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Ji R, Zhang L, Ji Y, Li G, Wang R, Xu C. Association of Self-Leadership With Acute Stress Responses and Acute Stress Disorders in Chinese Medics During the COVID-19 Pandemic: A Cross-Sectional Study. Front Psychiatry 2022; 13:836950. [PMID: 35770059 PMCID: PMC9235357 DOI: 10.3389/fpsyt.2022.836950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/04/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The outbreak of the highly infectious coronavirus disease 2019 (COVID-19) renders a huge physical and psychological risk to the public, especially to the medics. Additionally, self-leadership has proven to improve self-efficacy and mediate tension, such as nervousness and depression. Therefore, a cross-sectional survey was conducted to explore the association of self-leadership with acute stress responses (ASRs) and acute stress disorders (ASDs) in medics during the COVID-19 epidemic. METHODS Self-reported online questionnaires were administered, and 627 participants were finally included. The data were analyzed using the univariate analysis and the logistical regression model to identify whether self-leadership and sociodemographic and epidemic characteristics were associated with mental health, including ASRs and ASDs. RESULTS Initially, 790 medics responded. Of these, 627 remained after excluding for invalid questionnaires and those with a substantial amount of missing data. Therefore, the participation validity rate was 79.37%. Frontline medical staff (β = 0.338; p < 0.001), possibility of infection among people around the medic being mild (β = 0.141; p < 0.001), subjective estimation of epidemic duration being 3-6 months (β = 0.074; p < 0.05), self-sets (β = -0.022; p < 0.001), self-punishment (β = 0.229; p < 0.001), belief hypothesis and evaluation (β = -0.147; p < 0.05), and successful foresight (β = 0.105; p < 0.05) were statistically significant with ASRs. Marital status [adjusted odds ratio (AOR) =1.813; 95% CI (1.141, 2.881); p = 0.012], being a frontline worker [AOR = 25.760; 95% CI (14.220, 46.667); p < 0.001], visiting Hubei in the previous 14 days [AOR = 3.656; 95% CI (1.500, 8.911); p = 0.004], self-punishment [AOR = 1.352; 95% CI (1.180, 1.548); p < 0.001], and self-dialogue [AOR = 1.256; 95% CI (11.063, 1.483); p = 0.007] were the risk factors for ASD. Conversely, having frontline medical staff in one's family [AOR = 0.523; 95% CI (0.297, 0.923); p = 0.025], self-sets [AOR = 0.814; 95% CI (0.715, 0.826); p = 0.002], and belief hypothesis and evaluation [AOR = 0.796; 95% CI (0.672, 0.943); p = 0.038] were the protective factors. CONCLUSION The special working environment of the COVID-19 epidemic resulted in ASR and ASD. Notably, findings revealed a positive association between ASR symptoms and frontline medical staff, the subjective estimation of epidemic duration, self-punishment, and successful foresight. Nevertheless, marital status, having visited Hubei in the previous 14 days, and self-dialogue were the risk factors accounting for ASD symptoms. Surprisingly, having frontline medical staff in one's family, self-sets, and belief hypothesis and evaluation had potential benefits for ASD symptoms.
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Affiliation(s)
- Rongjian Ji
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China.,Department of Nursing, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Lan Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yanbo Ji
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Guangzhao Li
- Department of Nursing, Shandong Provincial Hospital Affiliated of Shandong First Medical University, Jinan, China
| | - Renxiu Wang
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Cuiping Xu
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China.,Department of Nursing, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
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Smith HP, Power J, Usher AM, Sitren AH, Slade K. Working with prisoners who self-harm: A qualitative study on stress, denial of weakness, and encouraging resilience in a sample of correctional staff. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2019; 29:7-17. [PMID: 30609122 DOI: 10.1002/cbm.2103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 03/23/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Rates of self-harm are high among prisoners. Most research focuses on the vulnerable prisoner, and there is little on the impact of these behaviours on staff. AIMS To investigate staff perceptions of self-harming behaviours by prisoners, including their views on its causes, manifestation, prevention in institutions, and impact on them. METHODS Semistructured interviews were conducted with 20 administrative and 21 therapeutic prison staff who are responsible in various ways for prisoners who self-harm. Their narratives were explored using interpretative phenomenological analysis. RESULTS Despite prison staff being experienced with prisoners' self-harming behaviours, including severe acts of self-harm, they were apt to reject any negative impact on their own mental health or well-being. This denial of negative impact was accompanied by perceptions of the inmate's actions being manipulative and attention seeking. Prison staff also perceived institutional responses to self-harming behaviours by prisoners as being mixed, ambiguous, or showing preference for relying on existing suicide protocols rather than task-specific guidance. CONCLUSIONS Although staff gave explanations of prisoner self-harm in terms of "manipulative behaviour," prisoners' self-harm is, in fact, complex, challenging, and often severe. This staff perception may reflect denial of impact of often distressing behaviours on them personally and their own coping mechanisms. This could be feeding in to a perceived lack of clear and effective institutional responses to the self-harm, so further research is needed to determine how staff could broaden their views, and respond more effectively to prisoners. Psychologically informed group work and/or reflective practice are among the candidates for such help for staff.
