to write in the diary twice per week until the end of hospital care. Assessments occurred at baseline enrollment, end of hospital care, and 30 days later. Participants' mean age was 50.73 years (SD = 13.41; 80% cis-gender female; 60% White). Recruitment (16/25 referred; 64.0%), retention (14/16 enrolled; 87.5%), and intervention adherence (7/10 completed; 70%) were promising. Most agreed that the ICU diary intervention was appropriate (7/10 completed; 70.0%), feasible (9/10 completed; 90.0%]), and acceptable (8/10 completed; 80.0%). Fear was nonsignificantly lower in intervention participants (v. control) at end of hospital care and 30 days later. FAID Fear represents a first step in building theory-based dyadic interventions that can be implemented to support family members of CA survivors in the ICU, with potential to improve outcomes in CA survivors.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Miguel Mendieta
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Robin M. Cumella
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
| | - David Lopez Veneros
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
- School of Nursing, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Isabella M. Tincher
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Sachin Agarwal
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Ian Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
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Asselbergs J, van Bentum J, Riper H, Cuijpers P, Holmes E, Sijbrandij M. A systematic review and meta-analysis of the effect of cognitive interventions to prevent intrusive memories using the trauma film paradigm. J Psychiatr Res 2023; 159:116-129. [PMID: 36708636 DOI: 10.1016/j.jpsychires.2023.01.028] [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: 11/21/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
There is an unmet need for effective early interventions that can relieve initial trauma symptoms and reduce symptoms of posttraumatic stress disorder (PTSD). We evaluated the efficacy of cognitive interventions compared to control in reducing intrusion frequency and PTSD symptoms in healthy individuals using the trauma film paradigm, in which participants view a film with aversive content as an experimental analogue of trauma exposure. A systematic literature search identified 41 experiments of different cognitive interventions targeting intrusions. In the meta-analysis, the pooled effect size of 52 comparisons comparing cognitive interventions to no-intervention controls on intrusions was moderate (g = -0.46, 95% CI [-0.61 to -0.32], p < .001). The pooled effect size of 16 comparisons on PTSD symptoms was also moderate (g = -0.31, 95% CI [-0.46 to -0.17], p < .001). Both visuospatial interference and imagery rescripting tasks were associated with significantly fewer intrusions than controls, whereas verbal interference and meta-cognitive processing tasks showed nonsignificant effect sizes. Interventions administered after viewing the trauma film showed significantly fewer intrusions than controls, whereas interventions administered during film viewing did not. No experiments had low risk of bias (ROB), 37 experiments had some concerns of ROB, while the remaining four experiments had high ROB. To the best of our knowledge, this is the first meta-analysis investigating the efficacy of cognitive interventions targeting intrusions in non-clinical samples. Results seem to be in favour of visuospatial interference tasks rather than verbal tasks. More research is needed to develop an evidence base on the efficacy of various cognitive interventions and test their clinical translation to reduce intrusive memories of real trauma.
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Affiliation(s)
- Joost Asselbergs
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands
| | - Jaёl van Bentum
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Faculty of Social and Behavioural Sciences, Dept. of Clinical Psychology, Universiteit Utrecht, Heidelberglaan 1, 3584 CS, Utrecht, Netherlands.
| | - Heleen Riper
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Medical Centre, VUmc, Dept. of Psychiatry, Amsterdam, the Netherlands; Research Unit for Telepsychiatry and E-Mental Health, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense, Denmark
| | - Pim Cuijpers
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, the Netherlands
| | - Emily Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Marit Sijbrandij
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, the Netherlands
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11
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Abstract
Within this paper, we discuss Moral Distress Reflective Debriefs as a promising approach to address and mitigate moral distress experienced by healthcare professionals. We briefly review the empirical and theoretical literature on critical incident stress debriefing and psychological debriefing to highlight the potential benefits of this modality. We then describe the approach that we take to facilitating reflective group discussions in response to morally distressing patient cases ("Moral Distress Reflective Debriefs"). We discuss how the debriefing literature and other clinical ethics activities influenced the development of our approach. In particular, we focus on the role of the clinical ethicist as a facilitator with particular emphasis on encouraging perspective-taking and nurturing ethical attunement in a supportive manner. We suggest that this approach reduces the narrowing effects of frustration and anger that are often reported when individuals experience moral-constraint distress. Finally, we provide an example of Moral Distress Reflective Debriefs, elucidating how this supportive process complements ethics consultation and can mitigate the negative effects of moral distress.
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Yeung NCY, Tang JLT, Lau STY, Hui KH, Cheung AWL, Wong ELY. 'Caring for the helpers': factors associated with professional quality of life among Hong Kong nurses during the fifth wave of the COVID-19 pandemic. Eur J Psychotraumatol 2023; 14:2183454. [PMID: 36927300 PMCID: PMC10026750 DOI: 10.1080/20008066.2023.2183454] [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] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Western studies have found that nurses are likely to experience both positive and negative emotions in their job, as a helping profession [professional quality of life (ProQoL)] during the coronavirus disease 2019 (COVID-19) pandemic, and that psychosocial and work-related variables (e.g. pandemic-related stressors, interpersonal and organizational support, coping strategies) are associated with such outcomes. However, relevant studies on nurses in the Asian context are limited. OBJECTIVE This study examined the psychosocial correlates of three indicators of ProQoL, i.e. compassion satisfaction, secondary traumatic stress (STS), and burnout, among nurses during the fifth wave of the COVID-19 pandemic in Hong Kong. METHOD Nurses in Hong Kong (N = 220) working in hospitals and community settings during the COVID-19 pandemic were recruited between 24 May and 27 June 2022 through nursing associations to complete an online survey measuring the aforementioned psychosocial variables. RESULTS Hierarchical regression results found that stressors from clinical work environments, insufficient emotional support, and less positive reframing were associated with poorer ProQoL (i.e. lower compassion satisfaction; higher STS and burnout) (β from 0.16, p > .05, to 0.44, p > .001). In addition, COVID-19-related worries/uncertainties and emotional processing were associated with higher STS (β from 0.21 to 0.23, p < .01), whereas insufficient organizational support for communication with the healthcare system was associated with higher burnout (β = 0.12, p < .05). CONCLUSIONS Our findings identified the important psychosocial determinants in ProQoL among nurses in Hong Kong and provide recommendations for services supporting the mental health of these nurses. Providing workshops for nurses to train their skills in coping with COVID-19-related uncertainties, worries, and stressors from the clinical work environment, in using adaptive coping strategies (e.g. positive reframing), and in soliciting emotional support from important others could facilitate their ProQoL. Moreover, the provision of organizational support through timely and transparent communication with the healthcare system could reduce STS in nurses.
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Affiliation(s)
- Nelson Chun Yiu Yeung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Jeremy Lok Tin Tang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Stephanie Tsz Yung Lau
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kam Hei Hui
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Annie Wai-Ling Cheung
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Eliza Lai-Yi Wong
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
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13
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Flannery H, McParland J, Baker H, Hitchcock M, Portnoy S. Morning Connections: How do you support hospital staff working remotely during a global pandemic without providing 'staff support'? Clin Child Psychol Psychiatry 2023; 28:143-156. [PMID: 35965443 PMCID: PMC9379589 DOI: 10.1177/13591045221119003] [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] [Indexed: 02/01/2023]
Abstract
When lockdown was announced in the United Kingdom, kitchen tables transformed into offices overnight, as many National Health Service (NHS) workers adapted to new ways of working from home. To respond to the developing situation, we established a programme of weekly 'Connections' meetings where staff could be together, remotely. This article describes the evolution of our Morning Connections and Oncology Connections virtual meetings, including the content of sessions, how they were evaluated and whether they met their intention to support colleagues during a particularly challenging time, both personally and professionally, for NHS staff.
