Psychological sequelae following the Gulf War. Factors associated with subsequent morbidity and the effectiveness of psychological debriefing.
TL;DR: Findings show that a psychological debriefing following a series of traumatic events or experiences does not appear to reduce subsequent psychiatric morbidity and highlights the need for further research in military and civilian settings.
Abstract: Background The aim was to study the effect of brief counselling and psychological debriefing following a trauma on subsequent morbidity. Method We investigated psychological morbidity in 62 British soldiers whose duties included the handling and identification of dead bodies of allied and enemy soldiers during the Gulf War. Of these soldiers, 69% received a psychological debriefing on completion of their duties. The subjects completed by post a demographic questionnaire, the General Health Questionnaire (GHQ-28) and the Impact of Events Scale. Results After nine months 50% had evidence of some psychological disturbance suggestive of posttraumatic stress disorder (PTSD); 18% had sought professional help; 26% reported relationship difficulties. Neither prior training nor the psychological intervention appeared to make any difference to subsequent psychiatric morbidity. Morbidity at nine months was more likely in those with a history of psychological problems and those who believed their lives had been in danger in the Gulf. Conclusions These findings show that a psychological debriefing following a series of traumatic events or experiences does not appear to reduce subsequent psychiatric morbidity and highlights the need for further research in military and civilian settings.
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TL;DR: There is no current evidence that psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents.
Abstract: BACKGROUND:
Over approximately the last last fifteen years early psychological interventions such as psychological 'debriefing' have been increasingly used to treat psychological trauma. While these intervention have become popular and their use spread to several settings - efficacy had largely not been tested empirically. In 1997 a systematic review of single session psychological "debriefing" was undertaken and this subsequently became a protocol and Cochrane Review published in 1998 (Issue2). This update forms the first substantive update of the original review.
OBJECTIVES:
To assess the effectiveness of brief psychological debriefing for the management of psychological distress after trauma, and the prevention of post traumatic stress disorder.
SEARCH STRATEGY:
Electronic searching of MEDLINE, EMBASE, PsychLit, PILOTS, Biosis, Pascal, Occ. Safety and Health,SOCIOFILE, CINAHL, PSYCINFO, PSYNDEX, SIGLE, LILACS, CCTR, CINAHL, NRR, Hand search of Journal of Traumatic Stress. Contact with leading researchers.
SELECTION CRITERIA:
The inclusion criteria for all randomized studies was that they should focus on persons recently (one month or less) exposed to a traumatic event, should consist of a single session only, and that the intervention involve some form of emotional processing/ventilation by encouraging recollection/reworking of the traumatic event accompanied by normalisation of emotional reaction to the event.
DATA COLLECTION AND ANALYSIS:
11 trials fulfilled the inclusion criteria. Quality was generally poor. Data from two trials could not be synthesised. Two trials involved the use of the intervention in an obstetric setting.
MAIN RESULTS:
Single session individual debriefing did not reduce psychological distress nor prevent the onset of post traumatic stress disorder (PTSD). Those who received the intervention showed no significant short term (3-5 months) in the risk of PTSD (odds ratio 1.22 (95% ci 0.60 to 2.46 )). At one year one trial reported that there was a significantly increased risk of PTSD in those receiving debriefing (odds ratio 2.88 (1.11 to 7.53))odds ratio 95%). There was also no evidence that debriefing reduced general psychological morbidity, depression or anxiety.
REVIEWER'S CONCLUSIONS:
There is no current evidence that psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease.
1,075 citations
TL;DR: In this article, a review identifies the core issues in early intervention that need to be addressed in resolving the debate over debriefing and cognitive-behavioral therapy (CBT).
Abstract: Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.
422 citations
Cites result from "Psychological sequelae following th..."
...PD in the Deahl et al. (2000) study are similar to those of...
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TL;DR: In this article, the authors examined the generalizability of the phenomenon across various research procedures that overcome the limits of previous studies, and examined the role of the intensity of the emotion and its relation with extent of social sharing.
Abstract: Rime et af. (1992) showed that most emotional experiences are shared with others shortly after they occurred. They proposed that social sharing represents an integral part of emotional experiences. The present chapter examines the generalizability of the phenomenon across various research procedures that overcome the limits of previous studies. Existing findings are extended to chil- dren and older populations, and individual and cultural differences are consid- ered. Furthermore, the role of the intensity of the emotion and its relation with extent of social sharing is investigated. The chapter then addresses the contribu- tion of social sharing to emotional recovery. Given that findings were generally not consistent with the view that sharing alleviates the memory of the shared emotional experience, the chapter discusses alternative potential effects and functions of social sharing.
