Patient-reported outcomes in post-traumatic stress disorder. Part I: focus on psychological treatment.

Since 2000, patient reports have contributed significantly to the widening diagnostic criteria for post-traumatic stress disorder, notably with the inclusion of complex, repeated, and indirect threat to people who develop symptoms. This paper describes and explains why patient reports matter, through worldwide mental health users' movements and the human rights movement. It looks at 46 recent patient-reported outcomes of preferred psychological treatments in clinical research and practice, and compares them with clinician-reported outcomes, using rating scales that diagnose and measure therapeutic gains. Attention is given to one qualitative study of survivors of the London bombings as an example of patients' personal traumatic experiences. Understanding patients' views and their limitations can help increase success in trauma-focused therapy outcomes, particularly where patients fail to engage with or complete treatment, where they doubt the validity of the treatment, or do not see it as culturally appropriate, or fear of revisiting the past. Specific recommendations are made for a more collaborative approach with patients in psychiatric and community care and clinical research.

Desde el año 2000, la informacón de los patientes ha contribuido de manera significativa a la ampliación de los criterios diagnósticos para el trastorno por estrés postraumátic, especialmente con la inclusión de la amenaza compleja, repetida e indirecta para las personas que desarrollan los síntomas. Este artículo descríbe y explica por qué la información del paciente es importante, a través de los movímientos de usuarios de salud mental en todo el mundo y del movimiento de derechos humanos. Se consideran 46 estudios recientes sobre resultados percibidos por el paciente de tratamientos psícológicos preferidos en la ínvestígación y práctica clínica, y se los compara con resultados informados por el clínico, utilizando escalas de evaluación que diagnostican y miden beneficios terapéuticos. Se centra la atención en un estudio cualitativo de supervivientes de los bombardeos de Londres como un ejemplo de experiencía traumática personal de los patientes. La comprensión de las consideraciones de los patientes y sus limitaciones puede ayudar a incrementar el éxito en los resultados de la terapia focalizada en el trauma, especialmente cuando los patientes no se comprometen con el tratamiento o no lo concluyen, cuando dudan de la validez de él, o no lo consideran como culturalmente apropiado, o cuando temen re-exponerse al pasado. Se dan recomendaciones específícas para un enfoque más cooperativo con los patientes en cuidados psiquiátricos y comunitarios, y en investigación clíníca.

Depuis l'année 2000, les critères diagnostiques de l'état de stress post-traumatique ont été significativement élargis grâce aux données des patients, en particulier avec l'inclusion d'une menace complexe, répétée et indirecte des individus symptomatiques. Cet article décrit et explique pourquoi les patients rapportent les faits, au travers des mouvements mondiaux d'utilisateurs de la santé mentale et les mouvements des droits de l'homme. Il s'intéresse à 46 résultats récents, déclarés par les patients, de traitements psychologiques favoris en recherche et en pratique cliniques et les compare aux résultats déclarés par les médecins, par des échelles de cotation de diagnostic et de mesure des bénéfices thérapeutiques. Une étude qualitative sur les survivants du bombardement de Londres est prise comme exemple d'une expérience de traumatisme personnel. Comprendre le point de vue des patients et leurs limites augmente les chances de succès d'un traitement centré sur le traumatisme, surtout lorsque les patients ne prennent pas ou ne terminent pas le traitement, lorsqu'ils doutent de sa validité ou le pensent inadapté à leur culture ou bien ont peur de revisiter le passé. Une meilleure collaboration entre les patients psychiatriques, les soins de proximité et la recherche clinique fait l'objet de recommandations spécifiques.

Group music therapy for patients with persistent post-traumatic stress disorder--an exploratory randomized controlled trial with mixed methods evaluation.

