Wellbeing of Helicopter Emergency Medical Services Personnel in a Challenging Work Context: A Qualitative Study.

BACKGROUND: Helicopter emergency medical services (HEMS) personnel provide on-scene trauma care to patients with high mortality risk. Work in the HEMS setting is characterized by frequent exposure to critical incidents and other stressors. The aim of this study was to further our understanding of the factors underlying HEMS personnel wellbeing to inform organizations regarding workplace interventions that can be implemented to support employees. METHOD: We conducted 16 semi-structured interviews with HEMS personnel from a university hospital in The Netherlands. Interview topics included work context, personal characteristics, coping, work engagement, and psychosocial support. To analyze the data, we used a generic qualitative research approach inspired by grounded theory, including open, axial, and selective coding. RESULTS: The analysis revealed ten categories that provide insight into factors underlying the wellbeing of HEMS personnel and their work context: team and collaboration, coping, procedures, informal peer support, organizational support and follow-up care, drives and motivations, attitudes, other stressors, potentially traumatic events, and emotional impact. Various factors are important to their wellbeing, such as working together with colleagues and social support. Participants reported that HEMS work can have an emotional impact on wellbeing, yet they use multiple strategies to cope with various stressors. The perceived need for organizational support and follow-up care is low among participants. CONCLUSION: This study identifies factors and strategies that support the wellbeing of HEMS personnel. It also provides insight into the HEMS work culture and help-seeking behavior in this population. Findings from this study may benefit employers by shedding much-needed light on factors that HEMS personnel feel affect wellbeing.

Health trajectories of international humanitarian aid workers: growth mixture modelling findings from a prospective cohort study.

BACKGROUND: Most staff stay healthy during humanitarian work, although some worsen. Mean scores on health indicators may be masking individual participants struggling with health issues. AIMS: To investigate different field assignment-related health trajectories among international humanitarian aid workers (iHAWs) and explore the mechanisms used to stay healthy. METHOD: Growth mixture modelling analyses for five health indicators using pre-/post-assignment and follow-up data. RESULTS: Among 609 iHAWs three trajectories (profiles) were found for emotional exhaustion, work engagement, anxiety and depression. For post-traumatic stress disorder (PTSD) symptoms, four trajectories were identified. The 'healthy/normative' trajectory had the largest sample size for all health indicators (73-86%). A stable (moderate) 'ill health' trajectory was identified for all health indicators (7-17%), except anxiety. An 'improving' trajectory was found for PTSD and anxiety symptoms (5-14%). A minority of staff (4-15%) worsened on all health indicators. Deterioration continued for PTSD, depressive symptoms and work engagement 2 months post-assignment. A strong sense of coherence was associated with higher odds of belonging to the 'healthy' trajectory. Female biological sex was associated with higher odds of belonging to the 'worsening' depression and anxiety trajectories. Extended duration of field assignment was related to higher odds of belonging to the 'worsening' depressive symptoms trajectory. CONCLUSIONS: Most iHAWs stayed healthy during their assignment; a stable 'ill health' trajectory was identified for most health indicators. Sense of coherence is an important mechanism for understanding the health of all iHAWs in the different health trajectories, including the 'healthy' profile. These findings give new possibilities to develop activities to prevent worsening health and help strengthen iHAWs' ability to remain healthy under stress.

The effect of multiple family therapy on mental health problems and family functioning: A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to provide an overview of existing controlled trials focusing on the impact of multiple family therapy (MFT) on mental health problems and family functioning, and to examine the efficacy of MFT. Relevant studies were selected following a screening of 3376 studies identified by a systematic search of seven databases. The following data were extracted: participant characteristics, program characteristics, study characteristics, and information of mental health problems and/or family functioning. A total of 31 peer-reviewed, English, controlled studies evaluating the effect of MFT were included in the systematic review. Sixteen studies presenting 16 trials were included in the meta-analysis. All but one of the studies was at risk of bias, with problems concerning confounding, selection of participants and missing data. The findings confirm that MFT is offered in diverse settings, with studies presenting a variety of therapeutic modalities, focal problems, and populations. Individual studies reported some positive findings, including improvements in mental health, vocational outcomes, and social functioning. The findings of the meta-analysis suggest that MFT is associated with improvements in symptoms of schizophrenia. However, this effect was found not to be significant due to the large amount of heterogeneity. In addition, MFT was associated with small improvements in family functioning. We found little evidence to suggest that MFT successfully alleviates mood and conduct problems. To conclude, more methodologically rigorous research is needed to further examine the potential benefits of MFT, as well as the working mechanisms and core components of MFT.

