Anxiety and depression in general medical settings:Authors' reply

Brief trauma therapy for occupational trauma-related PTSD/CPTSD in UK police

BACKGROUND

Police are frequently exposed to occupational trauma, making them vulnerable to post-traumatic stress disorder (PTSD) and other mental health conditions. Through personal and occupational trauma police are also at risk of developing Complex PTSD (CPTSD), associated with prolonged and repetitive trauma. Police Occupational Health Services require effective interventions to treat officers experiencing mental health conditions, including CPTSD. However, there is a lack of guidance for the treatment of occupational trauma.

AIMS

To explore differences in demographics and trauma exposure between police with CPTSD and PTSD and compare the effectiveness of brief trauma-focused therapy between these diagnostic groups.

METHODS

Observational cohort study using clinical data from the Trauma Support Service, providing brief trauma-focused therapy for PTSD (cognitive behavioural therapy/eye movement desensitization and reprocessing) to UK police officers. Demographics, trauma exposure, baseline symptom severity and treatment effectiveness were compared between police with PTSD and CPTSD. Changes in PTSD, depression and anxiety symptoms were used to measure treatment effectiveness.

RESULTS

Brief trauma therapy reduced symptoms of PTSD, depression and anxiety. Treatment effectiveness did not differ between CPTSD and PTSD groups. Police with CPTSD exposed to both primary and secondary occupational trauma had poorer treatment outcomes than those exposed to a single occupational trauma type.

CONCLUSIONS

Brief trauma-focused interventions are potentially effective in reducing symptoms of PTSD, depression and anxiety in police with CPTSD and PTSD. Further research is needed to establish whether additional CPTSD symptoms (affect dysregulation, self-perception and relational difficulties) are also reduced.

The prevalence of psychiatric morbidity on a coronary care ward

Numerous studies have documented the high prevalence of psychological and emotional disorders in patients seen in general medical settings. However, despite the emphasis placed on holistic approaches to nursing care in all professional models of nursing practice, much of this distress is still missed by nursing staff. The Hospital Anxiety and Depression (HAD) scale is an easy-to-use self-administered screening instrument purportedly designed to detect psychological distress amongst hospitalized patients with physical illnesses. On using the HAD scale on patients admitted to a coronary care ward of a district general hospital, 44% were found to be suffering high levels of anxiety or depression. This figure is consistent with the results of similar studies in other cardiac wards and out-patient clinics. In most cases, the levels of distress found were not sufficiently severe to warrant seeking specialist psychiatric support. Instead, there is much that the general nurse can do to alleviate the understandable fears and worries of patients being treated for cardiac disease. However, to respond appropriately, nursing staff must be able to identify psychological distress in patients. The HAD scale, if it can be validated in cardiac in-patient settings, provides an instrument which could easily become part of the routine assessment of patients' nursing needs.

Colostomy patients: psychological adjustment at 10 weeks and 1 year after surgery in districts which employed stoma-care nurses and districts which did not

Two hundred and fifteen colostomy patients were interviewed at 10 weeks after surgery from a stratified random sample of 12 health districts in which stoma-care nurses were employed and eight other districts: 85 survivors who did not have restorative surgery were reinterviewed 1 year later. The Present State Examination (PSE) was used to assess the prevalence of affective disorder on both occasions. Analysis of covariance of the 10-week PSE scores revealed that age was unrelated to psychological adjustment after controlling for the extent and severity of patients' symptoms and that patients in districts which employed stoma-care nurses had significantly lower PSE scores. Single and widowed males appeared to enjoy better emotional health than married men and than women. Analysis of covariance of PSE scores obtained 1 year later also revealed that age was unrelated to psychological adjustment after controlling for the patients' physical state. No difference was found between patients who had access to a National Health Service stoma-care nurse and patients in other districts, many of whom had seen a representative from one of the appliance companies. The finding that single and widowed males appeared to fare better than married men was repeated. Ten per cent of patients who felt completely well were anxious or depressed. Psychiatric referral may be inappropriate for the majority of depressed patients who may instead benefit from medical treatment or from nursing intervention to deal with physical symptoms such as pain or urinary incontinence.