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Affiliation(s)
- Halina Flannery
- Child and Adolescent Psychology, University College London Hospitals NHS Foundation Trust8964, UK
| | - James McParland
- Child and Adolescent Psychology, University College London Hospitals NHS Foundation Trust8964, UK
| | - Hannah Baker
- South London and Maudsley Mental Health NHS Trust4958, UK
| | - Megan Hitchcock
- Child and Adolescent Psychology, University College London Hospitals NHS Foundation Trust8964, UK
| | - Sara Portnoy
- Child and Adolescent Psychology, University College London Hospitals NHS Foundation Trust8964, UK
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14
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Role of noradrenergic arousal for fear extinction processes in rodents and humans. Neurobiol Learn Mem 2022; 194:107660. [PMID: 35870717 DOI: 10.1016/j.nlm.2022.107660] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/29/2022] [Accepted: 07/17/2022] [Indexed: 01/22/2023]
Abstract
Fear extinction is a learning mechanism that is pivotal for the inhibition of fear responses towards cues or contexts that no longer predict the occurrence of a threat. Failure of fear extinction leads to fear expression under safe conditions and is regarded to be a cardinal characteristic of many anxiety-related disorders and posttraumatic stress disorder. Importantly, the neurotransmitter noradrenaline was shown to be a potent modulator of fear extinction. Rodent studies demonstrated that excessive noradrenaline transmission after acute stress opens a time window of vulnerability, in which fear extinction learning results in attenuated long-term extinction success. In contrast, when excessive noradrenergic transmission subsides, well-coordinated noradrenaline transmission is necessary for the formation of a long-lasting extinction memory. In addition, emerging evidence suggests that the neuropeptide corticotropin releasing hormone (CRF), which strongly regulates noradrenaline transmission under conditions of acute stress, also impedes long-term extinction success. Recent rodent work - using sophisticated methods - provides evidence for a hypothetical mechanistic framework of how noradrenaline and CRF dynamically orchestrate the neural fear and extinction circuitry to attenuate or to improve fear extinction and extinction recall. Accordingly, we review the evidence from rodent studies linking noradrenaline and CRF to fear extinction learning and recall and derive the hypothetical mechanistic framework of how different levels of noradrenaline and CRF may create a time window of vulnerability which impedes successful long-term fear extinction. We also address evidence from human studies linking noradrenaline and fear extinction success. Moreover, we accumulate emerging approaches to non-invasively measure and manipulate the noradrenergic system in healthy humans. Finally, we emphasize the importance of future studies to account for sex (hormone) differences when examining the interaction between fear extinction, noradrenaline, and CRF. To conclude, NA's effects on fear extinction recall strongly depend on the arousal levels at the onset of fear extinction learning. Our review aimed at compiling the available (mainly rodent) data in a neurobiological framework, suited to derive testable hypotheses for future work in humans.
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15
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Christou-Ergos M, Wiley KE, Leask J, Shapiro GK. Traumatic Events and Vaccination Decisions: A Systematic Review. Vaccines (Basel) 2022; 10:vaccines10060911. [PMID: 35746519 PMCID: PMC9230365 DOI: 10.3390/vaccines10060911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Despite the apparent relationship between past experiences and subsequent vaccination decisions, the role of traumatic events has been overlooked when understanding vaccination intention and behaviour. We conducted a systematic review to synthesize what is known about the relationship between traumatic events and subsequent vaccination decisions. MEDLINE, PsycINFO and CINHAL electronic databases were searched, and 1551 articles were screened for eligibility. Of the 52 articles included in full-text assessment, five met the eligibility criteria. Findings suggest that the experience of trauma is associated with individual vaccination decisions. Social and practical factors related to both trauma and vaccination may mediate this relationship. As this is a relatively new field of inquiry, future research may help to clarify the nuances of the relationship. This review finds that the experience of psychological trauma is associated with vaccination intention and behaviour and points to the potential importance of a trauma-informed approach to vaccination interventions during the current global effort to achieve high COVID-19 vaccine coverage.
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Affiliation(s)
- Maria Christou-Ergos
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Correspondence:
| | - Kerrie E. Wiley
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Sydney Institute for Infectious Diseases, Westmead Hospital, Westmead 2145, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown 2006, Australia;
- Sydney Institute for Infectious Diseases, Westmead Hospital, Westmead 2145, Australia
| | - Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada;
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16
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Feinstein D. Uses of Energy Psychology Following Catastrophic Events. Front Psychol 2022; 13:856209. [PMID: 35548526 PMCID: PMC9084314 DOI: 10.3389/fpsyg.2022.856209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/14/2022] [Indexed: 12/15/2022] Open
Abstract
Energy psychology, as most widely practiced, integrates the manual stimulation of acupuncture points with imaginal exposure, cognitive restructuring, and other evidence-based psychotherapeutic procedures. Efficacy for energy psychology protocols has been established in more than 120 clinical trials, with meta-analyses showing strong effect sizes for PTSD, anxiety, and depression. The approach has been applied in the wake of natural and human-made disasters in more than 30 countries. Four tiers of energy psychology interventions following the establishment of safety, trust, and rapport are described, including (1) immediate relief/stabilization, (2) reducing limbic arousal to trauma-based triggers, (3) overcoming complex psychological difficulties, and (4) promoting optimal functioning. The first tier is most pertinent in psychological first aid immediately following a disaster, with the subsequent tiers progressively being introduced over time with complex stress reactions and chronic disorders. Advantages of adding the stimulation of acupuncture points to a conventional exposure approach are identified, and challenges around cultural sensitivities and unintended effects are discussed. After establishing a framework for introducing energy psychology in disaster relief efforts, reports from a sampling of settings are presented, based on interviews with this paper's author. These include accounts of relief work with survivors of mass shootings, genocide, ethnic warfare, earthquakes, hurricanes, tornadoes, floods, wildfires, and the COVID-19 pandemic. Hundreds of other reports from the field show a pattern of strong outcomes following the use of energy psychology in the days or weeks after a disaster and in the subsequent treatment of trauma-based psychological problems. Many of these accounts corroborate one another in terms of rapid relief and long-term benefits. Finally, examples of more efficient delivery methods utilizing large groups, lay counselors, digital technology, and cultivating community resilience are presented.
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17
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Psychometric properties of the Interpersonal Emotion Regulation Questionnaire (IERQ) in Turkish samples. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-019-00578-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Connolly P. Instability and Uncertainty Are Critical for Psychotherapy: How the Therapeutic Alliance Opens Us Up. Front Psychol 2022; 12:784295. [PMID: 35069367 PMCID: PMC8777103 DOI: 10.3389/fpsyg.2021.784295] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/06/2021] [Indexed: 01/04/2023] Open
Abstract
Tschacher and Haken have recently applied a systems-based approach to modeling psychotherapy process in terms of potentially beneficial tendencies toward deterministic as well as chaotic forms of change in the client's behavioral, cognitive and affective experience during the course of therapy. A chaotic change process refers to a greater exploration of the states that a client can be in, and it may have a potential positive role to play in their development. A distinction is made between on the one hand, specific instances of instability which are due to techniques employed by the therapist, and on the other, a more general instability which is due to the therapeutic relationship, and a key, necessary result of a successful therapeutic alliance. Drawing on Friston's systems-based model of free energy minimization and predictive coding, it is proposed here that the increase in the instability of a client's functioning due to therapy can be conceptualized as a reduction in the precisions (certainty) with which the client's prior beliefs about themselves and their world, are held. It is shown how a good therapeutic alliance (characterized by successful interpersonal synchrony of the sort described by Friston and Frith) results in the emergence of a new hierarchical level in the client's generative model of themselves and their relationship with the world. The emergence of this new level of functioning permits the reduction of the precisions of the client's priors, which allows the client to 'open up': to experience thoughts, emotions and experiences they did not have before. It is proposed that this process is a necessary precursor to change due to psychotherapy. A good consilience can be found between this approach to understanding the role of the therapeutic alliance, and the role of epistemic trust in psychotherapy as described by Fonagy and Allison. It is suggested that beneficial forms of instability in clients are an underappreciated influence on psychotherapy process, and thoughts about the implications, as well as situations in which instability may not be beneficial (or potentially harmful) for therapy, are considered.