Assessing psychological resilience: translation and validation of the Chinese version of the resilience evaluation scale (RES).

Background: The Resilience Evaluation Scale (RES) is a novel and freely available measure of psychological resilience (factored into self-confidence and self-efficacy). To date, psychometric properties were evaluated in Dutch and American samples, but not yet in a Chinese sample. Objective: We aimed to validate the RES in a Chinese sample by examining its factor structure, reliability, and construct validity. Methods: The RES was translated into Chinese following a cross-cultural translation and adaptation procedure. Self-report questionnaires including the RES, exposure to potentially traumatic events (PTE's), the PTSD checklist for DSM-5 (PCL-5), and scales for conceptually related constructs of psychological resilience were then administered via an online survey. Results: In total, 484 Chinese adults (females, 66.9%; age: 27.33 ± 6.86 years) participated. Parallel analysis results suggested a one-factor structure for the Chinese RES. The Chinese RES demonstrated good internal consistency (Cronbach's alpha = 0.88). Construct validity was demonstrated through significant associations with hypothesised related constructs and through a relation with lower levels of PTSD among the PTE-exposed subsample (n = 116) via the mediating role of avoidant coping strategies, i.e. behavioural disengagement and self-blame. Conclusion: Our results suggest that the RES is a reliable and valid assessment of psychological resilience to use in Chinese, in addition to its Dutch and English versions. The RES could potentially be adopted to measure psychological resilience in cross-cultural contexts.

Antecedentes: La Escala de Evaluación de la Resiliencia (RES en su sigla en inglés) es una medida nueva y disponible de forma gratuita de la resiliencia psicológica (conformada por los factores de autoconfianza y autoeficacia). A la fecha, las propiedades psicométricas fueron evaluadas en muestras danesas y americanas, pero no en una muestra china todavía.Objetivo: Buscamos validar la RES en una muestra china evaluando su estructura factorial, confiabilidad, y validez de constructo.Métodos: La RES fue traducida al chino siguiendo un procedimiento de traducción y adaptación intercultural. Se administraron en una encuesta en línea los cuestionarios de autoinforme incluyendo la RES, exposición a eventos potencialmente traumáticos (PTE's en su sigla en inglés), y la lista de chequeo del TEPT para el DSM-5 (PCL-5 en su sigla en inglés), y las escalas de constructos conceptualmente relacionados a la resiliencia psicológica.Resultados: En total, participaron 484 adultos chinos (mujeres, 66.9%; edad: 27.33 ± 6.86 años). Los resultados de los análisis paralelos sugirieron una estructura de un factor para la RES china. La RES china demostró una buena consistencia interna (alfa de Cronbach = 0.88). La validez de constructo fue demostrada a través de asociaciones significativas con los constructos hipotéticamente relacionades y a través de una relación con niveles más bajo de TEPT en la sub-muestra expuesta a PTEs (n = 116) por medio del rol mediador de los mecanismos de afrontamiento evitativos, es decir, desconexión conductual y autoculpa.Conclusión: Nuestros resultados sugieren que la RES es una evaluación fiable y valida de resiliencia psicológica para usar en chino, en adición a sus versiones danesa e inglesa. La RES podría potencialmente ser adaptada para medir la resiliencia psicológica en contextos interculturales.

Facilitating the transition home after military deployment: a systematic literature review of post-deployment adaptation programmes.

