Improving access to evidence-based interventions for trauma-exposed adults in low- and middle-income countries.

In low- and middle-income countries (LMICs), the mental health consequences of trauma exposure pose a substantial personal, societal, and economic burden. Yet, the significant need for evidence-based mental health treatment remains largely unmet. To unlock the potential for mental health care for trauma survivors in lower-resource contexts, it is critical to map treatment barriers and identify strategies to improve access to evidence-based, culturally appropriate, and scalable interventions. This review, based on an International Society for Traumatic Stress (ISTSS) briefing paper, describes the treatment gap facing adults with traumatic stress in LMICs and identifies the barriers that contribute to this gap. We then highlight strategies for enhancing access to effective treatments for these populations, including task-sharing, the use of culturally adapted and multiproblem interventions, and digital tools to scale access to appropriate care. Finally, we offer recommendations for policymakers, researchers, and service providers to guide an agenda for action to close the treatment gap for trauma survivors in LMICs.

Trauma survivors' perceptions and experiences of prolonged exposure for PTSD at a psychology clinic.

Background: Several trauma-focused treatments have been developed to treat post-traumatic stress disorder (PTSD). Yet there are limited studies on how trauma survivors perceive and experience trauma-focused treatments such as prolonged exposure therapy (PE) for PTSD, especially in low- and middle-income countries (LMIC). Aim: The study aimed to explore the perceptions and experiences of trauma survivors receiving prolonged exposure therapy for PTSD and the general acceptability of PE for PTSD in a LMIC. Setting: The study was conducted at a community psychology clinic in the Eastern Cape, South Africa. Method: Using a qualitative method, seven adult trauma survivors who completed six sessions of brief PE for PTSD were interviewed. Thematic analysis was used to identify relevant themes and to understand how participants perceived and experienced PE for PTSD. Results: The analysis yielded five themes, namely structure, obstacles, gender, exposure and experiences of recovery. Conclusion: The findings suggested that participants perceived and experienced PE to be generally beneficial for the treatment of PTSD. Moreover, the study suggested that PE is an acceptable trauma therapy in a contextually diverse setting such as the Eastern Cape, South Africa. Overall, considering the evidence base of PE for PTSD, this study contributed to the literature on the acceptability of PE in a South African setting. Contribution: The findings of the study are in keeping with the extant literature on how persons perceive and experience PE for PTSD. The findings of the study suggests that PE is an acceptable and beneficial trauma therapy for PTSD in a contextually diverse setting such as South Africa. It is recommended that large scale implementation studies be conducted to further investigate the effectiveness, feasibility, and acceptability of PE in South Africa.

The experiences of clinical psychologists in treating traumatic stress at a tertiary psychiatric hospital in the Eastern Cape: A qualitative study.

Background: Qualitative data on the experiences of treating post-traumatic stress disorder (PTSD) in a psychiatric setting in a low-resource context is sparse. Aim: The authors aimed to explore the lived experiences of clinical psychologists who treat patients who are either trauma survivors or perpetrators in a psychiatric hospital. Setting: A public psychiatric hospital in the Eastern Cape, South Africa. Method: A total of six individual semi-structured interviews were conducted with three clinical psychologists. Data were analysed using interpretive phenomenological analysis (IPA). Results: The analysis for each participant identified several significant themes, namely (1) support as a male person, (2) being appreciative, (3) difficult trauma narratives, (4) a mother and a psychologist and (5) fear and hopelessness. Conclusion: Treating traumatic stress amongst clinical psychologists working in a public psychiatric hospital can lead to experiences of vicarious trauma and traumatic stress. In addition, the participants experienced an added danger in treating high-risk state patients, exposing psychologists to traumatic stress. Furthermore, psychologists recognised the influence of gender and race and its impact on their roles in their personal and professional lives as practitioners treating traumatic stress.

The experiences and perceptions of mental health service provision at a primary health centre in the Eastern Cape.

BACKGROUND: Since 1994, the South African healthcare system has undergone several changes to meet the needs of contemporary South Africa. Yet the state of mental healthcare, especially in low-resource areas, remains in a precarious state. AIM: This study aimed to explore how persons diagnosed with a mental disorder experience and perceive mental health services in a low-resource community in the Eastern Cape, South Africa. SETTING: The study was conducted at a primary care clinic in a low resource community setting in the Eastern Cape, South Africa. METHOD: Semi-structured interviews were conducted with eight participants diagnosed with mental illness who had been accessing treatment for at least the past 6 months from a primary health clinic. Thematic analysis was used to analyse and identify pertinent themes. RESULTS: The following themes emerged from the data: (1) perceptions of mental disorders - role of culture, (2) experiences of having mental disorders - loss of employment, (3) problem of stigma - social rejection and labelling, (4) experience of distress - sadness and frustration and (5) challenges in accessing treatment - transport fee and shortage of staff. CONCLUSION: This study yielded several lived experiences and perceptions in relation to participants' feelings, opinions and interpretations of persons living with mental disorders and accessing mental health treatment in their local context. Future interventions should consider provision of more extensive professional help in the form of counsellors and social workers at the clinics, more efficient service delivery and future interventions regarding stigma should incorporate community members into the learning process.