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Affiliation(s)
- Patrick Connolly
- Counselling and Psychology Department, Hong Kong Shue Yan University, North Point, Hong Kong SAR, China
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19
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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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20
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Psychiatry of disasters. PSIHIATRU.RO 2022. [DOI: 10.26416/psih.71.4.2022.7329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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21
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Tsur N, Bachem R, Zhou X, Levin Y, Abu-Raiya H, Maercker A. Cross-cultural investigation of COVID-19 related acute stress: A network analysis. J Psychiatr Res 2021; 143:309-316. [PMID: 34530342 PMCID: PMC8437796 DOI: 10.1016/j.jpsychires.2021.09.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/08/2021] [Accepted: 09/01/2021] [Indexed: 12/16/2022]
Abstract
The outbreak of the COVID-19 pandemic has confronted humanity with an ongoing biopsychosocial stressor, imposing multifaceted challenges to individuals and societies. Particularly, the pandemic reflects an ongoing, potentially life-threatening danger to self and others, which may instigate acute stress symptoms (ASS). This study utilized a network framework to assess cross-national ASS a short time following the initial COVID-19 outbreak. Three samples of adult participants from China, Israel, and Switzerland completed a self-report assessment of acute stress symptoms. Network analyses were utilized to uncover the phenotype and dynamics of different ASS in these three countries. The ASS network analyses revealed extensive connections in all networks and reflected the structure of ASS. The centrality indexes in all networks were from the hyperarousal cluster. "Feeling jumpy" was the node with the highest strength centrality in the Israeli sample and "physiological reactivity" was the item with the highest centrality in the Swiss sample. In the Chinese sample, the item with the highest centrality was "feeling alert to danger." The findings reveal that despite some variations, the overall clinical picture of ASS in response to the COVID-19 pandemic is universal. These findings highlight the centrality of hyperarousal symptoms, presumably reflecting its significance for clinical interventions.
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Affiliation(s)
- Noga Tsur
- Bob Shapell School of Social Work, Tel-Aviv University, P.O.B. 39040, Ramat Aviv, Tel-Aviv, 69978, Israel.
| | - Rahel Bachem
- Department of Psychology, University of Zurich, Binzmuehlestrasse 14/17, CH-8050 Zurich, Switzerland
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, China
| | - Yafit Levin
- Department of Education, Ariel University, Ariel, Israel.
| | - Hisham Abu-Raiya
- Bob Shapell School of Social Work, Tel-Aviv University, P.O.B. 39040, Ramat Aviv, Tel-Aviv, 69978, Israel
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Binzmuehlestrasse 14/17, CH-8050 Zurich, Switzerland
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22
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Wong A, Olusanya O, Parulekar P, Highfield J. Staff wellbeing in times of COVID-19. J Intensive Care Soc 2021; 22:328-334. [PMID: 35154371 PMCID: PMC8829766 DOI: 10.1177/1751143720968066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2024] Open
Abstract
In the last 10 years, there has been increasing interest into the psychological wellbeing of healthcare providers. Within critical care, increasing attention is being paid to the concept of 'burnout' - a cluster of symptoms that adversely affect the health of critical care providers. Publications and statements from the major critical care societies have all addressed this syndrome and emphasised urgency in tackling it. The current COVID-19 pandemic has fundamentally changed the way we work, communicate and learn. Even before the pandemic, there have been growing concerns and acknowledgement that healthcare practitioners in intensive care are at increased risk of burnout and burnout syndrome. There has never been greater pressure on intensive care or indeed healthcare as a whole to look after so many patients during this pandemic and yet there is global acknowledgement that key to overcoming these challenges is to look after the care providers - both physically and psychologically. In this paper, we review the issue of burnout amongst healthcare practitioners during current pandemic. We present the impact of burnout on the individual and the system as a whole but perhaps most importantly, we provide a review of steps being taken to mitigate against these adverse outcomes in the short and longer term.
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23
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Bai M. Psychological Response to the Diagnosis of Advanced Cancer: A Systematic Review. Ann Behav Med 2021; 56:125-136. [PMID: 34473821 DOI: 10.1093/abm/kaab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite major efforts to address psychological distress and quality of life (QOL) in people with cancer, only none to small intervention effect has been observed. There is reason to question whether psychosocial needs of patients have already been met under the usual oncology care. PURPOSE The purpose of this systematic review was to examine changes in depression, anxiety and QOL during the existential plight in advanced cancer. METHODS A literature search was performed in the PubMed and APA PsycINFO databases from year 1976 up to May 31, 2021. Longitudinal observational or experimental research targeting depression, anxiety or QOL in advanced cancer (stage III or IV), with baseline time since cancer diagnosis within 100 days, follow-up within 16 weeks post-baseline were eligible. Quality rating was based on the GRADE guidelines. RESULTS Overall QOL did not reveal clinically relevant changes for the majority of studies as evaluated by effect size and raw score changes (median effect size 0.01, interquartile range -0.10-0.15). Nonetheless, modest to moderate improvement was found for depression (median effect size 0.28, interquartile range 0.03-0.38) and anxiety (median effect size 0.57, interquartile range 0.32-0.79). CONCLUSION Transient distress symptoms and temporarily reduced functioning in the oncology setting may be considered normal, whereas impaired overall QOL needs to be addressed. Developing innovative interventions that enhance QOL for patients newly diagnosed with advanced cancer without interfering with patients' natural adaptation process is imperative.
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Affiliation(s)
- Mei Bai
- University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205
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24
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de Leon Siantz ML. Guest Editorial: Unaccompanied Immigrant Children Detained at the Border: A Humanitarian Crisis. J Pediatr Nurs 2021; 60:A9-A12. [PMID: 34362612 DOI: 10.1016/j.pedn.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mary Lou de Leon Siantz
- Professor Emerita Betty Irene Moore School of Nursing, University of California Davis, United States; Founding Director Center for Multicultural Perspectives in Science (CAMPOS), University of California Davis, United States.
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25
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De Brier N, Borra V, Dockx K, Scheers H, Stroobants S, De Buck E, Lauwers K, Vandekerckhove P. Best Available Evidence on Communicative First Aid Interventions by Laypeople for Preventing and Relieving Posttraumatic Stress Disorder-Related Symptomatology Following Traumatic Events. J Trauma Stress 2021; 34:538-550. [PMID: 33217083 DOI: 10.1002/jts.22625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/07/2020] [Accepted: 10/17/2020] [Indexed: 11/09/2022]
Abstract
Trauma-exposed individuals are at risk of developing mental health problems, including posttraumatic stress disorder (PTSD). As an exposed individual's friend or family member may be the first person to provide posttrauma relief, informing and training laypeople in psychosocial first aid may benefit mental health outcomes of trauma-exposed individuals. We aimed to (a) collect the best available evidence on communication as a first aid intervention in assisting individuals following traumatic events and (b) formulate practical recommendations. Systematic literature searches were conducted in three databases (March 2019). Following study selection, the extracted data were tabulated and synthesized narratively. The evidence was appraised according to the GRADE methodology and evaluated by a multidisciplinary expert panel to formulate recommendations for practice. Out of 1,724 articles, no experimental studies were identified, showing a complete lack of high-quality controlled studies on the efficacy of communicative practices. However, when lower-quality study designs were included, nine cross-sectional studies constituted the best available evidence. The studies suggested that positive communication by family members, r = -.38, aOR = 0.26, β = -.22, p < .001-p < .05, and expressive coping by the victim, β = -.62, p < .001, were associated with PTSD diagnosis and/or symptom severity; however, the evidence was of very low certainty. The expert panel took the methodological limitations into account when formulating weak practical recommendations. Cross-sectional studies currently provide the best possible evidence for developing guidelines on psychosocial first aid. High-quality controlled studies are needed to establish casual associations and identify the most effective interventions.