Background: Many countries pay special attention to the transition of their military personnel from deployment to home via post-deployment adaptation programmes (PDAPs). Objective: This systematic review aims to provide a structured analysis of structure, process, and outcomes based on available empirical evidence for PDAPs. Methods: A systematic literature search was performed to identify original peer-reviewed studies on PDAP in six databases (MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, PTSDPubs, and OpenGrey). The overall risk of bias of the articles was assessed using GRADE guidelines. The literature was analysed in its description of PDAP structure, process, and outcomes. In addition, when effects were reported, these were extracted. Results: The search resulted in 1535 unique records that were screened for eligibility; 16 articles were included, of which only three showed low risk of bias according to GRADE. Few studies clearly described and investigated PDAP structure elements (i.e. combat exposure), process elements (i.e. who delivered the intervention), and other outcome elements (i.e. adjustment issues). Most articles included some form of third location decompression (N = 10; psychoeducation and time to rest and relax on a location that is not in the mission theatre or at home) and Battlemind (N = 4; interactive training focusing on how to adapt skills and cognitions after deployment at home). The results suggest positive mental health effects and satisfaction of these two types of PDAP, although the evidence is poor. Conclusions: Empirical, high-quality evidence for PDAP is scarce. In addition, the existing literature reveals a lack of systematic method in describing the goals of PDAP and the ways of achieving these. This leads to incomparability between studies and hinders the building of a knowledge base on PDAPs. A structure is proposed for describing the structure, process, and outcomes of PDAPs with measured effects. HIGHLIGHTS: High -quality evidence for post-deployment adaptation programmes is scarce.Programme structure, process, and aims with measured effects are not delineated.Positive mental health effects are reported for Battlemind and third location decompression.

Antecedentes: Muchos países ponen especial atención a la transición de su personal militar desde el despliegue al hogar por medio de los programas de adaptación luego del despliegue (PDAPs en su sigla en inglés).Objetivo: Esta revisión sistemática busca proveer un análisis estructurado de la estructura, proceso y resultados basados en la evidencia empírica disponible para PDAPs.Método: Se realizó una búsqueda sistemática de la literatura para identificar estudios originales revisados por pares en PDAP en seis bases de datos (MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, PTSDPubs y OpenGrey). El riesgo de sesgo general de los artículos fue evaluado usando las guías de GRADE. La literatura fue analizada en su descripción de la estructura, proceso y resultados de PDAP. Además, se extrajeron los efectos cuando fueron reportados.Resultados: La búsqueda resultó en 1535 registros únicos que fueron evaluados por la idoneidad; 16 artículos fueron incluidos, de los cuales solo 3 mostraron bajo riesgo de sesgo de acuerdo con GRADE. Pocos estudios describieron e investigaron claramente los elementos de la estructura (por ej., exposición a combate), los elementos del proceso (por ej., quien entrego la intervención), y otros elementos de los resultados (por ej., problemas de adaptacion). La mayoría de los artículos incluyeron alguna forma de descompresión en un tercer lugar (N = 10; psicoeducación y tiempo para descansar y relajarse en un lugar que no sea el teatro de la misión o en el hogar) y Mentalidad de Batalla [Battlemind] (N = 4; un entrenamiento interactivo centrado en cómo adaptar habilidades y cogniciones luego del despliegue en el hogar). Los resultados sugieren efectos positivos para la salud mental y satisfacción de esos dos tipos de PDAP, aunque la evidencia es escasa.Conclusiones: La evidencia empírica de alta calidad para PDAP es escasa. Además, la literatura existente revela una carencia de un método sistemático en describir los objetivos de PDAP y las formas de lograrlos. Esto lleva a que los estudios no sean comparables y limita la construcción de una base de conocimiento sobre PDAP. Se propone una estructura para describir la estructura, proceso, y los resultados de PDAPs con los efectos medidos.

Appraising Evidence-Based Mental Health and Psychosocial Support (MHPSS) Guidelines-PART II: A Content Analysis with Implications for Disaster Risk Reduction.

High quality mental health and psychosocial support (MHPSS) guidelines are indispensable for policy and practice to address the mental health consequences of disasters. This contribution complements a review that assessed the methodological quality of 13 MHPSS guidelines. We analyzed the content of the four highest-ranking guidelines and explored implications for disaster risk reduction (DRR). A qualitative explorative thematic analysis was conducted. The four guidelines proved largely similar, overlapping or at least complementary in their MHPSS definitions, stated purpose of the guidelines, user and target groups, terminology, and models used. Many recommended MHPSS measures and interventions were found in all of the guidelines and could be assigned to five categories: basic relief, information provision, emotional and social support, practical support, and health care. The guidelines stress the importance of monitoring needs and problems, evaluating the effect of service delivery, deliberate implementation and preparation, and investments in proper conditions and effective coordination across professions, agencies, and sectors. The MHPSS knowledge base embedded in the guidelines is comprehensive, coherent, and sufficiently universal to serve as the "overarching framework" considered missing yet vital for the integration of MHPSS approaches in DRR. Although application contexts differ geographically, this common ground should allow policymakers and practitioners globally to plan, implement, and evaluate MHPSS actions contributing to DRR, ideally together with target groups.

