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A Randomized Controlled Trial of a Brief Intervention for Delayed Psychological Effects in Snakebite Victims

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Wijesinghe, Chamara A., Williams, Shehan S., Kasturiratne, Anuradhani, Dolawaththa, Nishantha, Wimalaratne, Piyal, Wijewickrema, Buddhika, Jayamanne, Shaluka F., Isbister, Geoffrey K., Dawson, Andrew H., Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200 and de Silva, H. Janaka (2015) 'A Randomized Controlled Trial of a Brief Intervention for Delayed Psychological Effects in Snakebite Victims'. PLoS Neglected Tropical Diseases, Vol 9, Issue 8, e0003989.

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Abstract

Background

Snakebite results in delayed psychological morbidity and negative psycho-social impact. However, psychological support is rarely provided to victims.

Aim

To assess the effectiveness of a brief intervention which can be provided by non-specialist doctors aimed at reducing psychological morbidity following snakebite envenoming.

Method

In a single blind, randomized controlled trial, snakebite victims with systemic envenoming [n = 225, 168 males, mean age 42.1 (SD 12.4) years] were randomized into three arms. One arm received no intervention (n = 68, Group A), the second received psychological first aid and psychoeducation (dispelling prevalent cultural beliefs related to snakebite which promote development of a sick role) at discharge from hospital (n = 65, Group B), while the third received psychological first aid and psychoeducation at discharge and a second intervention one month later based on cognitive behavioural principles (n = 69, Group C). All patients were assessed six months after hospital discharge for the presence of psychological symptoms and level of functioning using standardized tools.

Results

At six months, there was a decreasing trend in the proportion of patients who were positive for psychiatric symptoms of depression and anxiety from Group A through Group B to Group C (Chi square test for trend = 7.901, p = 0.005). This was mainly due to a decreasing trend for symptoms of anxiety (chi-square for trend = 11.256, p = 0.001). There was also decreasing trend in the overall prevalence of disability from Group A through Group B to Group C (chi square for trend = 7.551, p = 0.006), predominantly in relation to disability in family life (p = 0.006) and social life (p = 0.005). However, there was no difference in the proportion of patients diagnosed with depression between the three groups (chi square for trend = 0.391, p = 0.532), and the intervention also had no effect on post-traumatic stress disorder.

Conclusions

A brief psychological intervention, which included psychological first aid and psychoeducation plus cognitive behavioural therapy that can be provided by non-specialist doctors appeared to reduce psychiatric symptoms and disability after snakebite envenoming, but not depression or post-traumatic stress disorder.

Item Type: Article
Subjects: WA Public Health > Health Administration and Organization > WA 590 Health education, Health communication
WD Disorders of Systemic, Metabolic or Environmental Origin, etc > Animal Poisons > WD 410 Reptiles
WM Psychiatry > WM 20 Research (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pntd.0003989
Depositing User: Lynn Roberts-Maloney
Date Deposited: 15 Oct 2015 09:43
Last Modified: 06 Feb 2018 13:10
URI: http://archive.lstmed.ac.uk/id/eprint/5353

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