Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: randomised controlled trial.
نویسندگان
چکیده
OBJECTIVE To evaluate the effectiveness of cognitive therapy for post-traumatic stress disorder related to terrorism and other civil conflict in Northern Ireland. DESIGN Randomised controlled trial. SETTING Community treatment centre, Northern Ireland. PARTICIPANTS 58 consecutive patients with chronic post-traumatic stress disorder (median 5.2 years, range 3 months to 32 years) mostly resulting from multiple traumas linked to terrorism and other civil conflict. INTERVENTIONS Immediate cognitive therapy compared with a waiting list control condition for 12 weeks followed by treatment. Treatment comprised a mean of 5.9 sessions during 12 weeks and 2.0 sessions thereafter. MAIN OUTCOME MEASURES Primary outcome measures were patients' scores for post-traumatic stress disorder (post-traumatic stress diagnostic scale) and depression (Beck depression inventory). The secondary outcome measure was scores for occupational and social functioning (work related disability, social disability, and family related disability) on the Sheehan disability scale. RESULTS At 12 weeks after randomisation, immediate cognitive therapy was associated with significantly greater improvement than the waiting list control group in the symptoms of post-traumatic stress disorder (mean difference 9.6, 95% confidence interval 3.6 to 15.6), depression (mean difference 10.1, 4.8 to 15.3), and self reported occupational and social functioning (mean difference 1.3, 0.3 to 2.5). Effect sizes from before to after treatment were large: post-traumatic stress disorder 1.25, depression 1.05, and occupational and social functioning 1.17. No change was observed in the control group. CONCLUSION Cognitive therapy is an effective treatment for post-traumatic stress disorder related to terrorism and other civil conflict. TRIAL REGISTRATION Current Controlled Trials ISRCTN16228473 [controlled-trials.com].
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Most studies which looked at the civil disturbances in Northern Ireland for the 25 years until the ceasefire declarations in late 1994 concluded that the impact on the psychological health of the population was insubstantial. In the study reported below doctors as a group were quite accurate in identifying the features of post traumatic stress disorder (P.T.S.D.) on a questionnaire but there is...
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Declaration of interest None. Fundingdetailed in Acknowledgements. Although war and political conflict have grave consequences, increased national identification and community solidarity during wartime appear to protect mental health. Moreover epidemiological studies in Northern Ireland have indicated comparatively good mental health of the population during the 35-year period of political viol...
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ورودعنوان ژورنال:
- BMJ
دوره 334 7604 شماره
صفحات -
تاریخ انتشار 2007