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Affiliation(s)
- Niels De Brier
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Vere Borra
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Cochrane First Aid, Mechelen, Belgium
| | - Kim Dockx
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Hans Scheers
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | | | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Cochrane First Aid, Mechelen, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Karen Lauwers
- Humanitarian Services, Belgian Red Cross, Mechelen, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Belgian Red Cross, Mechelen, Belgium
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26
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Bailey B, Morris MC. Longitudinal Associations Among Negative Cognitions and Depressive and Posttraumatic Stress Symptoms in Women Recently Exposed to Stalking. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:5775-5794. [PMID: 30353775 PMCID: PMC6482094 DOI: 10.1177/0886260518807905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Being stalked is a potentially traumatic experience associated with a threat to personal safety. Although major depression and posttraumatic stress (PTS) disorder are highly prevalent among stalking victims, little is known about factors associated with risk for the onset and maintenance of depressive and PTS symptoms in individuals with recent stalking exposure. The aim of this study was to determine the role of cognitive appraisals (negative views about the self, negative views about the world, self-blame) in the development of depressive and PTS symptoms in young adult women who had experienced stalking within 1 month of their baseline assessment. Participants (n = 82) completed self-report online surveys of posttraumatic cognitions and symptoms four times over the course of 3 months. Levels of posttraumatic cognitions among female stalking victims were comparable to those in other studies of trauma-exposed individuals. Multilevel models (MLMs) revealed that within-person changes in cognitions were differentially associated with concurrent changes in depressive and PTS symptoms over time, controlling for the influence of time, age, race, ethnicity, lifetime stalking victimization, childhood trauma exposure, and symptoms of the other disorder. Whereas more negative cognitions about the world were associated with higher levels of concurrent depressive and PTS symptoms, negative cognitions about the self were uniquely associated with higher concurrent depressive symptoms. Contrary to expectation, self-blame was not significantly associated with depressive or PTS symptoms. Results provided support for the potential utility of negative cognitions as risk markers for depressive and PTS symptoms in young adult female stalking victims. The present findings suggest that interventions targeting symptom-specific thinking patterns could help reduce risk for negative mental health outcomes associated with stalking victimization.
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Affiliation(s)
| | - Matthew C. Morris
- Meharry Medical College, Nashville, TN, USA
- Vanderbilt University, Nashville, TN, USA
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27
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Li J, Huang C, Yuan B, Liang H. The Impact of Stigmatization on Social Avoidance and Fear of Disclosure among Older People: Implications for Social Policy Preparedness in a Public Health Crisis. J Aging Soc Policy 2021; 33:342-358. [PMID: 33985419 DOI: 10.1080/08959420.2021.1924343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined whether older people with epicenter travel experiences in the event of the novel coronavirus disease epidemic suffered from stigmatization, which in turn affected subsequent behavior, including fear of disclosure and social avoidance. A three-wave survey was conducted using a time-lagged design of older people who had travel experiences in Hubei, China on the eve of the outbreak. Results reveal positive associations between stigmatization and stress, social avoidance, and fear of disclosure, in addition to positive associations between stress and social avoidance and fear of disclosure. Findings thus suggest that the effects of stigmatization on social avoidance and fear of disclosure is mediated, in part, by stress. De-stigmatization and psychological supports should be prioritized for epidemic prevention and control among older people in quarantine.
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Affiliation(s)
- Jiannan Li
- Research associate professor, Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China
| | - Chulan Huang
- Undergraduate, School of Tourism Management, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bocong Yuan
- Associate professor, School of Tourism Management, Sun Yat-sen University Guangzhou, Guangdong, China
| | - Haixuan Liang
- Undergraduate, School of Tourism Management, Sun Yat-sen University, Guangzhou, Guangdong, China
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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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Bryant RA. A critical review of mechanisms of adaptation to trauma: Implications for early interventions for posttraumatic stress disorder. Clin Psychol Rev 2021; 85:101981. [PMID: 33588312 DOI: 10.1016/j.cpr.2021.101981] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
Although many attempts have been made to limit development of posttraumatic stress disorder (PTSD) by early intervention after trauma exposure, these attempts have achieved only modest success. This review critiques the biological and cognitive strategies used for early intervention and outlines the extent to which they have prevented PTSD. The major predictors of PTSD are reviewed, with an emphasis on potential mechanisms that may underpin the transition from acute stress reaction to development of PTSD. This review highlights that there is a wide range of biological and cognitive factors that have been shown to predict PTSD. Despite this, the major attempts at early intervention have focused on strategies that attempt to augment extinction processes or alter appraisals in the acute period. The documented predictors of PTSD indicate that a broader range of potential strategies could be explored to limit PTSD. The evidence that people follow different trajectories of stress response following trauma and there is a wide array of acute predictors of PTSD indicates that a flexible and tailored approach needs to be investigated to evaluate more effective early intervention strategies.
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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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Han B, Ma C, Liu Z, Jiang R, Zhang T, Wang Y, Chen H, Wen J, Huang Y. Perceived Psychological Feelings Make Important Contributions to the Symptoms of Common Mental Disorders of Medical Staff During the COVID-19. Front Psychiatry 2021; 12:738610. [PMID: 35153846 PMCID: PMC8828733 DOI: 10.3389/fpsyt.2021.738610] [Citation(s) in RCA: 3] [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] [Received: 07/09/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Lack of information about mental health status among medical staff during the epidemic of COVID-19 in China is one of the major barriers to psychological interventions. This paper aims to evaluate the contributions of perceived psychological feelings to the symptoms of common mental disorders among medical staff during the epidemic of COVID-19 in China. METHOD A large sample of medical staff based on a non-probability sampling design was collected from February 17 to 24, 2020. The symptoms of common mental disorders were screened based on self-reported instruments to evaluate psychological distress, anxious symptoms, and depressive symptoms during the past week. Perceived psychological feelings were based on self-report. Logistic regressions and elastic net regularizations were used to evaluate the independent effect of the psychological feelings controlled by hospitals and participants characteristics. RESULTS Totally 4,677 medical staff completed the survey. The prevalence of psychological distress, anxious symptoms, and depressive symptoms were 15.9% (95% CI 14.8-16.9), 16.0% (95% CI 15.0-17.1), and 34.6% (95% CI 33.2-35.9). Feelings of having adequate personal protective equipment, receiving enough emotional supports from both family members and colleagues were significantly associated with fewer symptoms of common mental disorders, while the feelings of overloaded work and insufficient rest times contributed to more psychological problems. CONCLUSIONS Psychological feelings make important contributions to the symptoms of common mental disorders of medical staff during the epidemic of COVID-19. Strategies of psychological aids or interventions could be developed based on these feelings.
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Affiliation(s)
- Bing Han
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Chao Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Zhaorui Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Rongmeng Jiang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Tingting Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ying Wang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongguang Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jing Wen
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yueqin Huang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Hobfoll SE, Watson P, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, Friedman M, Gersons BPR, de Jong J, Layne CM, Maguen S, Neria Y, Norwood AE, Pynoos RS, Reissman D, Ruzek JI, Shalev AY, Solomon Z, Steinberg AM, Ursano RJ. Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence. Psychiatry 2021; 84:311-346. [PMID: 35061969 DOI: 10.1080/00332747.2021.2005387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.
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Plasse MJ. Psychosocial support for providers working high-risk exposure settings during a pandemic: A critical discussion. Nurs Inq 2020; 28:e12399. [PMID: 33382522 PMCID: PMC7883264 DOI: 10.1111/nin.12399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/22/2022]
Abstract
Psychological first aid is a form of support designed to lessen disaster‐related distress. In a pandemic, providers may need such support but with the high risk of exposure, such a program is offered only virtually. The research is scant for traditional post‐disaster support and non‐existent for virtual; therefore, by using related research this discussion considers the likelihood of providers accessing and benefiting from this program. The virtual platform is heralded as the responsible way to provide support in a pandemic but this standard may be ineffective and is inherently inequitable. As a global event, pandemics require containment strategies applicable on an international level; therefore, psychosocial support should also be developed with an international audience in mind. Online psychosocial support falls short of being such a strategy as it incorrectly assumes global internet access. Many low‐income areas such as Sub‐Saharan Africa will need support strategies which compliment local frontline staff and fit with community‐driven initiatives, whereas wealthier countries may use a combination of onsite and online support. Provider psychosocial support needs in a pandemic, if articulated, are globally similar but how this support is offered requires contextually sensitive considerations not yet found in the literature.