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Affiliation(s)
- Hayden P Smith
- Department of Criminology & Criminal Justice, University of South Carolina, Columbia, SC, USA
| | - Jenelle Power
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - Amelia M Usher
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Alicia H Sitren
- Department of Criminology & Criminal Justice, University of North Florida, Jacksonville, FL, USA
| | - Karen Slade
- College of Business Law and Social Sciences, School of Social Sciences, Nottingham Trent University, Nottingham, UK
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McNally RJ, Bryant RA, Ehlers A. Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress? Psychol Sci Public Interest 2016; 4:45-79. [DOI: 10.1111/1529-1006.01421] [Citation(s) in RCA: 357] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the wake of the terrorist attacks at the World Trade Center, more than 9,000 counselors went to New York City to offer aid to rescue workers, families, and direct victims of the violence of September 11, 2001. These mental health professionals assumed that many New Yorkers were at high risk for developing posttraumatic stress disorder (PTSD), and they hoped that their interventions would mitigate psychological distress and prevent the emergence of this syndrome. Typically developing in response to horrific, life-threatening events, such as combat, rape, and earthquakes, PTSD is characterized by reexperiencing symptoms (e.g., intrusive recollections of the trauma, nightmares), emotional numbing and avoidance of reminders of the trauma, and hyperarousal (e.g., exaggerated startle, difficulty sleeping). People vary widely in their vulnerability for developing PTSD in the wake of trauma. For example, higher cognitive ability and strong social support buffer people against PTSD, whereas a family or personal history of emotional disorder heightens risk, as does negative appraisal of one's stress reactions (e.g., as a sign of personal weakness) and dissociation during the trauma (e.g., feeling unreal or experiencing time slowing down). However, the vast majority of trauma survivors recover from initial posttrauma reactions without professional help. Accordingly, the efficacy of interventions designed to mitigate acute distress and prevent long-term psychopathology, such as PTSD, needs to be evaluated against the effects of natural recovery. The need for controlled evaluations of early interventions has only recently been widely acknowledged. Psychological debriefing—the most widely used method—has undergone increasing empirical scrutiny, and the results have been disappointing. Although the majority of debriefed survivors describe the experience as helpful, there is no convincing evidence that debriefing reduces the incidence of PTSD, and some controlled studies suggest that it may impede natural recovery from trauma. Most studies show that individuals who receive debriefing fare no better than those who do not receive debriefing. Methodological limitations have complicated interpretation of the data, and an intense controversy has developed regarding how best to help people in the immediate wake of trauma. Recent published recommendations suggest that individuals providing crisis intervention in the immediate aftermath of the event should carefully assess trauma survivors' needs and offer support as necessary, without forcing survivors to disclose their personal thoughts and feelings about the event. Providing information about the trauma and its consequences is also important. However, research evaluating the efficacy of such “psychological first aid” is needed. Some researchers have developed early interventions to treat individuals who are already showing marked stress symptoms, and have tested methods of identifying those at risk for chronic PTSD. The single most important indicator of subsequent risk for chronic PTSD appears to be the severity or number of posttrauma symptoms from about 1 to 2 weeks after the event onward (provided that the event is over and that there is no ongoing threat). Cognitive-behavioral treatments differ from crisis intervention (e.g., debriefing) in that they are delivered weeks or months after the trauma, and therefore constitute a form of psychotherapy, not immediate emotional first aid. Several controlled trials suggest that certain cognitive-behavioral therapy methods may reduce the incidence of PTSD among people exposed to traumatic events. These methods are more effective than either supportive counseling or no intervention. In this monograph, we review risk factors for PTSD, research on psychological debriefing, recent recommendations for crisis intervention and the identification of individuals at risk of chronic PTSD, and research on early interventions based on cognitive-behavioral therapy. We close by placing the controversy regarding early aid for trauma survivors in its social, political, and economic context.