Online One-Stop Shop for Disaster Response Services After the MH17 Airplane Crash: An Evaluation Study.

Background: A one-stop shop for disaster response services provides a central location for information and advice in an accessible way. Yet little is known about its organization and outcomes. After the MH17 airplane crash, the one-stop shop concept was realized through a digital environment called the Information and Referral Center (IRC). The aim of this study was to evaluate the experiences of users and providers in regard to the IRC and to identify improvement points for future IRCs. Method: Data was collected among affected ones as well as involved organizations, using interviews, focus groups, surveys and online user information. Existing evaluation and quality models were combined to design the study and analyze the data. Results: First, affected ones and a variety of organizations involved were positive about the merits of the IRC. Affected ones indicated they perceived the IRC as a reliable source of information and appreciated the referral possibilities. Second, the feature of the IRC to serve as a community where affected ones could meet, share experiences and support each other was hardly used according to participants. Lastly, tracking evolving psychosocial needs and problems through the IRC was hampered due to difficulty in accessing relevant data. Conclusions: The IRC helped organizations to structure and align their services. Affected ones were positive about its reliability and accessibility. An IRC has to be embedded within the established care structures. Future research could indicate whether an IRC is useful in other event types and population contexts as well.

Appraising Evidence-Based Mental Health and Psychosocial Support (MHPSS) Guidelines-PART I: A Systematic Review on Methodological Quality Using AGREE-HS.

In 2007, the Inter-Agency Standing Committee (IASC) published its guidelines for mental health and psychosocial support (MHPSS) in emergency situations. This was one of the first sets of MHPSS guidelines, developed during the last decades, to aid policymakers and practitioners in the planning and implementation of disaster mental health risk reduction activities. However, the potential merit of MHPSS guidelines for this purpose is poorly understood. The objective of this study is to review available MHPSS guidelines in disaster settings and assess their methodological quality. MHPSS guidelines, frameworks, manuals and toolkits were selected via a systematic literature review as well as a search in the grey literature. A total of 13 MHPSS guidelines were assessed independently by 3-5 raters using the Appraisal of Guidelines for Research and Evaluation-Health Systems (AGREE-HS) instrument. Guideline quality scores varied substantially, ranging between 21.3 and 67.6 (range 0-100, M = 45.4), with four guidelines scoring above midpoint (50). Overall, guidelines scored highest (on a 1-7 scale) on topic (M = 5.3) and recommendations (M = 4.2), while implementability (M = 2.7) is arguably the area where most of the progress is to be made. Ideally, knowledge derived from scientific research aligns with the receptive contexts of policy and practice where risks are identified and mitigated.

Stress at work: Self-monitoring of stressors and resources to support employees.

High levels of stress at work may have serious consequences for employee functioning and mental health. By providing employees with an easily accessible instrument to regularly evaluate stressors and resources, employee self-monitoring and guidance to support can be accommodated. We evaluated an online self-monitoring tool Brief Assessment of Stress and Energy (BASE). Through their organization, 139 railway emergency services employees were invited to complete BASE and six wellbeing measures. We assessed BASE in two ways: using multiple regression analysis (N = 102, 73.4%), as well as by telephone follow-up interviews during which experts and respondents evaluated the BASE outcome (N = 67, 65.7%). Explained variances of BASE on the six wellbeing measures ranged between 26.6% and 49.9%. Telephone interviews confirmed the BASE outcome. The results indicate that BASE is associated with several measures of wellbeing and accurately refers respondents to counseling. This study shows that BASE is a promising instrument to encourage employees to self-monitor stressors and resources and identify those who need counseling.

Caught between is and ought: The Moral Dissonance Model.