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34
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Peer-Based Mental First Aid Following Workplace Incidents: Implementation Evaluation. J Occup Environ Med 2020; 61:659-668. [PMID: 31205203 DOI: 10.1097/jom.0000000000001625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: The study evaluated the implementation of peer-based Mental First Aid (MFA) in a city organization. Its aim was to examine (1) the participants' user experiences of MFA, (2) the developmental needs of the MFA implementation process, and (3) whether and how the implementation of MFA changed the City's safety management. The data were from interviews, feedback from MFA testing and training, safety management documents, and a survey. MFA became established in the organization and there was a clear need for it. It was considered easy to use and had a low user threshold. It added value to traditional occupational safety and health practices by improving the participants' own practical skills to systematically manage the human factors of safety. MFA implementation needs clear management structures and a systematic commitment and learning process.
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35
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Jiang R. Knowledge, attitudes and mental health of university students during the COVID-19 pandemic in China. CHILDREN AND YOUTH SERVICES REVIEW 2020; 119:105494. [PMID: 33518860 PMCID: PMC7834369 DOI: 10.1016/j.childyouth.2020.105494] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND Little is known about the psychological impact of COVID-19 on university students during the disease outbreak in China, but this information is important for the development of services to support these students who are typically in their early 20s. Thus, the aim of this study was to examine university students' knowledge, attitudes, and mental health status during the COVID-19 pandemic in China. METHODS On February 10, 2020 and during the second week of national lockdown, 511 students from a university in China were assessed using the COVID-19 General Information Questionnaire and the Symptom Checklist 90 (SCL-90) questionnaire. To understand the mental health status of the current sample, we compared it with the normal population. RESULTS Four hundred and seventy-two valid questionnaires were collected. In total, 11% of respondents reported confirmed COVID-19 cases in their hometowns or communities. In view of students' knowledge about COVID-19, 56% had sufficient knowledge of typical symptoms of COVID-19, and 41% knew a lot about prevention methods for the future pandemic. In terms of the risk perceptions, 57% had experienced considerable fear of this disease, and 19% perceived a high risk of becoming infected. In terms of attitudes towards the COVID-19 pandemic, 63% felt positive about its development (i.e., it was generally under control), and 92% declared that they were willing to be vaccinated against COVID-19. The scores for somatization, obsessive-compulsive disorder, interpersonal sensitivity, anxiety, phobic anxiety, paranoid ideation, and the general severity index were significantly increased compared with the norm (p < 0.001). However, no differences in the scores for depression, hostility and psychoticism were noted (p > 0.05). CONCLUSION University students possessed insufficient COVID-19 knowledge and high-risk perceptions. The COVID-19 pandemic impacted the mental health of university students. Social support and targeted interventions tailored to university students should be provided during such an outbreak, and university administration should strengthen the cultivation of students' mental toughness using standard teaching processes.
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Affiliation(s)
- Ruichen Jiang
- School of Teacher Education, Anqing Normal University, Anqing, Anhui, China
- School of Psychology, Shanghai University of Sport, Shanghai, China
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36
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Pohane PU, Jaiswal SV, Vahia VN, Sinha D. Psychopathology, perceived social support, and coping in survivors of adult sexual assault: A cross-sectional hospital-based study. Indian J Psychiatry 2020; 62:718-722. [PMID: 33896980 PMCID: PMC8052890 DOI: 10.4103/psychiatry.indianjpsychiatry_432_19] [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: 07/20/2019] [Revised: 10/05/2019] [Accepted: 09/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adult sexual assault (ASA) is often associated with negative mental health consequences. The psychological needs of ASA survivors are overlooked while the legal and social needs focused on. METHODOLOGY It is a cross-sectional study. The ASA survivors who came for medical evaluation were included in the study after obtaining consent. Fifty ASA survivors were interviewed for the study. Psychopathology, perceived social support, and coping mechanisms were assessed during interview using especially designed semi-structured pro forma. RESULTS The mean age of participants was 25.6 ± 7.2 years. Forty-one of 50 survivors suffered from major depressive disorder or posttraumatic stress disorder or both with 33 expressing suicidal ideas. Maximum social support was perceived from family and least from significant others such as health-care workers, police, and judiciary. Problem solving and expressive action are associated with better perceived social support by family as well as friends. CONCLUSION Depression and suicidal ideas among majority the survivors of ASA highlight the mental devastation the sexual assault causes to a woman. Although family is primary social support to them, health-care workers and law enforcement officials are not perceived as supportive toward the survivors. Routine mental health assistance and empathetic approach by all parties involved in the management of survivors are needed in these cases.
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Affiliation(s)
- Pranav U. Pohane
- Department of Psychiatry, Seth G.S. Medical College and K.E.M. Hospital, Nagpur, Maharashtra, India
| | - Suyog Vijay Jaiswal
- Department of Psychiatry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Vihang N. Vahia
- Department of Psychiatry, H. B. T. Medical College and Dr. R. N. Cooper Municipal General Hospital, Mumbai, Maharashtra, India
| | - Deoraj Sinha
- Department of Psychiatry, H. B. T. Medical College and Dr. R. N. Cooper Municipal General Hospital, Mumbai, Maharashtra, India
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Pacella‐LaBarbara ML, Suffoletto BP, Kuhn E, Germain A, Jaramillo S, Repine M, Callaway CW. A Pilot Randomized Controlled Trial of the PTSD Coach App Following Motor Vehicle Crash-related Injury. Acad Emerg Med 2020; 27:1126-1139. [PMID: 32339359 DOI: 10.1111/acem.14000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/27/2020] [Accepted: 04/22/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) symptoms (PTSS) are common after minor injuries and can impair recovery. We sought to understand whether an evidence-based mobile phone application with self-help tools (PTSD Coach) could be useful to improve recovery after acute trauma among injured emergency department (ED) patients. This pilot study examined the feasibility, acceptability, and potential benefit of using PTSD Coach among acutely injured motor vehicle crash (MVC) patients. METHODS From September 2017 to September 2018, we recruited adult patients within 24 hours post-MVC from the EDs of two Level I trauma centers in the United States. We randomly assigned 64 injured adults to either the PTSD Coach (n = 33) or treatment as usual (TAU; n = 31) condition. We assessed PTSS and associated symptoms at 1 month (83% retained) and 3 months (73% retained) postenrollment. RESULTS Enrollment was feasible (74% of eligible subjects participated) but usability and engagement were low (67% used PTSD Coach at least once, primarily in week 1); 76% of those who used it rated the app as moderately to extremely helpful. No differences emerged between groups in PTSS outcomes. Exploratory analyses among black subjects (n = 21) indicated that those in the PTSD Coach condition (vs. TAU) reported marginally lower PTSS (95% CI = -0.30 to 37.77) and higher PTSS coping self-efficacy (95% CI = -58.20 to -3.61) at 3 months. CONCLUSIONS We demonstrated feasibility to recruit acutely injured ED patients into an app-based intervention study, yet mixed evidence emerged for the usability and benefit of PTSD Coach. Most patients used the app once and rated it favorably in regard to satisfaction with and helpfulness, but longitudinal engagement was low. This latter finding may explain the lack of overall effects on PTSS. Additional research is warranted regarding whether targeting more symptomatic patients and the addition of engagement and support features can improve efficacy.
