Psychosocial Interventions After Crises and Accidents [Internet]

Excerpt

The purpose of this health technology assessment was to evaluate the preventive effects of psychosocial interventions delivered within one year following accidents and crises, on trauma-related psychological disorders, functional impairments and behaviour problems. The assessment was commissioned by the Directorate for Social and Health Affairs in September 2004.

We searched international scientific databases, selected studies according to preset criteria, appraised the methodolical quality using checklists, and summarised the results narratively, in tables and in meta-analyses.

We included 10 systematic reviews, 29 randomised controlled trials (RCTs) and 10 non-randomised effect evaluations. The systematic reviews and the nonrandomised studies were accounted for only, while we performed more thorough analyses of the RCTs.

The 29 RCTs were published in 34 different articles. Interventions were:

1. Psychological debriefing (PD) delivered in one or two sessions less than 3 weeks after trauma (7 studies)

2. Other one- or two-session interventions, such as information, practical assistance and memory structuring therapy (4 studies)

3. Cognitive behaviour therapy (CBT) delivered in 4-14 sessions less than 6 months after trauma (9 studies)

4. Other multiple-session interventions, such as group interventions, counselling programs and individual support (4 studies)

5. Pharmacological interventions (2 studies)

6. Interventions for traumatised children (3 studies)

Meta-analyses showed that there was no effect of PD compared to no intervention. The outcomes were posttraumatic stress disorder (PTSD), posttraumatic stress symptoms, anxity and depression after 3-6 months and 1-3 years. Meta-analyses also showed that CBT was effective, both in comparison with no intervention and with other interventions. Relative risk for a PTSD diagnosis for CBT versus other interventions was 0.54 after 3-6 months, 0.38 after 9 months and 0.25 after 3-4 years.

Conclusions:

1. Cognitive behaviour therapy for 4 weeks or more may prevent traumarelated psychological disorders

2. There is no evidence of preventive effects of psychological debriefing

3. There is not sufficient research evidence on other types of interventions to conclude about effects.

Keywords: Crisis Intervention; Accidents; Psychological Trauma; Psychosocial interventions.