Task-shifting of prolonged exposure for primary care (PE-PC) for PTSD in a semirural setting in South Africa: A pilot implementation study.

Implementation science (IS) has received increased attention as it provides a means to bridge the know-do gap to implement evidence-based interventions in real-world settings. Against this backdrop, posttraumatic stress disorder (PTSD) is a global mental health concern (Koenen et al., 2017), especially in low- and middle-income countries characterized by limited trained health professionals, infrastructure, and limited access to evidence-based mental health care (Chen et al., 2017). Over the last 3 decades, effective trauma-focused psychotherapies (TFPs) for PTSD have been developed (Hamblen et al., 2019). Prolonged exposure therapy (PE) is a first-line TFP for PTSD (Hamblen et al., 2019), yet the dissemination and implementation of PE have been limited to specialty care settings in developed or industrialized countries (Booysen & Kagee, 2020). Implementation science provides an opportunity for disseminating and implementing TFPs like PE in low- and middle-income countries. This article describes mixed-method data from a pilot implementation study of an abbreviated version of PE, known as prolonged exposure for primary care (S. A. M. Rauch, Kim, et al., 2023), in a semirural city in the Eastern Cape of South Africa. Importantly, prolonged exposure for primary care shows a significant reduction in PTSD when provided by lay counselors and good feasibility and acceptability. In addition, we reflect on the barriers and facilitators related to implementation research within a low-resourced community, namely, (a) training lay counselors, (b) cultural diversity, and (c) mental health literacy. Mental health literacy is proposed as an essential component to consider in implementation science, especially in low-resourced communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The feasibility of prolonged exposure therapy for PTSD in low- and middle-income countries: a review.

There is a need in the global south to evaluate and implement empirically supported psychological interventions to ameliorate symptoms of posttraumatic stress disorder (PTSD). Empirically supported treatments (ESTs) have increasingly been developed and implemented, yet the majority people in the global south do not have access to these treatments for mental disorders such as PTSD. Prolonged exposure therapy has accrued substantial empirical evidence to show it as an effective treatment for PTSD. Research on the effectiveness and acceptability of prolonged exposure in a low- and middle-income countries (LMICs) are sparse. This brief report presents a review of prolonged exposure (PE) therapy and its feasibility as a trauma therapy for PTSD in LMICs. First, we present a brief overview of PE as a first-line treatment for PTSD. Second, using South Africa as a case example, we present a brief overview of traumatic stress in South Africa and how mental healthcare has developed since the abolishment of apartheid in 1994. Lastly, we discuss the challenges pertaining to the dissemination and implementation of PE in LMICs and propose future perspectives regarding the implementation of ESTs such as PE in LMICs.

Existe una necesidad, en el hemisferio sur, de evaluar e implementar intervenciones psicológicas basadas en la evidencia para mitigar los síntomas del trastorno de estrés postraumático (TEPT). Los tratamientos basados en investigación empírica (TBIEs) se han desarrollado e implementado de manera creciente; no obstante, la mayoría de las personas en el hemisferio sur no tienen acceso a este tipo de tratamientos para enfermedades mentales, tales como el TEPT. La terapia de exposición prolongada ha acumulado evidencia empírica substancial para demostrar que es un tratamiento efectivo para el TEPT. La investigación sobre la efectividad y aceptabilidad de la exposición prolongada en países de ingresos medios y bajos (PIMBs) es escasa. Este reporte breve presenta una revisión de la terapia de exposición prolongada (EP) y su viabilidad como un tratamiento enfocado en trauma para el TEPT en PIMBs. Primero, presentamos un breve panorama de la EP como primera línea de tratamiento para el TEPT. Segundo, usando a Sudáfrica como ejemplo, presentamos una breve perspectiva del estrés traumático en este país y cómo los servicios de salud mental se han desarrollado desde la abolición del Apertheid en 1994. Finalmente, discutimos los desafíos relacionados a la diseminación e implementación de la EP en PIMBs y proponemos perspectivas futuras en relación a la implementación de TBIEs, como la EP, en PIMBs. "The implementation of prolonged exposure therapy for PTSD is a necessary consideration given the prevalence of trauma and limited use of empirically supported treatments for PTSD in low- and middle-income countries.".