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Affiliation(s)
| | - Brian P. Suffoletto
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
| | - Eric Kuhn
- the Dissemination and Training Division National Center for PTSD Palo Alto CA
- the Department of Psychiatry and Behavioral Sciences School of Medicine Stanford University Stanford CA
| | - Anne Germain
- and the Department of Psychiatry School of Medicine University of Pittsburgh Pittsburgh PA
| | - Stephany Jaramillo
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
| | - Melissa Repine
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
| | - Clifton W. Callaway
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
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Chew NWS, Ngiam JN, Tan BYQ, Tham SM, Tan CYS, Jing M, Sagayanathan R, Chen JT, Wong LYH, Ahmad A, Khan FA, Marmin M, Hassan FB, Sharon TML, Lim CH, Mohaini MIB, Danuaji R, Nguyen TH, Tsivgoulis G, Tsiodras S, Fragkou PC, Dimopoulou D, Sharma AK, Shah K, Patel B, Sharma S, Komalkumar RN, Meenakshi RV, Talati S, Teoh HL, Ho CS, Ho RC, Sharma VK. Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic. BJPsych Open 2020; 6:e116. [PMID: 33028449 PMCID: PMC7542327 DOI: 10.1192/bjo.2020.98] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers. AIMS In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes. METHOD From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country. RESULTS A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries. CONCLUSIONS This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
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Affiliation(s)
- Nicholas W S Chew
- Department of Medicine, National University Health System, Singapore
| | | | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore; and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore,Singapore
| | - Sai-Meng Tham
- Department of Medicine, National University Health System, Singapore
| | | | - Mingxue Jing
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | | | - Jin Tao Chen
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Lily Y H Wong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Aftab Ahmad
- Department of Neurology, Ng Teng Fong General Hospital, Singapore
| | - Faheem Ahmed Khan
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, Singapore
| | - Maznah Marmin
- Department of Neurology, Ng Teng Fong General Hospital, Singapore
| | | | | | | | | | | | - Thang H Nguyen
- Cerebrovascular Disease Department, 115 People's Hospital, Vietnam
| | - Georgios Tsivgoulis
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Sotirios Tsiodras
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Paraskevi C Fragkou
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Dimitra Dimopoulou
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | | | | | | | | | | | | | - Shikha Talati
- Department of Psychiatry, Geetanjali Medical College and Hospital, India
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore; and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cyrus S Ho
- Department of Psychological Medicine, National University of Singapore, Singapore
| | - Roger C Ho
- Department of Psychological Medicine and Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore; and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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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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Affiliation(s)
- Jill Maben
- Professor of Health Services Research and Nursing, Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, UK.,Faculty of Health, University of Technology, NSW, Sydney, Australia.,Discipline of Nursing, College of Science, Health, Engineering and Education (SHEE), Murdoch University, Perth, WA, Australia
| | - Jackie Bridges
- Professor of Older People's Care, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Applied Research Collaboration Wessex, Innovation Centre, Southampton Science Park, Chilworth, Southampton, UK
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Jonker BE, Graupner LI, Rossouw L. An Intervention Framework to Facilitate Psychological Trauma Management in High-Risk Occupations. Front Psychol 2020; 11:530. [PMID: 32292370 PMCID: PMC7118223 DOI: 10.3389/fpsyg.2020.00530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/05/2020] [Indexed: 11/13/2022] Open
Abstract
Various psychological trauma management programs (PTMPs) are offered to assist employees who have been exposed to a traumatic event in the workplace. There is, however, limited literature available on how employees in high-risk occupations experience these programs. This study qualitatively explored the experiences of PTMPs from the perspective of employees working in three high-risk occupations. The purpose of this study was to explore the experiences of the participants in order to compile a framework that could help support and improve the productivity and wellbeing of employees affected by work-related trauma. The study used a qualitative research design based on an approach informed by interpretivism and social constructivism. A multiple-case study was used as research strategy to incorporate three sectors in South Africa, namely mining, policing, and emergency medical services. Data were gathered through semi-structured interviews and focus groups, and analyzed using thematic analysis. The findings across the three sectors showed effective strategies considered by participants to manage psychological trauma. These strategies include multiple counseling sessions, face-to-face counseling, regaining control, and receiving support. Strategies that were viewed as ineffective include inability of counselors to relate to the participants' work environments, lack of involvement, lack of supervisor support, unavailability of counseling and specialized skills, premature resuming of duties, and a single-dimension approach. Based on the findings, an intervention framework is proposed to address psychological trauma in high-risk occupations.
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Affiliation(s)
- Bouwer E Jonker
- WorkWell Research Unit, Faculty of Economic and Management Sciences, School of Industrial Psychology and Human Resource Management, North-West University, Potchefstroom, South Africa
| | - Lene Ilyna Graupner
- WorkWell Research Unit, Faculty of Economic and Management Sciences, School of Industrial Psychology and Human Resource Management, North-West University, Potchefstroom, South Africa
| | - Lizelle Rossouw
- WorkWell Research Unit, Faculty of Economic and Management Sciences, School of Industrial Psychology and Human Resource Management, North-West University, Potchefstroom, South Africa
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Thierrée S, Richa S, Brunet A, Egreteau L, Roig Q, Clarys D, El-Hage W. Trauma reactivation under propranolol among traumatized Syrian refugee children: preliminary evidence regarding efficacy. Eur J Psychotraumatol 2020; 11:1733248. [PMID: 32194925 PMCID: PMC7067198 DOI: 10.1080/20008198.2020.1733248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 01/08/2023] Open
Abstract
Background: There is a dearth of therapeutic solutions for traumatized young patients. Trauma reactivation conducted under the influence of the reconsolidation blocker propranolol (Reconsolidation Therapy) is a simple, cost-effective treatment option that has some promising initial results in adults suffering from posttraumatic stress disorder (PTSD). Objective: To explore the usefulness of this novel treatment in children. The primary outcome was the reduction of PTSD symptoms at the end of treatment, while secondary outcomes included reduction in anxiety and in depressive symptoms. Method: An open-label clinical trial was conducted in a refugee camp in Syria, investigating the safety and efficacy of this therapeutic strategy in 117 children suffering from enduring PTSD symptoms. Participants received propranolol 90 minutes before briefly recalling (i.e. reactivating) a single personal traumatic memory, for 5 consecutive days. Self-reported anxiety, depressive, and PTSD symptoms were assessed at baseline, as well as 4 and 13 weeks after treatment. Results: A significant, clinically meaningful symptom reduction was observed at all post-treatment measurement times vs. baseline. More specifically, between baseline and the 13-week follow-up we observed a 64% PTSD symptoms reduction (d = 2.71). In a similar vein, we obtained a 39% symptoms reduction for depressive symptoms (d = 1.01). The general anxiety symptoms improved, but eventually returned to prior level, probably because of the deteriorating living conditions in the camp. Conclusions: This therapy appeared as a potentially safe and useful treatment strategy for children suffering from PTSD symptoms, warranting replication studies using stronger study designs. The social acceptability and ease of implementation of the treatment should also be noted.
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Affiliation(s)
- Sarah Thierrée
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,No Lost Generation, Tours, France
| | - Sami Richa
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Alain Brunet
- Douglas Institute Research Center, and the Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Laurine Egreteau
- Centre de Psychotraumatologie CVL, Pôle de Psychiatrie, CHRU de Tours, Tours, France
| | | | - David Clarys
- UMR CNRS 7295, Centre de Recherches sur la Cognition et l'Apprentissage, Université de Poitiers, Poitiers, France
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,No Lost Generation, Tours, France.,Centre de Psychotraumatologie CVL, Pôle de Psychiatrie, CHRU de Tours, Tours, France
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Christian-Brandt AS, Santacrose DE, Farnsworth HR, MacDougall KA. When Treatment is Traumatic: An Empirical Review of Interventions for Pediatric Medical Traumatic Stress. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:389-404. [PMID: 31617588 DOI: 10.1002/ajcp.12392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pediatric medical traumatic stress (PMTS) is common among injured/ill children and is associated with elevated distress, treatment non-adherence, and poor health outcomes. As survivorship of life-threatening pediatric injury and illness continues to increase alongside rapid medical advancements, rates of PMTS and negative sequelae are expected to grow; however, research on prevention and treatment of PMTS is limited. The current study sought to systematically review the literature using a developmental framework to highlight research gaps. Sixteen peer-reviewed studies were identified via a systematic literature search. Consistent with best practices for treatment of childhood trauma, caregiver involvement and CBT principles served as the foundation for most interventions. All studies reported improvements in PMTS; however, among the most methodologically rigorous, few found statistically superior reductions in PMTS between intervention and control groups. While many studies focused on a specific developmental stage and discussed developmental considerations, others took a "one-size-fits" approach. Interventions that demonstrated the most promising findings were online, self-guided, or time-limited. Future research would benefit from expanding diversity of participants, continuing to evaluate novel delivery methods, and integrating developmental considerations along with trauma-informed care (TIC) approaches, given their useful framework for understanding child traumatic stress responses and avenues for prevention and treatment.
