Outreach and screening following the 2005 London bombings: usage and outcomes

Abstract

BackgroundLittle is known about how to remedy the unmet mental health needs associated with major terrorist attacks, or what outcomes are achievable with evidence-based treatment. This article reports the usage, diagnoses and outcomes associated with the 2-year Trauma Response Programme (TRP) for those affected by the 2005 London bombings.MethodFollowing a systematic and coordinated programme of outreach, the contact details of 910 people were obtained by the TRP. Of these, 596 completed a screening instrument that included the Trauma Screening Questionnaire (TSQ) and items assessing other negative responses. Those scoring ⩾6 on the TSQ, or endorsing other negative responses, received a detailed clinical assessment. Individuals judged to need treatment (n=217) received trauma-focused cognitive-behaviour therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR). Symptom levels were assessed pre- and post-treatment with validated self-report measures of post-traumatic stress disorder (PTSD) and depression, and 66 were followed up at 1 year.ResultsCase finding relied primarily on outreach rather than standard referral pathways such as primary care. The effect sizes achieved for treatment of DSM-IV PTSD exceeded those usually found in randomized controlled trials (RCTs) and gains were well maintained an average of 1 year later.ConclusionsOutreach with screening, linked to the provision of evidence-based treatment, seems to be a viable method of identifying and meeting mental health needs following a terrorist attack. Given the failure of normal care pathways, it is a potentially important approach that merits further evaluation.

Modelo de tamizaje, atención y monitoreo de la salud mental para adultos en casos de desastre

“…1,3,7,[12][13][14][15][16][17][18][19][20] Algunas de las principales competencias recomendadas para situaciones de desastre son: a) evaluación de sintomatología e identificación de casos; b) desarrollo de habilidades de intervención en crisis a nivel individual y grupal, y c) planeación e implementación de una iniciativa integrada, con múltiples fases y componentes para el tratamiento de salud mental en situaciones de emergencia. 1,16 Parte de la sustentabilidad de los modelos de intervención es su capacidad de ser escalables.…”

“…Esto tiene el objetivo de optimizar recursos, disminuir tiempos de espera y proporcionar intervenciones adecuadas a distintos problemas. 12,20,[23][24][25] Para facilitar el manejo ético de la información obtenida, se recomienda asegurar la confidencialidad de los usuarios y promover un manejo sustentable y responsable de datos. Se recomienda designar a instituciones educativas o de salud pública la elaboración de una base de datos clara, segura y eficiente, la cual resultará extremadamente útil para: a) mantener un control de referencias y agilizar transiciones; b) monitorear resultados; c) informar investigaciones para la mejora del modelo, y d) apoyar con la divulgación científica.…”

Does posttraumatic stress predict frequency of general practitioner visits in parents of terrorism survivors? A longitudinal study

“…Unmet healthcare needs are repeatedly reported following disasters (Brewin et al, 2010). A number of factors have been identified as barriers to post-disaster access to healthcare, including factors within the individuals in need (internal factors), as well as characteristics of the healthcare services or the community at large (external factors) (Kantor, Knefel, & Lueger-Schuster, 2016).…”

Impact of the Boston Marathon Bombing and Its Aftermath on Refugees and Survivors of Torture

“…The world watched the aftermath as the city was challenged to come together showing its resilience (''Boston Strong''). Acts of terrorism are known to trigger posttraumatic stress disorder (PTSD) and the exacerbation of mental health symptoms in populations who have previously suffered trauma [1][2][3][4]. Survivors of terrorist attacks often report substantial stress, perceived threat to self, and reductions in travel [5].…”

“…Many studies call for mental health outreach and screening for symptoms following terrorist attacks [1]. Some research examines the effects of continuous traumatic stress.…”