OBJECTIVES: Not all patients with post-traumatic stress disorder (PTSD) respond to cognitive behavioural therapy (CBT). Literature suggests group music therapy might be beneficial in treating PTSD. However, feasibility and effectiveness have not been assessed. The study objectives were to assess whether group music therapy was feasible for patients who did not respond to CBT, and whether it has an effect on PTSD symptoms and depression. DESIGN: The study employed mixed methods comprising of an exploratory randomized controlled trial, qualitative content analysis of therapy, and patient interviews. METHOD: Patients with significant PTSD symptoms (n = 17) following completion of CBT were randomly assigned to treatment (n = 9) or control groups (n = 8). The treatment group received 10 weeks of group music therapy after which exit interviews were conducted. Control group patients were offered the intervention at the end of the study. Symptoms were assessed on the Impact of Events Scale-Revised and Beck Depression Inventory II at the beginning and end of treatment. RESULTS: Treatment-group patients experienced a significant reduction in severity of PTSD symptoms (-20.18; 95% confidence interval [CI]: [-31.23, -9.12]) and a marginally significant reduction in depression (-11.92; 95%CI: [-24.05, 0.21]) at 10 weeks from baseline compared to the control. Patients viewed music therapy as helpful and reported experiences concur with current literature. CONCLUSIONS: Group music therapy appears feasible and effective for PTSD patients who have not sufficiently responded to CBT. Limitations include the small sample size and lack of blinding. Further research should address these limitations, test sustainability, and identify specific factors that address symptoms in treatment.

An exploratory survey of mental health services for traumatized people in Bangladesh.

BACKGROUND: There is little published in the field of mental health services for traumatized people in Bangladesh. OBJECTIVE: To identify the existence of any services for people with psychological trauma and to describe how they work. METHOD: A telephone survey using a semi-structured interview was carried out in Summer 2008. Eight organisations were contacted, including two government agencies, two universities and four non-governmental agencies (NGOs). RESULTS: The survey identified eight services, seven of which were based in Dhaka. Three of the respondents provided services for children. Mental health interventions included selective serotonin re-uptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), counselling, together with medical, educational, legal and occupational support. CONCLUSIONS: There are services for traumatized people in Dhaka, but most of the rural population has limited access to them. Respondents acknowledged their training and development needs and the requirement to communicate more with each other. Future research is needed to address the efficacy of these services as well as the unmet necessities of the majority of the rural population of Bangladesh.

Training in the management of post-traumatic stress disorder in Uganda.

The aims of this study were to establish the feasibility and effectiveness of training Ugandan mental health workers in the management of post-traumatic stress disorder (PTSD) based on guidelines from the UK National Institute of Health and Clinical Excellence (NICE). The Butabika Link is a mental health partnership between the East London Foundation NHS Trust (ELFT) and Butabika National Psychiatric Referral Hospital, Kampala, Uganda, supported by the Tropical Health Education Trust (THET), and based on the recommendations of the Crisp report (Crisp, 2007). The Link has worked on the principle that the most effective partnership between high-income and low- or middle-income countries is through organisations already delivering healthcare, that is, through the support of existing services. Butabika Hospital is a centre of excel-. Butabika Hospital is a centre of excellence, serving an entire nation of 30 million people, many of them recovering from 20 years of armed conflict that took place mainly in the north of Uganda. In addition, Uganda has received refugees from conflicts in neighbouring states, including Congo, Rwanda, Kenya, Sudan and Burundi. The Ugandan Ministry of Health's Strategic Plan (2000) has prioritised post-conflict mental disorders and domestic violence, which is reflected in the vision of the Link's work.

Promoting mental health following the London bombings: a screen and treat approach.

Following the 2005 London bombings, a novel public health program was instituted to address the mental health needs of survivors. In this article, the authors describe the rationale for the program, characteristics of individuals assessed within the program, and preliminary outcome data. In addition to validated screening instruments and routine service usage data, standardized questionnaire outcome measures were collected. Seventy-one percent of individuals screened positive for a mental disorder. Of those receiving a more detailed clinical assessment, PTSD was the predominant diagnosis. Preliminary outcome data on 82 patients revealed large effect sizes for treatment comparable to those previously obtained in randomized controlled trials. The program succeeded in its aim of generating many more referrals of affected individuals than came through normal referral channels.

Subjective quality of life and posttraumatic stress disorder.

Subjective quality of life (SQOL) and its predictors were assessed in 117 patients with posttraumatic stress disorder (PTSD) in a specialized clinic. Scores were compared with other samples. PTSD patients had lower SQOL than the comparison groups. Higher levels of depression and anxiety, fewer PTSD avoidance symptoms, being older, and being from an ethnic minority were all independent predictors of lower SQOL. The high dissatisfaction with several social domains of life should be considered in treatment, and depressive and anxiety symptoms might be targeted to improve SQOL.