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Maddox SA, Hartmann J, Ross RA, Ressler KJ. Deconstructing the Gestalt: Mechanisms of Fear, Threat, and Trauma Memory Encoding. Neuron 2019; 102:60-74. [PMID: 30946827 DOI: 10.1016/j.neuron.2019.03.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/03/2019] [Accepted: 03/12/2019] [Indexed: 01/14/2023]
Abstract
Threat processing is central to understanding debilitating fear- and trauma-related disorders such as posttraumatic stress disorder (PTSD). Progress has been made in understanding the neural circuits underlying the "engram" of threat or fear memory formation that complements a decades-old appreciation of the neurobiology of fear and threat involving hub structures such as the amygdala. In this review, we examine key recent findings, as well as integrate the importance of hormonal and physiological approaches, to provide a broader perspective of how bodily systems engaged in threat responses may interact with amygdala-based circuits in the encoding and updating of threat-related memory. Understanding how trauma-related memories are encoded and updated throughout the brain and the body will ultimately lead to novel biologically-driven approaches for treatment and prevention.
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Affiliation(s)
- Stephanie A Maddox
- Neurobiology of Fear Laboratory, Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Jakob Hartmann
- Neurobiology of Fear Laboratory, Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Rachel A Ross
- Neurobiology of Fear Laboratory, Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Kerry J Ressler
- Neurobiology of Fear Laboratory, Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.
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Roberts NP, Kitchiner NJ, Kenardy J, Robertson L, Lewis C, Bisson JI. Multiple session early psychological interventions for the prevention of post-traumatic stress disorder. Cochrane Database Syst Rev 2019; 8:CD006869. [PMID: 31425615 PMCID: PMC6699654 DOI: 10.1002/14651858.cd006869.pub3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The prevention of long-term psychological distress following traumatic events is a major concern. Systematic reviews have suggested that individual psychological debriefing is not an effective intervention at preventing post-traumatic stress disorder (PTSD). Over the past 20 years, other forms of intervention have been developed with the aim of preventing PTSD. OBJECTIVES To examine the efficacy of psychological interventions aimed at preventing PTSD in individuals exposed to a traumatic event but not identified as experiencing any specific psychological difficulties, in comparison with control conditions (e.g. usual care, waiting list and no treatment) and other psychological interventions. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO and ProQuest's Published International Literature On Traumatic Stress (PILOTS) database to 3 March 2018. An earlier search of CENTRAL and the Ovid databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to May 2016). We handsearched reference lists of relevant guidelines, systematic reviews and included study reports. Identified studies were shared with key experts in the field.We conducted an update search (15 March 2019) and placed any new trials in the 'awaiting classification' section. These will be incorporated into the next version of this review, as appropriate. SELECTION CRITERIA We searched for randomised controlled trials of any multiple session (two or more sessions) early psychological intervention or treatment designed to prevent symptoms of PTSD. We excluded single session individual/group psychological interventions. Comparator interventions included waiting list/usual care and active control condition. We included studies of adults who experienced a traumatic event which met the criterion A1 according to the Diagnostic and Statistical Manual (DSM-IV) for PTSD. DATA COLLECTION AND ANALYSIS We entered data into Review Manager 5 software. We analysed categorical outcomes as risk ratios (RRs), and continuous outcomes as mean differences (MD) or standardised mean differences (SMDs), with 95% confidence intervals (CI). We pooled data with a fixed-effect meta-analysis, except where there was heterogeneity, in which case we used a random-effects model. Two review authors independently assessed the included studies for risk of bias and discussed any conflicts with a third review author. MAIN RESULTS This is an update of a previous review.We included 27 studies with 3963 participants. The meta-analysis included 21 studies of 2721 participants. Seventeen studies compared multiple session early psychological intervention versus treatment as usual and four studies compared a multiple session early psychological intervention with active control condition.Low-certainty evidence indicated that multiple session early psychological interventions may be more effective than usual care in reducing PTSD diagnosis at three to six months' follow-up (RR 0.62, 95% CI 0.41 to 0.93; I2 = 34%; studies = 5; participants = 758). However, there was no statistically significant difference post-treatment (RR 1.06, 95% CI 0.85 to 1.32; I2 = 0%; studies = 5; participants = 556; very low-certainty evidence) or at seven to 12 months (RR 0.94, 95% CI 0.20 to 4.49; studies = 1; participants = 132; very low-certainty evidence). Meta-analysis indicated that there was no statistical difference in dropouts compared with usual care (RR 1.34, 95% CI 0.91 to 1.95; I2 = 34%; studies = 11; participants = 1154; low-certainty evidence) .At the primary endpoint of three to six months, low-certainty evidence indicated no statistical difference between groups in reducing severity of PTSD (SMD -0.10, 95% CI -0.22 to 0.02; I2 = 34%; studies = 15; participants = 1921), depression (SMD -0.04, 95% CI -0.19 to 0.10; I2 = 6%; studies = 7; participants = 1009) or anxiety symptoms (SMD -0.05, 95% CI -0.19 to 0.10; I2 = 2%; studies = 6; participants = 945).No studies comparing an intervention and active control reported outcomes for PTSD diagnosis. Low-certainty evidence showed that interventions may be associated with a higher dropout rate than active control condition (RR 1.61, 95% CI 1.11 to 2.34; studies = 2; participants = 425). At three to six months, low-certainty evidence indicated no statistical difference between interventions in terms of severity of PTSD symptoms (SMD -0.02, 95% CI -0.31 to 0.26; I2 = 43%; studies = 4; participants = 465), depression (SMD 0.04, 95% CI -0.16 to 0.23; I2 = 0%; studies = 2; participants = 409), anxiety (SMD 0.00, 95% CI -0.19 to 0.19; I2 = 0%; studies = 2; participants = 414) or quality of life (MD -0.03, 95% CI -0.06 to 0.00; studies = 1; participants = 239).None of the included studies reported on adverse events or use of health-related resources. AUTHORS' CONCLUSIONS While the review found some beneficial effects of multiple session early psychological interventions in the prevention of PTSD, the certainty of the evidence was low due to the high risk of bias in the included trials. The clear practice implication of this is that, at present, multiple session interventions aimed at everyone exposed to traumatic events cannot be recommended. There are a number of ongoing studies, demonstrating that this is a fast moving field of research. Future updates of this review will integrate the results of these new studies.