Considerable academic effort has been invested in explaining the causes of, and processes behind moral injury. These efforts are mostly focused on assessment and treatment within a clinical setting. Collective and social factors contributing to moral injury are often overlooked in current literature. This perspective article considers the role of contextual factors associated with moral injury and proposes a framework that describes their relation to individual aspects. The resulting Moral Dissonance Model (MDM) draws on existing theories and frameworks. The MDM explains how dissonance can occur when the actual behavior-the response to a morally challenging situation-contradicts with morally desirable behavior. Individual and collective factors, which change over time, contribute to the experience of dissonance. The inability to sufficiently solve dissonance can lead to moral injury, but not as a matter of course. The MDM can help to understand the underlying processes of moral distress. It raises awareness of the influence of public debate and controversy, and the resulting changing societal attitudes over time. Its implications and future use are discussed.

Family Empowerment (FAME): A feasibility trial of preventive multifamily groups for asylum seeker families in the Netherlands.

This study evaluated the feasibility of Family Empowerment (FAME), a preventive multifamily program for asylum seeker families in the Netherlands. FAME aims to reinforce the parent-child relationship, family functioning, and social support. We used an uncontrolled pre-test-post-test design, embedded in a mixed-methods approach. FAME was offered to 46 asylum seeker families, mostly originating from Eritrea, Armenia, or Syria. Twenty-seven parents gave consent to participate in this study. Program integrity and evaluations of participating parents and trainers were assessed. Family functioning and parental symptoms of depression and anxiety were measured pre- and post-FAME. Six participants completed all assessments. Most participants valued gathering with multiple families. Although FAME might coincide with decreases in anxiety and depression, the program had a limited impact on family functioning. Possibly, the aims of FAME did not align with some families' current needs. Lessons learned and recommendations to further improve interventions for refugee families are discussed.

Correction: Mobile Insight in Risk, Resilience, and Online Referral (MIRROR): Psychometric Evaluation of an Online Self-Help Test.

[This corrects the article DOI: 10.2196/19716.].

Mobile Insight in Risk, Resilience, and Online Referral (MIRROR): Psychometric Evaluation of an Online Self-Help Test.

BACKGROUND: Most people who experience a potentially traumatic event (PTE) recover on their own. A small group of individuals develops psychological complaints, but this is often not detected in time or guidance to care is suboptimal. To identify these individuals and encourage them to seek help, a web-based self-help test called Mobile Insight in Risk, Resilience, and Online Referral (MIRROR) was developed. MIRROR takes an innovative approach since it integrates both negative and positive outcomes of PTEs and time since the event and provides direct feedback to the user. OBJECTIVE: The goal of this study was to assess MIRROR's use, examine its psychometric properties (factor structure, internal consistency, and convergent and divergent validity), and evaluate how well it classifies respondents into different outcome categories compared with reference measures. METHODS: MIRROR was embedded in the website of Victim Support Netherlands so visitors could use it. We compared MIRROR's outcomes to reference measures of PTSD symptoms (PTSD Checklist for DSM-5), depression, anxiety, stress (Depression Anxiety Stress Scale-21), psychological resilience (Resilience Evaluation Scale), and positive mental health (Mental Health Continuum Short Form). RESULTS: In 6 months, 1112 respondents completed MIRROR, of whom 663 also completed the reference measures. Results showed good internal consistency (interitem correlations range .24 to .55, corrected item-total correlations range .30 to .54, and Cronbach alpha coefficient range .62 to .68), and convergent and divergent validity (Pearson correlations range -.259 to .665). Exploratory and confirmatory factor analyses (EFA+CFA) yielded a 2-factor model with good model fit (CFA model fit indices: χ219=107.8, P<.001, CFI=.965, TLI=.948, RMSEA=.065), conceptual meaning, and parsimony. MIRROR correctly classified respondents into different outcome categories compared with the reference measures. CONCLUSIONS: MIRROR is a valid and reliable self-help test to identify negative (PTSD complaints) and positive outcomes (psychosocial functioning and resilience) of PTEs. MIRROR is an easily accessible online tool that can help people who have experienced a PTE to timely identify psychological complaints and find appropriate support, a tool that might be highly needed in times like the coronavirus pandemic.

Family Empowerment (FAME): study protocol for a pilot implementation and evaluation of a preventive multi-family programme for asylum-seeker families.