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Affiliation(s)
| | | | - Anke Ehlers
- Institute of Psychiatry, King's College London, London, United Kingdom
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Parental exposure to mass violence and child mental health: the First Responder and WTC Evacuee Study. Clin Child Fam Psychol Rev 2010; 12:95-112. [PMID: 19484384 DOI: 10.1007/s10567-009-0047-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Children's reactions after being exposed to mass violence may be influenced by a spectrum of factors. Relatively unexplored is the extent to which family exposure to mass violence may affect child mental health, even when these children have not been directly exposed. In a representative sample of NYC public school children assessed 6 months after the September 11, 2001 attack on the World Trade Center (WTC), seemingly elevated rates of psychopathology were recorded among children of WTC evacuees. Children of NYC First Responders (police officers, EMTs, and fire fighters) displayed a complex pattern of response to the WTC attack. Overall, the findings from this previous study support putative transmission of trauma to children whose parents were exposed to the WTC attack. The "Children of First Responder and WTC Evacuee Study"-a two-site longitudinal study-is currently underway in the United States (New York City) and in Israel (Tel Aviv area) in an effort to understand the impact of different patterns of mass violence. The NYC sample permits us to examine the impact of a rare instance of mass violence (e.g., WTC attack), while the Israeli sample provides information about repeated and frequent exposure to mass violence brought about by acts of terrorism. In addition, children's exposure to mass violence is considered in the context of their exposure to other potentially traumatic events. This study aims to improve our general understanding of the impact of mass violence on children, especially the psychological effects on children whose parents' work experiences are by nature stressful. Knowledge generated by this study has implications for guiding efforts to meet the needs of children who have, directly or through a family member, been subjected to rare or infrequent mass violent event as well as to children whose exposure to mass violence is part of daily life.
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Wain HJ, Gabriel GM. Psychodynamic concepts inherent in a biopsychosocial model of care of traumatic injuries. THE JOURNAL OF THE AMERICAN ACADEMY OF PSYCHOANALYSIS AND DYNAMIC PSYCHIATRY 2007; 35:555-573. [PMID: 18335610 DOI: 10.1521/jaap.2007.35.4.555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The psychological issues facing medical and surgical patients suffering from traumatic injuries are numerous and varied. These injuries may occur in the settings of armed conflict, terrorist attack, natural disaster, or accident. The goal of preventing or decreasing significant and disabling psychiatric comorbidity can be the objective and assignment of a Psychiatry Consultation Liaison Service (PCLS) within the hospital setting. A comprehensive trauma consultation service could be designed to assist the entire medical complex in its response to various events. The needs of the patient, the patient's primary support group, and the medical staff must be considered in the development of a treatment strategy for the setting of a traumatic event. This article describes the integration of a Preventive Medical Psychiatry Service (PMP) at Walter Reed Army Medical Center (WRAMC) into a traditional PCLS. The PMP model is built upon the biopsychosocial model and psychodynamic developmental concepts.
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Affiliation(s)
- Harold J Wain
- Psychiatry Consultation Liaison Service, Walter Reed Army Medical Center, Washington, DC 20307, USA.