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Affiliation(s)
- Neil P Roberts
- Cardiff University School of MedicineDivision of Psychological Medicine and Clinical NeurosciencesHadyn Ellis BuildingMaindy RoadCardiffUKCF24 4HQ
| | - Neil J Kitchiner
- Cardiff & Vale, University Health BoardVeterans' NHS WalesGlobal LinkDunleavy DriveCardiffUKCF11 0SN
| | - Justin Kenardy
- The University of QueenslandSchool of MedicineHerston RoadHerstonAustralia4006
| | - Lindsay Robertson
- University of YorkCochrane Common Mental DisordersHeslingtonYorkUKYO10 5DD
| | - Catrin Lewis
- Cardiff University School of MedicineDivision of Psychological Medicine and Clinical NeurosciencesHadyn Ellis BuildingMaindy RoadCardiffUKCF24 4HQ
| | - Jonathan I Bisson
- Cardiff University School of MedicineDivision of Psychological Medicine and Clinical NeurosciencesHadyn Ellis BuildingMaindy RoadCardiffUKCF24 4HQ
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The Role of the Amygdala and the Ventromedial Prefrontal Cortex in Emotional Regulation: Implications for Post-traumatic Stress Disorder. Neuropsychol Rev 2019; 29:220-243. [DOI: 10.1007/s11065-019-09398-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
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Gregory J, de Lepinau J, de Buyer A, Delanoy N, Mir O, Gaillard R. The impact of the Paris terrorist attacks on the mental health of resident physicians. BMC Psychiatry 2019; 19:79. [PMID: 30791878 PMCID: PMC6385411 DOI: 10.1186/s12888-019-2058-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND On November 13, 2015, terrorist attacks took place in Paris. One hundred and twenty-nine people were immediately killed and 302 needed emergency care. Many resident physicians were on the front line of the medical response. Our aim was to report the frequency of symptoms of post-traumatic stress disorder (PTSD), anxiety and depression among resident physicians after the Paris terrorist attacks. METHODS Anonymous questionnaires, including the Impact of Event Scale- Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS), were emailed two months after the attacks to 2413 Parisian resident physicians. Exposure to the attacks was defined as having direct clinical contact with one of the victims up to one week after the attacks, being one of the victims, or having one among close relatives. RESULTS The questionnaire was completed by 680 (28.2%) residents. Eighty-four (12.4%) reported symptoms of PTSD (IES-R ≥ 33), 76 (11.2%) reported symptoms of anxiety (HADS anxiety score > 10) and 16 (2.4%) reported symptoms of depression (HADS depression score > 10). Exposed residents had higher IES-R scores than non-exposed residents (18.8 ± 16.6 versus 14.2 ± 12.0, p = 0.001), and 40 (18.5%) of them reported symptoms of PTSD, compared to 44 (9.5%) of the non-exposed residents (p = 0.001). CONCLUSIONS There was a high frequency of symptoms of mental distress among our respondents. Dedicated screening and care strategies must be considered in the event of new attacks.
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Affiliation(s)
- Jules Gregory
- Syndicat des Internes des Hôpitaux de Paris (SIHP), 17 rue du Fer à Moulin, 75005 Paris, France
| | - Jean de Lepinau
- Syndicat des Internes des Hôpitaux de Paris (SIHP), 17 rue du Fer à Moulin, 75005 Paris, France
| | - Ariane de Buyer
- Syndicat des Internes des Hôpitaux de Paris (SIHP), 17 rue du Fer à Moulin, 75005 Paris, France
| | - Nicolas Delanoy
- Syndicat des Internes des Hôpitaux de Paris (SIHP), 17 rue du Fer à Moulin, 75005 Paris, France
| | - Olivier Mir
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Raphaël Gaillard
- Department of Psychiatry, Service Hospitalo-Universitaire, Centre Hospitalier Sainte Anne, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France
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48
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Glass O, Dreusicke M, Evans J, Bechard E, Wolever RQ. Expressive writing to improve resilience to trauma: A clinical feasibility trial. Complement Ther Clin Pract 2019; 34:240-246. [DOI: 10.1016/j.ctcp.2018.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/17/2018] [Accepted: 12/13/2018] [Indexed: 11/27/2022]
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49
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Oosterbaan V, Covers MLV, Bicanic IAE, Huntjens RJC, de Jongh A. Do early interventions prevent PTSD? A systematic review and meta-analysis of the safety and efficacy of early interventions after sexual assault. Eur J Psychotraumatol 2019; 10:1682932. [PMID: 31762949 PMCID: PMC6853210 DOI: 10.1080/20008198.2019.1682932] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 12/19/2022] Open
Abstract
Objective: To review the safety and efficacy of early interventions after sexual assault in reducing or preventing posttraumatic stress disorder (PTSD). Method: Systematic searches were performed on studies (1980-2018) that examined the efficacy of interventions for PTSD within 3 months after sexual assault. Results: The review identified 7 studies (n = 350) with high risk of bias that investigated 5 interventions. Only two studies reported on safety. Contact with the authors of six studies provided no indications for the occurrence of adverse events. Two studies reported the efficacy using PTSD diagnosis as dependent variable but found no difference between groups. All studies reported on efficacy using PTSD severity as dependent variable. For the meta-analysis, 4 studies (n = 293) were included yielding significantly greater reductions of PTSD severity than standard care at 2 to 12 months follow-up (g = -0.23, 95% CI [-0.46, 0.00]), but not at 1 to 6 weeks post-intervention (g = -0.28, 95% CI [-0.57, 0.02]). The heterogeneity of the interventions precluded further analyses. Discussion: Findings suggest that early interventions can lead to durable effects on PTSD severity after sexual assault. However, due to limited availability of data, it is impossible to draw definite conclusions about safety and efficacy of early interventions, and their potential to prevent PTSD.
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Affiliation(s)
- Veerle Oosterbaan
- National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Milou L V Covers
- National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Iva A E Bicanic
- National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rafaële J C Huntjens
- Department of Experimental Psychotherapy & Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Ad de Jongh
- Department of Social Dentistry and Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Psychotrauma Expertise Center (PSYTREC), Bilthoven, The Netherlands.,Institute of Health and Society, University of Worcester, Worcester, UK.,Queen's University Belfast, Belfast, Northern Ireland, UK
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50
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Roberts NP, Kitchiner NJ, Kenardy J, Lewis CE, Bisson JI. Early psychological intervention following recent trauma: A systematic review and meta-analysis. Eur J Psychotraumatol 2019; 10:1695486. [PMID: 31853332 PMCID: PMC6913678 DOI: 10.1080/20008198.2019.1695486] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) is a common and debilitating disorder which has a significant impact on the lives of sufferers. A number of early psychological interventions have been developed to try to prevent chronic difficulties. Objective: The objective of this study was to establish the current evidence for the effectiveness of multiple session early psychological interventions aimed at preventing or treating traumatic stress symptoms beginning within three months of trauma exposure. Methods: Randomized controlled trials of early multiple session psychological interventions aimed at preventing or reducing traumatic stress symptoms of individuals exposed to a traumatic event, fulfiling trauma criteria for an ICD or DSM diagnosis of PTSD were identified through a search of the Cochrane Common Mental Disorders Group Clinical Trials Registers database, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO and PILOTS. Two authors independently extracted study details and data and completed risk of bias assessments. Analyses were undertaken using Review Manager software. Quality of findings were rated according to 'Grades of Recommendation, Assessment, Development, and Evaluation' (GRADE) and appraised for clinical importance. Results: Sixty-one studies evaluating a variety of interventions were identified. For individuals exposed to a trauma who were not pre-screened for traumatic stress symptoms there were no clinically important differences between any intervention and usual care. For individuals reporting traumatic stress symptoms we found clinically important evidence of benefits for trauma-focused cognitive-behavioural therapy (CBT-T), cognitive therapy without exposure and eye movement desensitization and reprocessing (EMDR). Differences were greatest for those diagnosed with acute stress disorder (ASD) and PTSD. Conclusions: There is evidence for the effectiveness of several early psychological interventions for individuals with traumatic stress symptoms following trauma exposure, especially for those meeting the diagnostic threshold for ASD or PTSD. Evidence is strongest for trauma-focused CBT.
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Affiliation(s)
- Neil P Roberts
- Psychology & Psychological Therapies Directorate, Cardiff & Vale University Health Board, Cardiff, UK.,Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Neil J Kitchiner
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.,, Veterans' NHS Wales, Cardiff & Vale University Health Board, Cardiff, UK
| | - Justin Kenardy
- Psychology and Medicine, University of Queensland, Brisbane, Australia
| | - Catrin E Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
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