Treatment of Acute Posttraumatic Stress Disorder with Brief Cognitive Behavioral Therapy: A Randomized Controlled Trial

Objective: The purpose of this study was to evaluate the efficacy of brief cognitive behavioral therapy for patients with acute posttraumatic stress disorder (PTSD) resulting for various types of psychological trauma. Method: The authors randomly assigned 143 patients with acute PTSD (irrespective of the time criterion), within 3 months after experiencing a traumatic incident, to either brief cognitive behavioral theraypy (N=79) or a waiting list comparison group (N=64). Cognitive behavioral therapy consisted of four weekly sessions containing education, relaxation exercises, imaginal exposure, in vivo exposure, and cognitive restructuring. Main outcomes measures was PTSD score measured by structured interview; secondary outcomes were anxiety and depressin measured by questionnaire. Assessments took palce before the intervention and 1 week and 4 months after the intervention. Results: Sympoms of PTSD, anxiety, and depression decreased in both groups over time. One week after the intervention, the cognitive behavioral therapy group had significantly fewer sumptoms of PTSD than the comparisson group, but this diference was smaller and no longer significant 4 months after the interventions. Similar results were founf of anxiety and depression scores. Subrgroup analuses showed that cognitive behavioral therapy led to significantly lower PTSD scores at 4 months in patients with baseline comorbid major depression and in patients who were included within the firs month after the traumatic incident both at 1 week and at 4 months. Conclusions: Brief early cognitive behavioral therapy accelerated recovery from symptoms of acute PTSD but did not influence long-term results. Brief early cognitive behavioral therapy showed enhanced efficacy in patients with baseline comorbid depression and patients who were included within 1 month after their traumatic experience. (AU)

Mental Illness and Suicidality after Hurricane Katrina

Objective: To estimate the impact of Hurricane Katrina on mental illness and suicidality by comparing results of a post-Katrina survey with those of an earlier survey. Methods: The earlier survey interviewed 826 adults in the Census Divisions affected by Katrina. The post-Katrina survey interviewed a new sample of 1043 adults who lived in the area prior to the hurricane. Identical questions were asked about mental illness and suicidality. The post-Katrina survey also assessed several dimensions of post-traumatic personal growth (e.g., increased closeness to loved one, increased religiosity). Outcome measures were the K6 screening scale of serious (SMI) and mild-moderate (MMI) mental illness and questions about suicide ideation, plans and attempts. Findings: Post-Katrina respondents has significantly higher estimated prevalence if SMI (13.8% vs. 6.1, x2sub1=24.6,p<.001) and MMI (21.3% vs. 9-7%, x2sub1=33.8,p <.001) than respondents in the earlier survey. Suicidal ideation and plans given estimated mental illness were significantly lower in the post-Katrina survey (0.6% vs. 8.4%, x2sub1=14.3, p<.001 ideation; 0.2% vs. 3.6%, x2sub1=13.3,p<.001 plans). This lower suicidality was strongly realted to two dimentions of post-traumatic personal growth (increased sense of meaning and purpose in life, realization of inner strenght), without between-survey differences in suicidality were insignificant. Conclusions: Despite the estimated prevalence of mental illness doubling after Hurricane Katrina, suicidality was unexpectedly low. The role of post-traumatic personal growth in ameliorating the effects of trauma-related mental illness on suicidality warrants further investigation.

Psychological Distress Among Bam Earthquake Survivors in Iran: A Population-based study

Backgrond: An earthquake measuring 6.3 on the Ritcher scale struck the city of Bam in Iran on the 26th at 5.26 A.M. It was devasting, and left over 40,000 dead and around 30,000 injured. The profound tragedy of thousands killed has caused emotional an psychological trauma of tens of thousands of people who have survived. A study was carried otu to assess psychological distress among Bam earthquake survivors and factors associated with serever mental health in those who survived the tragedy. Methods: This was population-based study measuring psychological distress amoong the survivors of Bam earthquake in Iran. Using a multi-stage stratified sampling method a random sample of individual aged 15 years and over living in Bam wee interviewed. Psychologial distress was measured using the 12-item General Health Questionnaire (GHW-12). Results: In all 916 survivors were interviewed. The mean age of the respondents was 32.9 years (SD=12.4), mostly were males (53%), married (66%) and had secndary school education (50%). Forty-one percent reported they lost 3 to 5 members of their family in the earthquake. In addition the findigns showed that 58% of the repondents suffered from severe mental health as measured by the GHQ-12 and this was three times higher than reported psychological distress among the general population. There were significant differences between sub-groups of the study sample with regard to their psychological distress. The results of the logistic regression analysis also indicated that female gender; lower education, unemployment, and loss of family members were associated with severe physcological distress among earthquake victims. (AU)

Salud mental y desastres : Nuevos desafíos

El presente trabajo hace un abordaje amplio sobre las diferentes variables de la problemática de la salud mental en desastres y catástrofes, combinando la visión de la escuela francesa, la americana y la israelí. Un desastre puede provocar una profunda patagenicidad en el psiquismo del damnificado en el caso que el abordaje y enfrentamiento con el mismo sean desvirtuados. Junto a ello una adecuada confrontación con la situación, podrá permitir a la población desarrollar sus propios recursos para que lo disruptivo de la situación no se transforme en un fenómeno patológico para el psiquismo.Se presentan un abordaje del concepto trauma y lo traumático y se expone una breve reseña del concepto con sus diferentes usos, proponiendo centralizarnos en los conceptos de vivencia traumática y el de situación disruptiva. También se abordan los diferentes tipos de desastres tanto naturales como producidos por el hombre, y se revisan las diferentes clasificaciones en la literatura así como la especificidad de las fases del preimpacto, impacto y postimpacto. En esta revisión se postula importancia de relacionarse con aquellas personas que han sufrido las consecuencias de un desastre como un damnificado y no como una víctima. Se hace un estudio de los problemas y situaciones que enfrenta el profesional de la salud mental ante los desastres, como la cantidad insuficiente de profesionales entrenados disponibles; su interacción con los grupos de ayuda, instituciones, organismos políticos; la importancia del desarrollo de programas de salud mental flexibles pero con base en las experiencias del pasado, dirigidos con el uso del liderazgo funcional; y que deben realizar intervenciones por presencia a diferencia de las intervenciones por demanda. El abordaje asistencial en este tipo de situaciones es múltiple, incluye el individual, familiar, grupal, del medio ambiente, e institucional. El abordaje de un programa de salud mental para niños es de fundamental importancia en estos casos. Los aportes de los profesionales de salud mental posibilitan al damnificado a comunicar su dolor y superarlo, y tratan de evitar que la crueldad disruptiva del mundo externo lo enajenen crónicamente.(AU)