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Dekel R, Solomon Z, Bleich A. Emotional distress and marital adjustment of caregivers: contribution of level of impairment and appraised burden. ANXIETY STRESS AND COPING 2005. [DOI: 10.1080/10615800412336427] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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North CS. The Oklahoma City bombing study and methodological issues in longitudinal disaster mental health research. J Trauma Dissociation 2005; 6:27-35. [PMID: 16150667 DOI: 10.1300/j229v06n02_04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Several methodological issues may affect the findings of studies of the mental health effects of disasters over time. These issues include analysis of the course of individual disorders over time that may be lost when they are presented embedded in general summary statistics, consideration of assessment of psychiatric disorders versus symptoms, adherence to established criteria in assigning psychiatric diagnoses, and orientation of mental health issues to the type of disaster exposure of the sample. This report will explore these methodological issues in a review of disaster literature and in data obtained from study of survivors of the Oklahoma City bombing. Clinical implications of the data obtained from the Oklahoma City bombing study of survivors of the direct bomb blast are presented in the context of these methodological concerns.
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Affiliation(s)
- Carol S North
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Aulagnier M, Verger P, Rouillon F. [Efficiency of psychological debriefing in preventing post-traumatic stress disorders]. Rev Epidemiol Sante Publique 2004; 52:67-79. [PMID: 15107694 DOI: 10.1016/s0398-7620(04)99023-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Traumatic events are frequently followed by an acute stress reaction that may develop into a post-traumatic stress disorder. An intervention called psychological debriefing has been proposed to prevent these disorders. Although this method is widely used at present, its preventive effect is controversial. This article consist in a review of the studies which evaluated psychological debriefing efficiency in the prevention of post-traumatic stress disorder and associated disorders in adults. METHOD We carried out a bibliographical search on MEDLINE (1966-2001), PASCAL (1987-2001), EMBASE (1988-2001), FRANCIS (1984-2001) and SCIENCEDIRECT (1967-2001). The key words were posttraumatic stress disorder, debriefing, treatment, psychological follow up, and prevention. We selected the studies with the following criteria: adults, one psychological debriefing session in the Month following the event, inclusion of a control group, more than 20 persons per group and evaluation of psychological disorders with standardized instruments more than one Month after the trauma. RESULTS Twenty nine studies were identified and 8 selected. Four studies did not show any intervention effect, 3 suggested a negative intervention effect, and 1 suggested a positive effect on anxiety, depressive symptoms and alcohol dependence. CONCLUSION Psychological debriefing implies re-exposure through memory processes to the trauma, which can interfere with the natural course of adjustment and recovery. Several Authors have suggested that psychological debriefing may delay the diagnosis and thus the early treatment of post-traumatic stress disorder. Psychological debriefing may not be appropriate to all victims of every type of incident or trauma. We discuss the intervention and its design. This review did not show evidence for psychological debriefing efficiency, as a unique session, in the prevention of posttraumatic reactions. The design and the objectives may be re-examined. Further evaluations following rigorous methods are warranted.
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Affiliation(s)
- M Aulagnier
- Observatoire Régional de la Santé de Provence-Alpes-Côte d'Azur (ORS - PACA), 23, rue Stanislas-Torrents, 13006 Marseille.
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Affiliation(s)
- Yori Gidron
- Department of Sociology of Health, Faculty of Health Sciences, Ben-Gurion University, Be'er Sheeba, 84105, Israel
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Aardal-Eriksson E, Eriksson TE, Thorell LH. Salivary cortisol, posttraumatic stress symptoms, and general health in the acute phase and during 9-month follow-up. Biol Psychiatry 2001; 50:986-93. [PMID: 11750895 DOI: 10.1016/s0006-3223(01)01253-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Because traumatic events are unpredictable, there are few studies of psychobiological states immediately following such events. Our study aimed to determine the relation of salivary cortisol to psychologic distress immediately after a traumatic event and then during follow-up. METHODS Measurement of morning and evening salivary cortisol and ratings of psychologic distress (using the Impact of Events Scale [IES], the Post Traumatic Symptom Scale, and the General Health Questionnaire) were performed with 31 United Nations soldiers at three time points--5 days and 2 and 9 months--following a mine accident in Lebanon. RESULTS Five days after the accident, 15 subjects reported substantial posttraumatic distress according to the IES, as well as significantly lower morning and higher evening cortisol levels compared with the low-impact group. Within 9 months, the posttraumatic distress of the high-impact group was reduced, accompanied by an increase in morning and a decrease in evening cortisol levels. There were significant relationships between evening cortisol and all rating scales at the first and third time points. CONCLUSIONS Subclinical posttraumatic stress following an adverse event can be measured biologically via salivary cortisol levels soon after the event.
