Patients' Experiences of Using an eHealth Pain Management Intervention Combined With Psychomotor Physiotherapy: Qualitative Study.

BACKGROUND: Chronic pain is a major health challenge to those affected. Blended care with psychomotor physiotherapy (PMP) combined with eHealth self-management might be beneficial. OBJECTIVE: This study aims to explore how patients with chronic pain experience the combination of PMP and the use of EPIO, an eHealth self-management intervention for chronic pain. METHODS: Individual semistructured interviews were conducted with 5 adult patients with chronic pain (ie, participants) who used EPIO in combination with PMP over a period of 10 to 15 weeks. Interviews explored participants' experiences using this treatment combination in relation to their pain and analyzed their experiences using systematic text condensation. RESULTS: Participants described having benefited from using EPIO in combination with PMP in terms of increased awareness of bodily signals and how pain was related to stress and activity. They also described changes in the relationship to themselves in terms of increased self-acceptance, self-assertion, and hope and their relationship to their pain in terms of seeing pain as less harmful and engaging in more active coping strategies. CONCLUSIONS: Results indicate that a blended care approach combining eHealth self-management interventions such as EPIO with PMP may be of value to patients living with chronic pain. TRIAL REGISTRATION: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104.

The Relationship Between Perceived Social Support and PTSD Symptoms After Exposure to Physical Assault: An 8 Years Longitudinal Study.

Consequences of nondomestic violence are known to be multifaceted with high rates of emotional and psychological problems in addition to physical injuries, and victims report many trauma related symptoms. This study explore if perceived social support (PSS) (Social Provisions Scale [SPS]) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale [IES-22]) are interrelated among adult victims at four assessment points up until eight years after the exposure to physical assault; soon after the event (T1), three months after T1 (T2), one year after T1 (T3), and eight years after T1 (T4). One hundred and forty-three subjects participated at T1, 94 at T2, 73 at T3, and 47 accepted a follow-up at T4. At T1, 138 of 143 completed the questionnaires within 16 weeks after the incident. PTSD symptoms were highly correlated across time (p < .001); PSS were significantly correlated only between T1 and T2 (p < .001), T1 and T3 (p < .05), and between T2 and T3 (p < .05). Cross-lagged analyses showed an inverse relationship between prior PSS and later PTSD symptoms across all time points (ps < .05); not proved between prior PTSD symptoms and later PSS (ps > .1). PSS at T1 was an independent predictor of PSS one year and eight years after the incident. We conclude that higher perception of social support protects against the development of PTSD symptoms; diminished perception of social support increases the risk of developing PTSD symptoms. These findings suggest that PSS after experiencing a violent assault should be considered as an important factor in natural recovery in the long run, as well as essential alongside psychiatric treatment. Establishing psychosocial interventions for victims of physical violence in the acute phase may prevent prolonged trauma reactions.

Prior adversities predict posttraumatic stress reactions in adolescents following the Oslo Terror events 2011.

BACKGROUND: Former studies suggest that prior exposure to adverse experiences such as violence or sexual abuse increases vulnerability to posttraumatic stress reactions in victims of subsequent trauma. However, little is known about how such a history affects responses to terror in the general adolescent population. OBJECTIVE: To explore the role of prior exposure to adverse experiences as risk factors for posttraumatic stress reactions to the Oslo Terror events. METHOD: We used data from 10,220 high school students in a large cross-sectional survey of adolescents in Norway that took place seven months after the Oslo Terror events. Prior exposure assessed was: direct exposure to violence, witnessing of violence, and unwanted sexual acts. We explored how these prior adversities interact with well-established risk factors such as proximity to the events, perceived life threat during the terror events, and gender. RESULTS: All types of prior exposure as well as the other risk factors were associated with terror-related posttraumatic stress reactions. The effects of prior adversities were, although small, independent of adolescents' proximity to the terror events. Among prior adversities, only the effect of direct exposure to violence was moderated by perceived life threat. Exposure to prior adversities increased the risk of posttraumatic stress reactions equally for both genders, but proximity to the terror events and perceived life threat increased the risk more in females. CONCLUSIONS: Terror events can have a more destabilizing impact on victims of prior adversities, independent of their level of exposure. The findings may be relevant to mental health workers and others providing post-trauma health care.

Posttraumatic responses to the July 22, 2011 Oslo Terror among Norwegian high school students.

