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

• Published in: PLOS Neglected Tropical Diseases
• Main Authors: Chamara A Wijesinghe, Shehan S Williams, Anuradhani Kasturiratne, Nishantha Dolawaththa, Piyal Wimalaratne, Buddhika Wijewickrema, Shaluka F Jayamanne, Geoffrey K Isbister, Andrew H Dawson, David G Lalloo, H Janaka de Silva
• Format: Article in Journal/Newspaper
• Language: English
• Published: Public Library of Science (PLoS) 2015
• Subjects: Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic; Three Arms
• Online Access: https://doi.org/10.1371/journal.pntd.0003989; https://doaj.org/article/d220590b5ac14f049196cff9a336518f

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 ...