Post-traumatic stress disorder (PTSD) and associated common mental disorders among walk-in clinic patients in Trinidad: an exploratory cross-sectional study

Posttraumatic stress disorder (PTSD) and associated common mental disorders among walk-in clinic patients in Trinidad: an exploratory cross-sectional study. Objective: To determine the possible prevalence of post-traumatic stress disorder (PTSD) and its commonly associated mental disorders among walk in clinic patients in Trinidad. Methods: A secondary analysis of data from a study of participants from 16 randomly selected public health centres which provide primary health care in Trinidad. Participants were screened using the PRIME-MD questionnaire. Participants were screened using the PRIME-MD questionnaire. Results: There were 594 participants, response rate 92 percent; 72.7 percent were female. Ages from 18-93, 54.5 percent were over 50 years; 37.2 percent were married and 25.9 percent single; Indo-Trinidadians made up 43.1 percent, Afro-Trinidadians, 36 percent; 56.5 percent reported incomes of less than USD $400/month, and 65.7 percent were unemployed. Fifty-seven (9.6 percent) (95 percent CI 6.7-12.5) of participants were designated as having PTSD, being "bothered a lot" in the last 4 weeks by "thinking or dreaming about something terrible that happened to them in the past". Older participants were less likely to have PTSD, with 8 percent of those over 50 years being positive versus 11.5 percent of younger patients. Females (10.4 percent) and Indo (13.3 percent) were more represented than males (7.4 percent) and Afro-Trinidadians (7.5 percent). Statistically significant associations (p<0.05) were between PTSD and depression, somatization, anxiety, panic, and hypochondriasis. Logistic regression suggests that the only predictor of PTSD was ethnicity, with Indo-Trinidadians more like to report PTSD than other ethnic groups (p=0.005). Conclusions: This exploratory study of PTSD suggests that walk-in clinics in Trinidad serving older, lower income patients, on screening have high proportions of patients with PTSD. More rigorous studies should be carried out to confirm these preliminary findings.

An integrated program to train local health care providers to meet post-disaster mental health needs

This paper describes a post-disaster mental health training program developed by the International Section of the Department of Psychiatry at Dalhousie University (Halifax, Canada) and delivered in Grenada after Hurricane Ivan struck the country in Septemeber 2004. This train-the-trainer program used an integrated community health model to help local health care providers develop the necessary skills for the identification and evidenced-based treatment of mental disorders occuring after a natural disaster. The approach also provided for ongoing sustainable mental health care delivered in the community setting, as advocated by the World Health Organization and the Pan American Health Organization. This approach is in contrast to the largely ineffective and costly vertical whole-population psychosocial counselling activities that have often been used in the Caribbean following natural disasters(AU)

Mental disorders in female victims of intimate partner violence in Trinidad

The study examines the prevalence of major depression, posttraumatic stress disorder, alcohol and substance abuse disorders in a sample of 21 women between the ages of 18 and 57 who had experienced intimate partner violence within the previous year. The findings are compared to those in a control sample of 60 women who had never experienced physical abuse. The prevalence of major depression in the battered sample was 71 percent compared to 10 percent in the control sample. Posttraumatic stress disorder was found in 62 percent of the battered sample compared to 2 percent of the control sample. Both findings were statistically significant. Alcohol and substance abuse disorders were found in 14 percent of battered subjects as compared to 2 percent in the control group. This finding was not statistically significant. The findings are consistent with the hypothesis that intimate partner violence increases risk for mental health problems (AU)

An exploration of the hurricane experiences of nine elementary school children of St. Croix, United State Virgin Islands

The purpose of this study was to explore the hurricane experiences of elementary school children of St. Croix, United States Virgin Islands. Measures of effecting positive change by significantly reducing symptomatic behavior resulting from the effects of natural disasters such as Hurricane Hugo were suggested. Qualitative inquiry was utilized, and case studies of children's family situations, school context, hurricane and aftermath experiences, the effects of the hurricane on families and friends, and related issues were presented.(AU)

The hostage crisis: psychological reactions to the trauma

This paper describes some of the psychological reactions common to victims in a hostage crisis. It focusses basically on hostage coping behaviours and post-traumatic stress disorders, that seem more characteristic of the members of the armed forces. A very brief reference to treatment modalities has been included for the interested clinician. The responses exhibited by an individual confronted with a life threatening situation which generates severe anxiety, is determined by personality of the victim, duration and to a greater extent, intensity of the stress. Understandably, victims of prolonged captivity will utilize different adaptive behaviours to victims who were confronted by a terrifying but relatively brief threat. Unless adaptive behaviours is adjusted to the duration and intensity of the threat, some individuals will be unable to withstand the physical and emotional stress. Initial coping response usually induces sustained and directed activity, increased vigilance and greater alertness to outside events as the body prepares for strenous activity. According to Selye (1956), individuals cannot maintain this response over a prolonged period of time. Unless other adaptive behaviours are utilized, a persistent threat will result in physical exhaustion, thinking and judgement will deteriorate, with erratic and impulsive behaviour manifesting soon after, the victims may become indiscriminating and emotionally and behaviourally labile; they may even panic - not the kind of response that makes for survival (White 1956). (AU)