The July 22, 2011, Oslo Terror was defined as a national disaster. Former studies on terror attacks and mass shootings have shown elevated levels of posttraumatic complaints both in direct victims and in general populations. Little is known about how such extreme events in a generally safe society such as Norway would affect an adolescent population. This study examines posttraumatic stress reactions and changes in worldview in relationship to risk factors among 10,220 high school students using data from the ung@hordaland survey. One out of 5 respondents knew someone directly exposed, 55.7% experienced the events to some extent as threatening to their own or their close ones' lives, and 79.9% reported their worldview to be changed. For posttraumatic stress disorder (PTSD) DSM IV criteria, 0.8% reported substantial symptoms of reexperiencing (Criterion B), 4.9% of avoidance (Criterion C), and 1.1% of hyperarousal (Criterion D). Greater personal proximity to the events, higher levels of perceived life threat, and being a female or an immigrant predicted higher levels of PTSD symptom distress. Results indicate that the terror events made a deep impression on Norwegian adolescents, but without causing markedly elevated levels of PTSD symptomatology in the general young population.

Prevalence, comorbidity and stability of post-traumatic stress disorder and anxiety and depression symptoms after exposure to physical assault: an 8-year prospective longitudinal study.

BACKGROUND: There is a lack of prospective longitudinal studies focusing specifically on the victims exposed to physical violence by a perpetrator other than a family member. AIMS: To assess the prevalence and comorbidity of post-traumatic stress disorder (PTSD) and anxiety and depression symptoms and the stability of symptoms, in a population of victims of non-domestic physical violence through 8 years. METHOD: This study had a single group longitudinal design with four repeated measures-the first as soon as possible after the exposure (n = 143 at T1), the second 3 months later (n = 94 at T2), the third after 1 year (n = 73 at T3) and the fourth after 8 years (n = 47 at T4). Questionnaires used were Impact of Event Scale-15 and 22 (IES-15 and 22), Post Traumatic Symptom Scale-10 (PTSS-10) and the Hopkins Symptoms Check List (HSCL-25). RESULTS: Probable PTSD cases measured with IES-15 were 33.6% at T1, 30.9 at T2, 30.1% at T3 (12 months) and 19.1% at T4 (8 years), while probable anxiety and depression cases measured with HSCL-25 were 42.3% at T1, 35.5% at T2, 35.6% at T3 and 23.4% at T4. The estimated probability of recovery from PTSD symptoms during the 8 years is 52%, whereas the corresponding finding concerning anxiety and depression is 43%. CONCLUSION: The consequences of exposure to physical assault by strangers need to be given more attention as a severe risk of chronic mental health problems.

Post-disaster psychosocial services across Europe: the TENTS project.

At present post-disaster activities and plans seem to vary widely. An adequate estimation of the availability of post-disaster psychosocial services across Europe is needed in order to compare them with recently developed evidence-informed psychosocial care guidelines. Here we report on the results of a cross-sectional web-based survey completed in 2008 by two hundred and eighty-six representatives of organizations involved in psychosocial responses to trauma and disaster from thirty-three different countries across Europe. The survey addressed planning and delivery of psychosocial care after disaster, methods of screening and diagnosis, types of interventions used, and other aspects of psychosocial care after trauma. The findings showed that planning and delivery of psychosocial care was inconsistent across Europe. Countries in East Europe seemed to have less central coordination of the post-disaster psychosocial response and fewer post-disaster guidelines that were integrated into specific disaster or contingency plans. Several forms of psychological debriefing, for which there is no evidence of efficacy to date, were still used in several areas particularly in North Europe. East European countries delivered evidence-based interventions for PTSD less frequently, whilst in South- and South-Eastern European countries anxiety suppressing medication such as benzodiazepines were prescribed more frequently to disaster victims than in other areas. Countries across Europe are currently providing sub-optimal psychosocial care for disaster victims. This short report shows that there is an urgent need for some countries to abandon non-effective interventions and others to develop more evidence based and effective services to facilitate the care of those involved in future disasters.

Using a Delphi process to develop an effective train-the-trainers program to train health and social care professionals throughout Europe.

Research has shown that developing a Train-the-Trainers (TTT) program is important if agencies are to implement guidelines, but the most effective way to deliver a TTT program remains unanswered. This article presents data from a 3-round Internet-based Delphi process, which was used to help develop consensus-based guidelines for a TTT programme to deliver to health and social care professionals throughout Europe a curriculum on traumatic stress. In Round 1, 74 experts rated the importance of statements relating to the TTT field and then reassessed their scores in the light of others' responses in subsequent rounds. Forty-one (67%) of 61 statements achieved consensus (defined as having a mean score >7 or < 3 on the 0-9 rating scales used and 70% of participants scoring 7 and above or 3 and below) for inclusion. Key TTT components included interactive and practical presentations, delivery to groups of 7-12 people over 2 days, external and local expert facilitation, course manuals, refresher courses, and supervision. The Delphi process allowed a consensus to be achieved in an area in which there are limitations in the current evidence.

