An explosion in a Danish supertanker under construction in 1994 caused the death of six workers and injured 15. Six months later 270 workers took part in this study, which analyses the relationships between objective stressors, the workers' own feelings and the reactions of their families after the explosion together with training, attitude to the workplace, general out-look, and received crisis help. Traumatisation, coping style and crisis support was assessed via the Impact of Event Scale (IES), the Coping Styles Questionnaire (CSQ) and the Crisis Support Scale (CSS). Emotionally, workers and their families were strongly affected by the explosion. The IES-score was 17.6 and the invasion score 9.1. The degree of traumatisation was higher in the group who had an 'audience position' than in the group who was directly hit by the explosion. Training in rescue work did not protect against adverse effects. Rescue work had a strong impact on the involved. Social support was a significant factor, that seems to buffer negative effects. High level of social integration, effective leadership in the situation, and professional crisis intervention characterised the disaster situation. All the same, 41 per cent of the workers reached the caseness criteria by Horowitz (IES > or = 19).
Changes in the Canadian military healthcare structure, and an increased reliance on the public healthcare sector, resulted in care fragmentation and a growing dissatisfaction among members with the quality of health services. To remedy the situation, the Canadian Forces began a major re-engineering of its healthcare services. A component of this reform was the implementation of a case management program to improve the continuity of care for members with complex or chronic medical conditions. Member satisfaction surveys revealed that the case management program meets their needs.
American Indian and Alaska Native (AI/AN) people experience high rates of acute, chronic, and intergenerational trauma. Traumatic experiences often increase the risk of both medical and behavioral health problems making primary care settings opportune places to screen for trauma exposure or symptomology. The objective of this study was to determine considerations and recommendations provided by patients, health care providers, health care administrators, and tribal leaders in the development of an adult trauma screening, brief intervention, and referral for treatment process to pilot at two large AI/AN primary care systems. A qualitative and iterative data collection and analysis process was undertaken using a community-based participatory research approach guided by a cross-site steering committee. Twenty-four leaders and providers participated in individual interviews, and 13 patients participated in four focus groups. Data were thematically analyzed to select a trauma screening instrument, develop a screening process, and develop brief intervention materials. The nature of traumas experienced in the AI/AN community, the need to develop trusting patient-provider relationships, and the human resources available at each site drove the screening, brief intervention, and referral process decisions for a future trauma screening pilot in these health systems.
BACKGROUND: Psychotherapy is an effective treatment for borderline personality disorder (BPD), but little is known about the long-term effect of non-manualized psychotherapy for these patients. AIMS: The aim of the preliminary study was to investigate the long-term effect of non-manualized psychotherapy on an outpatient sample (n = 32) with a primary diagnosis of BPD. METHODS: The current study was based on an open-ended naturalistic design with a 2-year follow-up. Assessment at intake, discharge and follow-up comprised the Structured Clinical Interview for DSM-IV Axis I, II and V, and the general level of self-reported symptomatic (SCL-90R) and interpersonal distress (IIP-64C). RESULTS: Patients with BPD respond well to non-manualized psychotherapy as intent-to-treat analyses estimate that 62% no longer met the DSM-IV criteria for a BPD diagnosis at discharge, 66% at 2-year follow-up. In addition, significant improvement with large effect sizes was found for all outcome variables at both discharge and at follow-up. Attrition was associated with patient-therapist gender mismatch, low occupational status and the presence of post-traumatic stress disorder. CONCLUSION: The results imply that the natural course of non-manualized psychotherapy is overall beneficial for outpatients with BPD.
The authors sought to determine the learning needs, experiences, and attitudes of psychiatric residents in relation to war and mental health; to discover if residents in their training program have had clinical experiences with patients affected by war and if they believed that they were adequately trained to deal with these encounters; and to explore if residents believe psychiatrists should play a role in the lives of those affected by war and, if so, what types of roles they believe psychiatrists should take.
The authors developed a survey to assess resident attitudes toward psychiatrists' roles in relation to war and related clinical experiences and learning needs. The survey was administered to psychiatric residents at the largest psychiatric residency program in Canada.
The majority of the 52 respondents believed that psychiatrists have a role in mitigating the effects of war. Although 75% of residents (n=38) had encountered a patient who was traumatized by war, none reported feeling completely prepared. Approximately 90% of residents (n=44) reported that they would like to learn more about this area.
