Evaluating psychological debriefing: are we measuring the right outcomes?

The efficacy of critical incident stress debriefing (CISD) and psychological debriefing (PD) following potentially traumatising events has recently been challenged after a number of recent randomised controlled trials (RCTs) failed to demonstrate that CISD or PD prevents or reduces the incidence of posttraumatic stress disorder (PTSD). These studies have used measures of PTSD as the principal outcome and have generally not measured comorbid psychopathology, behavioral or social dysfunction. In a recent RCT of group debriefing amongst British soldiers returning from peacekeeping operations in Bosnia, PD had a significant effect in reducing a worrying level of alcohol misuse in the sample. The findings of this study suggest that that it is premature to conclude that debriefing is ineffective and that a broader range of outcome measures should be employed in future trials of debriefing.

Dealing with disasters: does psychological debriefing work?

The psychological aftermath of disaster causes significant long-term psychiatric disability and suffering to victims and rescuers alike. This paper examines the effectiveness of psychological debriefing (PD), an early intervention that is widely used and claimed to reduce long-term psychiatric morbidity in the wake of disaster. Numerous factors hamper the design of methodologically sound research in this field and there is a lack of controlled studies supporting the efficacy of PD. Further research is needed to demonstrate the effectiveness of any immediate psychological intervention before significant resources are allocated to their routine provision.

Psychological sequelae following the Gulf War. Factors associated with subsequent morbidity and the effectiveness of psychological debriefing

BACKGROUND

The aim was to study the effect of brief counselling and psychological debriefing following a trauma on subsequent morbidity.

METHOD

We investigated psychological morbidity in 62 British soldiers whose duties included the handling and identification of dead bodies of allied and enemy soldiers during the Gulf War. Of these soldiers, 69% received a psychological debriefing on completion of their duties. The subjects completed by post a demographic questionnaire, the General Health Questionnaire (GHQ-28) and the Impact of Events Scale.

RESULTS

After nine months 50% had evidence of some psychological disturbance suggestive of posttraumatic stress disorder (PTSD); 18% had sought professional help; 26% reported relationship difficulties. Neither prior training nor the psychological intervention appeared to make any difference to subsequent psychiatric morbidity. Morbidity at nine months was more likely in those with a history of psychological problems and those who believed their lives had been in danger in the Gulf.

CONCLUSIONS

These findings show that a psychological debriefing following a series of traumatic events or experiences does not appear to reduce subsequent psychiatric morbidity and highlights the need for further research in military and civilian settings.

Physical illness and depression: the effects of acute physical illness on the mental state of psychiatric inpatients

A patient is described with a severe agitated depression who made a dramatic recovery following an acute myocardial infarction. A retrospective case notes study was conducted to investigate the effects of a sudden physical illness on the mental state of a group of psychiatric inpatients. Seven patients were identified with agitated depression who improved considerably following an acute life-threatening physical event. Patients with other forms of depression, schizophrenia and schizoaffective disorder showed either no change or underwent a deterioration in mental state.

Lithium-induced carpal tunnel syndrome

Two cases of lithium-induced hypothyroidism, presenting as carpal tunnel syndrome, are reported. This is believed to be the first report of such an association.