TENTS guidelines: development of post-disaster psychosocial care guidelines through a Delphi process.

BACKGROUND: How best to plan and provide psychosocial care following disasters remains keenly debated. AIMS: To develop evidence-informed post-disaster psychosocial management guidelines. METHOD: A three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others' responses in the subsequent rounds. RESULTS: A total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement 'all responses should provide access to pharmacological assessment and management' did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cognitive-behavioural therapy (CBT) is recommended for acute stress disorder or acute post-traumatic stress disorder, with other treatments with an evidence base for chronic post-traumatic stress disorder being made available if trauma-focused CBT is not tolerated. CONCLUSIONS: The Delphi process allowed a consensus to be achieved in an area where there are limitations to the current evidence.

Coping with loss and bereavement in post-war Tigray, Ethiopia.

Drawing upon data collected through in-depth interviews with 20 victims of the Ethio-Eritrean war, this article addresses how psychosocial impacts of political violence are coped with in a Tigrayan context in northern Ethiopia. Qualitative procedures of condensation and categorization of interview texts revealed that informants presented three kinds of coping strategies, all aimed at avoiding indulging in sorrow: (1) diverted thinking, (2) distraction, and (3) future investment. As their main rationale for employing such coping strategies, informants reported the belief that grieving and crying would have negative impacts on their health, their household, and on their relationship with God. This belief is discussed in terms of how it is informed by sociocultural discourses of the Tigrayan community in general, and discourses of the Ethiopian Orthodox Church in particular. Some implications concerning the mismatch between the western trauma discourse and local discourses for psychosocial coping are discussed.

Discourses of loss and bereavement in Tigray, Ethiopia.

Western trauma frameworks, such as PTSD-focused inventories and interventions, are embedded in a psychosocial discourse saying that highly distressing experiences must be expressed and confronted. This study, which is based on six months of focused ethnographic research in postwar Tigray, Ethiopia, reveals authoritative Tigrayan discourses that encourage people to avoid disclosing and expressing emotional pain. Dogmas of the Ethiopian Orthodox Church, saying that grieving and crying would have negative physical and spiritual consequences, were found to have a broad consensus in the society. The ethnography suggests that the Tigrayan psychosocial discourses make sense and may be functional in their context, as the marginal socioeconomic conditions of Tigray force individuals to concentrate on their day-to-day struggle for survival. Findings are discussed in terms of implications for the cross-cultural applicability of conventional frameworks of Western trauma psychology.

Beyond PTSD: Socio-economic Bereavement in Tigray, Ethiopia.

By drawing upon data collected through in-depth interviews with 20 victims of the Ethio-Eritrean war, this paper addresses how psychosocial consequences of political war are expressed and conceptualized by people from Tigray, Ethiopia. War events were typically described in terms of their negative impacts on the household's means for income generation, and psychosocial complaints centred on aspects of impaired post-war economy rather than on politically violent experiences. The most reported complaints were (a) household erosion complaints, (b) social marginalization complaints and (c) education abortion complaints. Post-war psychosocial health problems were perceived as consequences of these aspects of impaired household economy, and were described in terms of their negative impacts on future income generation. Informants' expressions of distress were found to be highly informed by the socio-cultural and socio-economic structures of the Tigrayan society. Being the only study of its kind from this context, the study provides a unique illustration of the limitations of western trauma measures and calls for a context-based conceptualization of trauma.

Predictors of psychosocial distress after suicide, SIDS and accidents.

This article compares the outcome and predictors of psychosocial distress of parents bereaved by young suicides, sudden infant death syndrome (SIDS), and child accidents. One objective is to explore whether suicide bereavement is more difficult for those left behind than other forms of bereavement. Data have been collected from 140 families, consisting of 232 parents, by the use of the Impact of Event Scale, the General Health Questionnaire, and the Inventory of Traumatic Grief. Qualitative aspects of bereavement are assessed by in-depth interviews with family members from 40 families. The results show that the similarities between the samples on outcome and predictors are more striking than the differences, which is explained by the common traumatic aspect of unexpected and violent deaths. One and a half years post-loss, 57-78% of the survivors scored above the cut-off levels for traumatic grief reactions. Although no significant differences are found between survivors of suicide and accidents, both groups evidence significantly greater subjective distress than the survivors of SIDS. Self-isolation is by far the best predictor of psychosocial distress in all three samples. Rather than focusing on the exceptional position of suicide survivors, it seems important to call attention to sudden and traumatic death in general as a factor to be associated with post-traumatic reactions and complicated mourning.