RESUMEN
BACKGROUND: Without effective treatment, PTSD and depression can cause persistent disability in disaster-affected populations. METHODS: Our objective was to test the efficacy of Interpersonal Psychotherapy (IPT) delivered by trained local personnel compared with treatment as usual (TAU) for Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) among adults affected by the Sichuan 2008 earthquake. A small randomized controlled trial of IPT + TAU versus TAU alone was delivered by local mental health personnel in Shifang, China. Between July 2011 and January 2012, 49 adults ≥ 18 years with PTSD, MDD or both were enrolled and randomized to 12 weekly sessions of IPT + TAU (27) or TAU (22) alone x 12 weeks. IPT was then offered to the TAU group. Unblinded follow up assessments were conducted at three and six months. IPT was a 12 session, weekly one hour treatment delivered by local personnel who were trained and supervised in IPT. TAU was continuation of prescribed psychotropic medication (if applicable) and crisis counseling, as needed. MAIN OUTCOME(S) AND MEASURES (S): Clinician Administered PTSD Scale (CAPS) PTSD diagnosis; Structured Clinical Interview for DSM-IV (SCID) for MDD diagnosis. Secondary measures included PTSD/depression symptoms, interpersonal conflict/anger, social support, self-efficacy and functioning. RESULTS: Using an intent-to-treat analysis, 22 IPT + TAU and 19 TAU participants were compared at three months post-baseline. A significantly greater reduction of PTSD and MDD diagnoses was found in the IPT group (51.9%, 30.1%, respectively) versus the TAU group (3.4%, 3.4%, respectively). Despite the small sample, the estimates for time-by-condition analyses of target outcomes (2.37 for PTSD (p = .018) and 1.91 for MDD (p = .056)) indicate the improvement was better in the IPT + TAU condition versus the TAU group. Treatment gains were maintained at 6 months for the IPT group. A similar treatment response was observed in the TAU group upon receipt of IPT. CONCLUSIONS: This initial study shows that IPT is a promising treatment for reducing PTSD and depression, the two major mental health disorders affecting populations surviving natural disaster, using a design that builds local mental health care capacity. TRIAL REGISTRATION: ClinicalTrials.Gov number, NCT01624935.
RESUMEN
The aim of the present study was to determine the most commonly used and primary psychotherapeutic orientations adopted by Chinese practitioners and to examine the factors associated with the choice of orientation. A nationwide survey using multi-stage convenience sampling without replacement was conducted. A total of 1,232 respondents out of the 1,325 participants selected completed the survey, which corresponds to an overall response rate of 93.0%. The respondents were practitioners who were providing consultations and psychotherapy in China at the time. The main outcome measures were the most commonly used and primary psychotherapeutic orientations. A Chi-square test was used to examine the factors associated with therapeutic orientation. The most commonly used psychotherapies were cognitive therapy (59.2%), behavioral therapy (38.1%) and the psychoanalytic/psychodynamic model (29.4%). The primary orientations were cognitive therapy (41.6%), the psychoanalytic/psychodynamic model (15.7%) and cognitive-behavioral therapy (10.3%). Gender had no effect on the orientation choice. Cognitive therapy was used significantly more by respondents who were ≤30 years old (50.5%), who had been in practice ≤3 years (45.9%), received continuing education ≤64 h (47.2%) and accepted no clinical supervision (53.1%). Those who were ≥31 years old (18.4%), had been in practice ≥7 years (21.0%), received continuing education ≥65 h (23.6%), worked full-time (20.2%) and accepted clinical supervision (20.6%) used the psychoanalytic/psychodynamic model significantly more. The respondents who used cognitive-behavioral therapy had graduated from the medical profession (14.1%) and were not licensed (15.8%). Cognitive therapy and the psychoanalytic/psychodynamic model were the two most popular orientations adopted by Chinese counselors and psychotherapists. Age, years of practice, graduate profession, continuing education, working hours (full/part-time), licensure and supervision are significant factors that affect the choice of orientation.