Psychological debriefing for road traffic accident victims. Three-year follow-up of a randomised controlled trial.
BACKGROUND: Psychological debriefing is widely used for trauma victims but there is uncertainty about its efficacy. We have previously reported a randomised controlled trial which concluded that at 4 months it was ineffective. AIMS: To evaluate the 3-year outcome in a randomised controlled trial of debriefing for consecutive subjects admitted to hospital following a road traffic accident. METHOD: Patients were assessed in hospital by the Impact of Event Scale (IES), Brief Symptom Inventory (BSI) and questionnaire and re-assessed at 3 months and 3 years. The intervention was psychological debriefing as recommended and described in the literature. RESULTS: The intervention group had a significantly worse outcome at 3 years in terms of general psychiatric symptoms (BSI), travel anxiety when being a passenger, pain, physical problems, overall level of functioning, and financial problems. Patients who initially had high intrusion and avoidance symptoms (IES) remained symptomatic if they had received the intervention, but recovered if they did not receive the intervention. CONCLUSIONS: Psychological debriefing is ineffective and has adverse long-term effects. It is not an appropriate treatment for trauma victims. (+info)
Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth.
OBJECTIVE: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. DESIGN: Randomised controlled trial. SETTING: Large maternity teaching hospital in Melbourne, Australia. PARTICIPANTS: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). MAIN OUTCOME MEASURES: Maternal depression (score >/=13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. RESULTS: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1. 37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= -2.31, 95% confidence interval -10.48 to -0.84). CONCLUSIONS: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded. (+info)
A special courage: dealing with the Paddington rail crash.
Supporting traumatized employees requires special skills and techniques if it is to be effective. Unfortunately, there is little to inform or guide organizations on how this should be achieved. The present controversy over the use of trauma management systems and debriefing has not been helpful in informing organizations on the best way to take care of employees who become traumatized during the course of their work. This paper looks at how Sainsbury's Supermarkets Ltd managed traumatization through the activation of its Violence at Work policy and procedures, and finally presents the results of an evaluation exercise that was undertaken following the Paddington rail crash. (+info)
Effects of a coping intervention on patients with rheumatic diseases: results of a randomized controlled trial.
OBJECTIVE: To test the effects (on coping, social interactions, loneliness, functional health status, and life satisfaction) of an intervention aimed at teaching people with rheumatic diseases to cope actively with their problems. METHODS: A total of 168 patients with chronic rheumatic disorders affecting the joints were randomly assigned to a coping intervention group, a mutual support control group, or a waiting list control group. Measurements were by self-report questionnaires. RESULTS: Post-intervention measurements showed that the coping intervention increased action-directed coping and functional health status, but these effects did not persist up to 6-months followup. In patients who attended at least half of the 10 sessions, the coping intervention contributed to decreased loneliness at post-intervention and to improvements in social interactions and life satisfaction at 6-months followup. CONCLUSION: Teaching patients with rheumatic diseases to cope actively with their problems had positive impacts. Consequently it is recommended that the coping intervention be incorporated into regular care. Maintenance sessions are advisable. (+info)
The World Trade Center attack. Lessons for all aspects of health care.
The attack on the World Trade Center had the potential to overwhelm New York's health services. Sadly, however, the predicted thousands of treatable patients failed to materialize. Horror and sadness has now been replaced by anger, fear, and the determination to be better prepared next time. This determination not only exists in politics but also in health care, and as with all attempts to enforce change there needs to be a period of collecting opinions and data. This article introduces nine reviews in Critical Care offering varied health care perspectives of the events of 11 September 2001 from people who were there and from experts in disaster management. (+info)
The World Trade Center attack. Helping the helpers: the role of critical incident stress management.
Healthcare and prehospital workers involved in disaster response are susceptible to a variety of stress-related psychological and physical sequelae. Critical incident stress management, of which critical incident stress debriefing is a component, can mitigate the response to these stressors. Critical incident stress debriefing is a peer-driven, therapist-guided, structured, group intervention designed to accelerate the recovery of personnel. The attack on the World Trade Center, and the impact it may have on rescue, prehospital, and healthcare workers, should urge us to incorporate critical incident stress management into disaster management plans. (+info)
The World Trade Center attack. Lessons for disaster management.
As the largest, and one of the most eclectic, urban center in the United States, New York City felt the need to develop an Office of Emergency Management to coordinate communications and direct resources in the event of a mass disaster. Practice drills were then carried out to assess and improve disaster preparedness. The day of 11 September 2001 began with the unimaginable. As events unfolded, previous plans based on drills were found not to address the unique issues faced and new plans rapidly evolved out of necessity. Heroic actions were commonplace. Much can be learned from the events of 11 September 2001. Natural and unnatural disasters will happen again, so it is critical that these lessons be learned. Proper preparation will undoubtedly save lives and resources. (+info)
Telephone intervention with family caregivers of stroke survivors after rehabilitation.
BACKGROUND AND PURPOSE: Social problem-solving therapy shows promise as an intervention to improve the well-being of family caregivers. There is some evidence that training in problem solving may be effectively delivered by telephone. The purpose of this study was to quantify the impact of social problem-solving telephone partnerships on primary family caregiver outcomes after stroke survivors are discharged home from a rehabilitation facility. METHODS: Using a randomized 3-group repeated-measures experimental design, 74 stroke survivors with an admitting diagnosis of ischemic stroke and their primary family caregivers were entered into the study. The intervention consisted of an initial 3-hour home visit between a trained nurse and the family caregiver within 1 week after discharge to begin problem-solving skill training. This initial session was followed by weekly (the first month) and biweekly (the second and third month) telephone contacts. RESULTS: Compared with the sham intervention and control groups, family caregivers who participated in the social problem-solving telephone partnership intervention group had better problem-solving skills; greater caregiver preparedness; less depression; and significant improvement in measures of vitality, social functioning, mental health, and role limitations related to emotional problems. There were no significant differences among the groups in caregiver burden. Satisfaction with healthcare services decreased over time in the control group while remaining comparable in the intervention and sham intervention groups. CONCLUSION: These results indicate that problem-solving training may be useful for family caregivers of stroke survivors after discharge from rehabilitative facilities. (+info)