Terremoto en Chile: estrés agudo y estrés post-traumático en mujeres en tratamiento por depresión grave / Earthquake in Chile: acute stress and post traumatic stress disorder among women in treatment for severe depression

Background: Depression is a risk factorfor developing secondary post-traumatic stress disorder. The earthquake on February 27th, 2010, destroyed the Hospital of Curicó. Despite the prevailing chaos, patients in treatment for severe depression actively maintained their treatment from the first post-earthquake workingday Aim: To determine prevalence of acute stress (AS) and post-traumatic stress disorder (PTSD) after the earthquake amongwomen in treatment for severe depression. Material and Methods: Seventy five women aged 20 to 73 years in treatment for depression for at least six months before the oceurrence of the earthquake, who continued in follow up after the event, were studied. According to the Tenth International Classification ofDiseases, thefrequency ofAS was assessed duringthe consultation oceurring one month after the event and thefrequency ofPTSD was assessed during the consultation oceurring six months after the event. Results: Fifty nine percent of women hadAS symptoms at thefirst month and 53.3% had PTSD, six months later. AS was signifi cantly associated with a low educational level. PTSD was significantly associated with prior oceurrence of AS and a history of childhood trauma history. Conclusions: A high frequeney ofPTSD was observed in thisgroup of depressive patients, which was significantly associated with a history ofprevious AS and childhood trauma.

Eficacia y costos asociados a un tratamiento ambulatorio en mujeres con depresión severa y trauma temprano / Efficacy and associated costs of an outpatient intervention in women with severe depression and early trauma

Background: A high proportion of women consulting for depression have a history of childhood abuse and trauma. Aim: To compare the effcacy and costs associated with a treatment that inquires directly into childhood trauma and understands present interpersonal diffculties as a compulsion to repeat the traumatic past, versus the usual treatment, in women with severe depression and childhood trauma. Material and Methods: Eighty seven women with depression and prior history of early trauma that sought help at the Mental Health Unit of the Hospital de Curicó were studied. Forty four were randomly assigned to the experimental treatment, and 43 to the usual management. Patients were evaluated using the Hamilton Depression Scale, the Outcome Questionnaire (OQ 45.2) and an expenditures sheet at baseline, three and six months. An intention to treat analysis and a simple cost-analysis were performed. Results: Hamilton and OQ 45.2 scores improved in both treatment groups, with signifcantly better results achieved in the experimental patients. The direct overall costs of experimental and control treatments were CLP 8,628,587 and 9,688,240, respectively. The main contributors to costs in both arms were medications (26.5 percent), followed by the number of psychiatric consultations (19.2 percent) in the experimental group and by hospitalizations (25.4 percent) in the control group. The costs per patient recovered in experimental and control groups were CLP 616,328 and 1,973,649, respectively. Conclusions: The proposed model resulted more effective for the treatment of this group of women.