Mental health care after trauma, new guidelines released by WHO

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Mental-Health-ProblemsTraumatic 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)‬.

References:

  • http://www.who.int/mediacentre/news/releases/2013/trauma_mental_health‭_‬20130806/en/
  • http://www.who.int/mental_health/emergencies/mhgap_module_management_stress/en/index.html