In a Canadian residency program that does not provide clinical rotations in a military hospital, most psychiatric residents surveyed were interested in the effects of war on mental health and would like more clinical training in this area.
The efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) has been shown in several randomized controlled trials. However, few trials have been conducted in community clinics, few have used therapy as usual (TAU) as a comparison group, and none have been conducted outside of the United States. The objective of this study was to evaluate the effectiveness of TF-CBT in regular community settings compared with TAU. One hundred fifty-six traumatized youth (M age = 15.1 years, range = 10-18; 79.5% girls) were randomly assigned to TF-CBT or TAU. Intent-to-treat analysis using mixed effects models showed that youth receiving TF-CBT reported significantly lower levels of posttraumatic stress symptoms (est. = 5.78, d = 0.51), 95% CI [2.32, 9.23]; depression (est. = 7.00, d = 0.54), 95% CI [2.04, 11.96]; and general mental health symptoms (est. = 2.54, d = 0.45), 95% CI [0.50, 4.58], compared with youth in the TAU group. Youth assigned to TF-CBT showed significantly greater improvements in functional impairment (est. = -1.05, d = -0.55), 95% CI [-1.67, -0.42]. Although the same trend was found for anxiety reduction, this difference was not statistically significant (est. = 4.34, d = 0.30), 95% CI [-1.50, 10.19]. Significantly fewer youths in the TF-CBT condition were diagnosed with posttraumatic stress disorder compared to youths in the TAU condition, ?(2)(1, N = 116) = 4.61, p = .031, Phi = .20). Findings indicate that TF-CBT is effective in treating traumatized youth in community mental health clinics and that the program may also be successfully implemented in countries outside the United States.
Cites: Am J Public Health. 1996 May;86(5):726-88629727
This study investigated crisis intervention in three secondary schools after the suicides of five students, focusing on the 89 classmates' risk of developing symptoms of PTSD (measured by IES) and high intensity (HI) grief as measured by Hogan Sibling Inventory of Bereavement. Crisis interventions for the students varied from none to first talk-throughs and psychological debriefings. Six months after the suicide, 30% of the classmates evidenced scores indicative of PTSD and 9.8% evidenced HI grief. Friendship was a predictor of PTSD and HI grief. Inadequate crisis intervention was a risk factor for HI grief. Proper crisis intervention, and appropriate screening and focused post-trauma psychotherapy after a suicide of a student are recommended.
Response to mental health treatment varies highly among refugee patients. Research has not established which factors relate to differences in outcome. This study is a follow-up of Opaas and Hartmann's (2013) Rorschach Inkblot Method (RIM; Exner, 2003) pretreatment study of traumatized refugees, where 2 RIM principal components, Trauma Response and Reality Testing, were found descriptive of participants' trauma-related personality functioning. This study's aims were to examine relationships of the RIM components with measures of anxiety, depression, posttraumatic stress, quality of life (QOL), employment, and exile language skills throughout 3 years. We found that impaired Reality Testing was related to more mental health symptoms and poorer QOL; furthermore, individuals with adequate Reality Testing improved in posttraumatic stress symptoms the first year and retained their improvement. Individuals with impaired Reality Testing deteriorated the first year and improved only slightly the next 2 years. The results of this study imply that traumatized refugee patients with impaired Reality Testing might need specific treatment approaches. Research follow-up periods should be long enough to detect changes. The reality testing impairment revealed by the RIM, mainly perceptual in quality, might not be easily detected by diagnostic interviews and self-report.
This report describes an exploratory study of a school-based mental health service developed to address the psychological needs of refugee children. The service was made available in three schools and followed a consultative framework. Refugee children were discussed with the mental health team and children at greatest risk were seen. A questionnaire of psychological functioning was completed by teachers before and after the intervention. Data were collected on 47 refugee children and two control groups (ethnic minority and indigenous white children). Subgroup analyses compared children who were seen directly by the service with those for whom only consultation was provided. Refugee children had poorer overall adjustment at baseline particularly in the emotional and peer problem domains. The greatest improvements following the intervention were seen in hyperactivity for the refugee group and in peer problems for the refugees directly seen by the service. While further studies are necessary to assess its efficacy, this exploratory study indicates that an intervention which involves collaboration with teachers and parents, in an environment where children spend much of their time, can benefit vulnerable children.