418 citations
TL;DR: It is concluded that it is difficult to use pre-treatment variables as a powerful and reliable tool for predicting treatment outcome or dropout, and it is argued that exclusion of PTSD-patients from prolonged exposure treatment on the basis of pre- treatment characteristics is not justified.
350 citations
TL;DR: Considering the large populations of civilians that experience the trauma of war, it is timely to review existing literature, summarize approaches for helping war-affected children, and suggest future directions for research and policy.
Abstract: The atrocities of war have detrimental effects on the development and mental health of children that have been documented since World War II. To date, a considerable amount of knowledge about various aspects of this problem has been accumulated, including the ways in which trauma impacts child mental health and development, as well as intervention techniques, and prevention methods. Considering the large populations of civilians that experience the trauma of war, it is timely to review existing literature, summarize approaches for helping war-affected children, and suggest future directions for research and policy.
330 citations
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TL;DR: A scale of current subjective distress, related to a specific event, was based on a list of items composed of commonly reported experiences of intrusion and avoidance, and responses indicated that the scale had a useful degree of significance and homogeneity.
Abstract: Clinical, field, and experimental studies of response to potentially stressful life events give concordant findings: there is a general human tendency to undergo episodes of intrusive thinking and periods of avoidance. A scale of current subjective distress, related to a specific event, was based on a list of items composed of commonly reported experiences of intrusion and avoidance. Responses of 66 persons admitted to an outpatient clinic for the treatment of stress response syndromes indicated that the scale had a useful degree of significance and homogeneity. Empirical clusters supported the concept of subscores for intrusions and avoidance responses.
7,692 citations
TL;DR: In this article, a shorter, 28-item General Health Questionnaire (GHQ) consisting of four subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression was proposed.
Abstract: This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.
4,485 citations
Journal Article•
TL;DR: The factor structure of the symptomatology of the General Health Questionnaire when it is completed in a primary care setting is found to be very similar for 3 independent sets of data.
Abstract: This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.
4,434 citations
TL;DR: Findings on the epidemiology of post-traumatic stress disorder in 2493 participants examined as part of a nationwide general-population survey of psychiatric disorders show Behavioral problems before the age of 15 predicted adult exposure to physical attack and (among Vietnam veterans) to combat, as well as the development ofPost- traumatic stress disorder among those so exposed.
Abstract: There have been numerous studies of post-traumatic stress disorder in trauma victims, war veterans, and residents of communities exposed to disaster. Epidemiologic studies of this syndrome in the general population are rare but add an important perspective to our understanding of it. We report findings on the epidemiology of post-traumatic stress disorder in 2493 participants examined as part of a nationwide general-population survey of psychiatric disorders. The prevalence of a history of post-traumatic stress disorder was 1 percent in the total population, about 3.5 percent in civilians exposed to physical attack and in Vietnam veterans who were not wounded, and 20 percent in veterans wounded in Vietnam. Post-traumatic stress disorder was associated with a variety of other adult psychiatric disorders. Behavioral problems before the age of 15 predicted adult exposure to physical attack and (among Vietnam veterans) to combat, as well as the development of post-traumatic stress disorder among those so exposed. Although some symptoms of post-traumatic stress disorder, such as hyperalertness and sleep disturbances, occurred commonly in the general population, the full syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, third edition, was common only among veterans wounded in Vietnam.
1,144 citations
Journal Article•
TL;DR: The Critical Incident Stress Debriefing is a simple, but effective tool to help the emergency worker cope with what he has seen, and continue a productive career with minimal long-term effects.
Abstract: Major disasters over the past five years have brought attention to the fact that rescue workers themselves can become psychological casualties from the overwhelming carnage and suffeng they witness. The Critical Incident Stress Debriefing is a simple, but effective tool to help the emergency worker cope with what he has seen, and continue a productive career with minimal long-term effects
795 citations
"Psychological sequelae following th..." refers background in this paper
...It is widely believed that brief counseffing and psychological or ‘¿ criticalncident' debriefing (PD) following a trauma reduce subsequent morbidity (Mitchell, 1983; Dyregov, 1989)....
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