BACKGROUND: Families applying for asylum have often experienced multiple potentially traumatic events and continue to face stressors during their resettlement. Studies have indicated that traumatic events can negatively impact parenting behaviour and child development. A secondary preventive multi-family intervention programme, called Family Empowerment, was developed. Family Empowerment aims to strengthen parenting skills and prevent exacerbation of emotional problems in asylum-seeker families. This study protocol aims to evaluate the feasibility, acceptability, and potential effectiveness of Family Empowerment to reduce parental mental health problems and improve family functioning. METHODS: An uncontrolled pre-test-post-test design will be conducted, using a mixed-methods approach. Approximately 60 families living at asylum centres and family locations with children aged 0-18 will be included. All participants will be invited to take part in seven sessions of Family Empowerment. Measurements take place at baseline, during implementation of Family Empowerment and 1 week post-Family Empowerment. Demographic data, the quality of the parent-child interaction, family functioning, parental symptoms of depression and anxiety, and participants' feedback on progress and the therapeutic alliance will be assessed. A programme integrity list will be filled out during each session. Semi-structured interviews at baseline and post-Family Empowerment will be used to evaluate Family Empowerment. DISCUSSION: This is the first study to provide a pilot implementation and evaluation of Family Empowerment. The current study will inform us on how to improve programme elements and the implementation of Family Empowerment. Limitations are discussed. TRIAL REGISTRATION: Dutch Trial Register, TC = NTR6934. Registered on January 8 2018.

A longitudinal evaluation of active outreach after an aeroplane crash: screening for post-traumatic stress disorder and depression and assessment of self-reported treatment needs.

Background: In 2009, an aeroplane crashed near Amsterdam. To remedy unmet mental health needs, active outreach was used to identify victims at risk for post-traumatic stress disorder (PTSD) and depression. Objective: The active outreach strategy was evaluated by examining the accuracy of screening methods in predicting PTSD and depression, self-reported treatment needs, and the extent to which perceived treatment needs predict trajectories of PTSD. Method: In 112 adult survivors, semi-structured telephone interviews were held at 2 (T1, n = 76), 9 (T2, n = 77) and 44 months (T3, n = 55) after the crash. The Trauma Screening Questionnaire (TSQ) and the Patient Health Questionnaire-2 (PHQ-2) measured symptoms of PTSD and depression, respectively. At T3, a clinical interview assessed PTSD and depression diagnoses. Based on the TSQ scores at the three time-points, participants were grouped into five 'trajectories': resilient (n = 38), chronic (n = 30), recovery (n = 9), delayed onset (n = 9) and relapse (n = 3). Results: The TSQ accurately predicted PTSD at T3 (sensitivity: .75-1.00; specificity: .79-.90). The PHQ-2 showed modest accuracy (sensitivity: .38-.89; specificity: .67-.90). Both measures provided low positive predictive values (TSQ: 0.57; PHQ-2: .50 at T3). A number of participants reported unmet treatment needs (T1: 32.9%; T2: 19.5%; T3: 10.9%). Reporting unmet needs at T2 was more often assigned to a chronic PTSD trajectory compared to reporting no needs (p < .01). Conclusions: The prevalence of unmet needs at 44 months after the crash within a chronic PTSD trajectory indicated that active outreach may be warranted. Nevertheless, although the TSQ was accurate, many participants screening positive did not develop PTSD. This implies that, although active outreach may benefit those with unmet needs, it also has its costs in terms of possible unnecessary clinical assessments.

