Traumatic events and loss are common in people’s lives. In a WHO study of 21 countries, more than 10% of respondents reported witnessing violence (21.8%) or experiencing interpersonal violence (18.8%), accidents (17.7%), exposure to war (16.2%) or trauma to a loved one (12.5%). An estimated 3.6% of the world’s population has suffered from post-traumatic stress disorder (PTSD) in the previous year.
In 2010 WHO launched WHO’s Mental Health Global Action Program to provide better care to patients in primary care setting in low to middle income countries. Previously WHO has addressed depression, substance abuse and other psychiatric disorders under this program. Now this module has been extended to include care for patients suffering from acute stress, after a traumatic event.
“We have received numerous requests for guidance for mental health care after trauma and loss” says Dr Oleg Chestnov, WHO Assistant Director-General for Non-communicable Diseases and Mental Health. “Primary health-care providers will now be able to offer basic support consistent with the best available evidence. They will also learn when to refer to more advanced treatment.”
WHO has recommended that Post traumatic stress disorder (PTSD) should be managed with cognitive-behavioral therapy (CBT) or eye movement desensitization and reprocessing (EMDR). It has also recommended stress management like stress inoculation training and relaxation training for adults suffering from PTSD. Although stress management has shown less benefit as compared to CBT and EMDR but it is included in guidelines because of its cost and feasibility.
As far as pharmacological treatment of PTSD is concerned WHO has limited the use of anti-depressants. This is because of very small benefit of these drugs for treatment of PTSD. However it can be given to those adults who do not respond to psychological therapy or those who has moderate to severe depression.
The WHO said benzodiazepines should not be offered to reduce acute traumatic stress symptoms or insomnia in the first month after a traumatic event. This is because there is no evidence that benzodiazepines decrease the symptoms of acute stress after a traumatic event. Also factors like dependence and withdrawal syndrome limit the use of these drugs.
WHO has said that this module should always be used together with the mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-specialized Health Settings (WHO, 2010), which outlines relevant general principles of care and management of a range of other mental, neurological and substance use conditions. These new guidelines are available on WHO website (click on link below).