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Adults who experienced the 1992 and 2008 armed conflicts in the Republic of Georgia were exposed to multiple traumatic events and stressors over many years. The aim was to investigate what coping strategies are used by conflict-affected persons in Georgia and their association with mental disorders.
A cross-sectional survey was conducted with 3600 adults, representing internally displaced persons (IDPs) from conflicts in the 1990s (n = 1200) and 2008 (n = 1200) and former IDPs who returned to their homes after the 2008 conflict (n = 1200). Post-traumatic stress disorder, depression, anxiety and coping strategies were measured using the Trauma Screening Questionnaire, Patient Health Questionnaire-9, Generalised Anxiety and adapted version of the Brief Coping Inventory, respectively. Descriptive and multivariate regression analyses were used.
Coping strategies such as use of humour, emotional support, active coping, acceptance and religion were significantly associated with better mental health outcomes. Coping strategies of behavioural and mental disengagement, denial, venting emotions, substance abuse and gambling were significantly associated with poorer mental health outcomes. The reported use of coping strategies varied significantly between men and women for 8 of the 15 strategies addressed.
Many conflict-affected persons in Georgia are still suffering mental health problems years after the conflicts. A number of specific coping strategies appear to be associated with better mental health and should be encouraged and supported where possible.
Post-traumatic stress disorder (PTSD) is typically associated with high-risk population groups, but the risk of PTSD that is associated with trauma experienced in the community, and effect of changes in diagnostic criteria in DSM-5 on prevalence in the general population, is unknown.
Cross-sectional analysis of population-based data from 4558 adults aged 25–83 years resident in Caerphilly county borough, Wales, UK. Exposure to different traumatic events was assessed using categorisation of free-text descriptions of trauma. PTSD caseness was determined using items assessing Diagnostic and Statistical Manual IV (DSM-IV) and DSM-5 A criteria and the Traumatic Screening Questionnaire.
Of the 4558 participants, 1971 (47.0%) reported a traumatic event. The most common DSM-IV A1 qualifying trauma was life-threatening illnesses and injuries (13.6%). The highest risk of PTSD was associated with assaultive violence [34.1%]. The prevalence of PTSD using DSM-IV A criteria was 14.3% (95% confidence interval [CI] = 12.8, 15.9%). Using DSM-5 A criteria reduced the prevalence to 8.0 (95% CI = 6.9, 9.4%), primarily due to exclusion of DSM-IV A1 qualifying events, such as life-threatening illnesses.
Nearly one-half of a general community sample had experienced a traumatic event and of these around one in seven was a DSM-IV case of PTSD. Although the majority of research has concentrated on combat, rape and assaultive violence, life threatening illness is a more common cause of PTSD in the community. Removal of this traumatic event in DSM-5 could reduce the number of cases of PTSD by around 6.0%.
The development of ICD11 and DSM5 was seen as an opportunity to harmonize the two major classification systems for mental disorders. The proposed ICD11 and DSM5 diagnostic criteria for PTSD are markedly different. The implications of this remain to be seen, but have the potential to cause confusion to PTSD sufferers, clinicians, researchers and others impacted on by the condition.
How best to plan and provide psychosocial care following disasters remains keenly debated.
To develop evidence-informed post-disaster psychosocial management guidelines.
A three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others' responses in the subsequent rounds.
A total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement ‘all responses should provide access to pharmacological assessment and management’ did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cognitive–behavioural therapy (CBT) is recommended for acute stress disorder or acute post-traumatic stress disorder, with other treatments with an evidence base for chronic post-traumatic stress disorder being made available if trauma-focused CBT is not tolerated.
The Delphi process allowed a consensus to be achieved in an area where there are limitations to the current evidence.
Trauma focused cognitive behavioural therapy (TFCBT) is recommended as a first line treatment for post traumatic stress disorder (PTSD). Unfortunately, it is not widely available, often resulting in long waits for sufferers. We attempted to overcome this through a pilot feasibility study of brief training and supervision with a group of mental health professionals (MHPs). The MHPs attended a structured weekly clinical supervision group adhering to a cognitive therapy model of supervision. Eleven PTSD sufferers were treated during the pilot phase. Davidson Trauma Scale scores dropped by a mean of 36.5 points (95% C.I. 12.8, 60.5) over the course of treatment. Group Clinical Supervision for TFCBT appears to have the potential to offer a clinically and cost-effective model of maximizing treatment availability for PTSD sufferers.
A new method for surface functionalization of inherently reactive polymers such as polyesters has been developed. It is based on the direct nucleophilic attack on the ester group in the polyethyleneterephtalate backbone by the acid moiety of polyacrylic acid (PAA) catalyzed by titaniumisopropoxide. The PAA grafted surfaces were characterized by X-ray photoelectron spectroscopy to demonstrated the presence of a thin grafted layer rendering the substrates hydrophilic. Subsequent acid group activation using N-ethyl-N'-(3-dimethylaminopropyl) carbodiimide hydrochloride allowed for in-situ collagen immobilization rendering the surfaces cell adhesive. Human smooth muscle and urothelial cells successfully seeded these surfaces, reaching confluence after 7 days.