Antecedentes: En 2009 ocurrió un accidente aéreo cerca de Amsterdam. Para subsanar las necesidades de salud mental insatisfechas, se usó contacto activo para identificar víctimas en riesgo de trastorno de estrés postraumático (TEPT) y depresión. Objetivo: Evaluar esta estrategia examinando: 1) la precisión de los métodos de tamizaje para predecir TEPT Y depresión, 2) necesidades de tratamiento auto-reportadas, y 3) el grado en que las necesidades de tratamiento percibidas predicen las trayectorias de TEPT. Métodos: En 112 adultos sobrevivientes, se realizaron entrevistas telefónicas semi-estructuradas a los 2 (T1, n=76), 9 (T2, n=77) y 44 meses (T3, n=55) posteriores al accidente. El Cuestionario de Tamizaje de Trauma (TSQ por sus siglas en inglés) y el Cuestionario de Salud de los Pacientes-2 (PHQ-2 por sus siglas en inglés) midieron síntomas de TEPT y depresión, respectivamente. En T3, se evaluó con una entrevista clínica los diagnósticos de TEPT y depresión. En base a los puntajes de TSQ en los 3 puntos de tiempo, los participantes fueron agrupados en 5 'trayectorias': resiliente (n=38), crónico (n=30), recuperación (n=9), inicio demorado (n=9) y recaída (n=3). Resultados: la TSQ predijo TEPT en forma precisa al T3 (sensibilidad: .75 a 1.00, especificidad: .79 a .90). El PHQ-2 mostró modesta precisión (sensibilidad: .38 a .89, especificidad: .67 a .90). Ambas medidas entregaron bajos valores predictivos positivos (TSQ: .57, PHQ-2: .50 en T3). Un número de participantes reportaron necesidades de tratamiento insatisfechas (T1: 32.9%, T2: 19.5%, T3: 10.9%). El reportar necesidades insatisfechas en T2 fue más frecuentemente asignado a una trayectoria crónica de TEPT comparado a no reportar necesidades (p<.01). Conclusiones: La prevalencia de necesidades insatisfechas 44 meses después del accidente dentro de una trayectoria crónica de TEPT indicó que el contacto activo puede estar justificado. Sin embargo, aunque la TSQ fue precisa, muchos participantes detectados como positivos no desarrollaron TEPT. Esto implica que, aunque el contacto activo puede beneficiar a aquellos con necesidades insatisfechas, tiene también sus costos en términos de posibles evaluaciones clínicas innecesarias.

Assessing Psychological Resilience: Development and Psychometric Properties of the English and Dutch Version of the Resilience Evaluation Scale (RES).

Background: Psychological resilience is a distinct factor that affects mental health outcomes after adversities. This study describes the development, validity and measurement invariance (MI) of a Dutch and English scale on psychological resilience, called the Resilience Evaluation Scale (RES). Methods: Separate online surveys with the Dutch and English version of the RES and hypothesized related measures were distributed in a Dutch- and English-speaking group, both drawn from the general population. Results: Exploratory factor analysis, using data from 522 respondents (n = 296 Dutch, n = 226 English), yielded a two-factor structure for the final 9-item RES. The factors reflected the hypothesized underlying constructs of psychological resilience: self-confidence and self-efficacy. The items and constructs of psychological resilience as measured by the RES were interpreted and conceptualized in the same way by both language groups, with the exception of one item. The RES showed good convergent validity and good internal consistency. Conclusions: The current study establishes sound psychometric properties of a new, brief, and freely available scale on psychological resilience. This study contributes to the identification and measurement of psychological resilience after adversities. The final 9-item RES may serve as a valuable instrument in research and in clinical practice.

The risk of PTSD and depression after an airplane crash and its potential association with physical injury: A longitudinal study.

In 2009, a commercial airplane crashed near Amsterdam. This longitudinal study aims to investigate (1) the proportion of survivors of the airplane crash showing a probable posttraumatic stress disorders (PTSD) or depressive disorder, and (2) whether symptoms of PTSD and depression were predicted by trauma characteristics. Identifying these trauma characteristics is crucial for early detection and treatment. Of the 121 adult survivors, 82 participated in this study 2 months after the crash and 76 participated 9 months after the crash. Risk for PTSD and depression was measured with the self-report instruments Trauma Screening Questionnaire and Patient Health Questionnaire-2. Trauma characteristics assessed were Injury Severity Score (ISS), hospitalisation, length of hospital stay, and seating position in the plane. Two months after the crash, 32 participants (of N=70, 46%) were at risk for PTSD and 28 (of N=80, 32%) were at risk for depression. Nine months after the crash, 35 participants (of N=75, 47%) were at risk for PTSD and 24 (of N=76, 35%) were at risk for depression. There was a moderate correlation between length of hospital stay and symptoms of PTSD and depression 9 months after the crash (r=.33 and r=.45, respectively). There were no differences in seating position between participants at high risk vs. participants at low risk for PTSD or depression. Mixed design ANOVAs showed also no association between the course of symptoms of PTSD and depression 2 and 9 months after the crash and ISS or hospitalisation. This suggests that health care providers need to be aware that survivors may be at risk for PTSD or depression, regardless of the objective severity of their physical injuries.