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Affiliation(s)
- E Aardal-Eriksson
- Department of Biomedicine and Surgery, Division of Clinical Chemistry, Linköping University Hospital, S-581 85 Linköping, Sweden
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Abstract
OBJECTIVE To identify literature concerning the effectiveness of psychological debriefing (PD) and analyse results according to different criteria of success and different uses of the intervention format. METHOD Literature search was made in databases PubMed, PsycInfo and Psychlit. Twenty-five studies were selected for a thorough description. Forty-two studies provided additional information. RESULTS Results indicate that, in general, debriefing does not prevent psychiatric disorders or mitigate the effects of traumatic stress, even though people generally find the intervention helpful in the process of recovering from traumatic stress. The intervention holds potential as a screening procedure, and there may be economic arguments for continued use. When used with adherence to traditional descriptions of treatment group, events, group format, leadership and time spent, a preventive effect emerges. No tendency according to timing was found. CONCLUSION Current uses of PD are problematic. The concept needs to be redefined, and the scope of application must be revised. The objectives for use need to be clarified.
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Affiliation(s)
- M Arendt
- Danish Red Cross and Department of Psychiatric Demography, Institute for Basic Psychiatric Research, Psychiatric Hospital in Aarhus, Skovagervej 2, 8240 Risskov, Denmark
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Rose SC, Bisson J, Churchill R, Wessely S. Brief psychological interventions ("debriefing") for trauma-related symptoms and the prevention of post traumatic stress disorder. Cochrane Database Syst Rev 2000; 2002:CD000560. [PMID: 10796724 PMCID: PMC7032695 DOI: 10.1002/14651858.cd000560] [Citation(s) in RCA: 283] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess the effectiveness of brief psychological debriefing for the management of psychological distress after trauma, and the prevention of post traumatic stress disorder. SEARCH STRATEGY Electronic searching of MEDLINE, EMBASE, PsychLit, PILOTS, Biosis, Pascal, Occ.Safety and Health, CDSR and the Trials Register of the Depression, Anxiety and Neurosis group. Hand search of Journal of Traumatic Stress. Contact with leading researchers. SELECTION CRITERIA The inclusion criteria for all randomized studies was that they should focus on persons recently (one month or less) exposed to a traumatic event, should consist of a single session only, and that the intervention involve some form of emotional processing/ventilation by encouraging recollection/reworking of the traumatic event accompanied by normalisation of emotional reaction to the event. DATA COLLECTION AND ANALYSIS 8 trials fulfilled the inclusion criteria. Quality was generally poor. Data from two trials could not be synthesised. MAIN RESULTS Single session individual debriefing did not reduce psychological distress nor prevent the onset of post traumatic stress disorder (PTSD). Those who received the intervention showed no significant short term (3-5 months) in the risk of PTSD (pooled odds ratio 1.0, 95% ci 0.6-1.8). At one year one trial reported that there was a significantly increased risk of PTSD in those receiving debriefing (odds ratio 2.9, 95% ci 1.1-7.5). The pooled odds ratio for the two trials with follow ups just included unity (odds ratio 2.0, 95% ci 0.9-4.5). There was also no evidence that debriefing reduced general psychological morbidity, depression or anxiety. REVIEWER'S CONCLUSIONS There is no current evidence that psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease.
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Affiliation(s)
- Suzanna C Rose
- Berkshire Healthcare NHS Trust, UK.Berkshire Traumatic Stress ServiceErleigh Road Clinic25 Erleigh RoadReadingBerksUKRG1 5LR
| | - Jonathan Bisson
- Cardiff UniversityDepartment of Psychological MedicineMonmouth House, University Hospital of WalesHeath ParkCardiffUKCF14 4XW
| | - Rachel Churchill
- University of BristolAcademic Unit of Psychiatry, Community Based MedicineCotham House, Cotham HillBristolAvonUKBS6 6JL
| | - Simon Wessely
- Guy's, King's & St Thomas School of Medicine & Institute of PsychiatryAcademic Dept of Psychological Medicine103 Denmark HillLondonUKSE5 8AF
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