Psychosocial care to affected citizens and communities in case of CBRN incidents: a systematic review.

Disasters are associated with a substantial psychosocial burden for affected individuals (including first responders) and communities. Knowledge about how to address these risks and problems is valuable for societies worldwide. Decades of research into post-disaster psychosocial care has resulted in various recommendations and general guidelines. However, as CBRN (chemical, biological, radiological, nuclear) events form a distinctive theme in emergency planning and disaster preparedness, it is important to systematically explore their implications for psychosocial care. The aim of this study is to answer two questions: 1). To what extent does psychosocial care in the case of CBRN events differ from other types of events? 2). How strong is the scientific evidence for the effectiveness of psychosocial care interventions in the context of a CBRN event? A systematic literature review was conducted. Searches were performed in Medline, PsychINFO, Embase and PILOTS. Studies since January 2000 were included and evaluated by independent reviewers. The 39 included studies contain recommendations, primarily based on unsystematic literature reviews, qualitative research and expert opinions. Recommendations address: 1) public risk- and crisis communication, 2) training, education and exercise of responders, 3) support, and 4) psychosocial counselling and care to citizens and responders. Although none of the studies meet the design criteria for effectiveness research, a substantial amount of consensus exists on aspects relevant to CBRN related psychosocial care. Recommendations are similar or complementary to general post-disaster psychosocial care guidelines. Notable differences are the emphasis on risk communication and specific preparation needs. Relevant recurring topics are uncertainty about contamination and health effects, how people will overwhelm health care systems, and the possibility that professionals are less likely to respond. However, the lack of evidence on effectiveness makes it necessary to be careful with recommendations. More evaluation research is absolutely needed.

Changes in the remuneration system for general practitioners: effects on contact type and consultation length.

In The Netherlands, the remuneration system for GPs changed in 2006. Before the change, GPs received a capitation fee for publicly insured patients and fee for service (FFS) for privately insured patients. In 2006, a combined system was introduced for all patients, with elements of capitation as well as FFS. This created a unique opportunity to investigate the effects of the change in the remuneration system on contact type and consultation length. Our hypothesis was that for former publicly insured patients the change would lead to an increase in the proportion of home visits, a decrease in the proportion of telephone consultations and an increase in consultation length relative to formerly privately insured patients. Data were used from electronic medical records from 36 to 58 Dutch GP practices and from 532,800 to 743,961 patient contacts between 2002 and 2008 for contact type data. For consultation length, 1,994 videotaped consultations were used from 85 GP practices in 2002 and 499 consultations from 16 GP practices in 2008. Multilevel multinomial regression analysis was used to analyse consultation type. Multilevel logistic and linear regression analyses were used to examine consultation length. Our study shows that contact type and consultation length were hardly affected by the change in remuneration system, though the proportion of home visits slightly decreased for privately insured patients compared with publicly insured patients. Declaration behaviour regarding telephone consultations did change; GP practices more consistently declared telephone consultations after 2006.

Early psychosocial interventions after disasters, terrorism and other shocking events: is there a gap between norms and practice in Europe?

BACKGROUND: Internationally, several initiatives exist to describe standards for post-disaster psychosocial care. OBJECTIVE: This study explored the level of consensus of experts within Europe on a set of recommendations on early psychosocial intervention after shocking events (Dutch guidelines), and to what degree these standards are implemented into mental health care practice. METHODS: Two hundred and six (mental) health care professionals filled out a questionnaire to assess the extent to which they consider the guidelines' scope and recommendations relevant and part of the regular practice in their own country. Forty-five European experts from 24 EU countries discussed the guidelines at an international seminar. RESULTS: The data suggest overall agreement on the standards although many of the recommendations appear not (yet) to be embedded in everyday practice. CONCLUSIONS: Although large consensus exists on standards for early psychosocial care, a chasm between norms and practice appears to exist throughout the EU, stressing the general need for investments in guideline development and implementation.