Clinical, Educational and Health Psychology, University College London, UK.
Psychol Med. 2010 Dec;40(12):2049-57. doi: 10.1017/S0033291710000206.
Little is known about how to remedy the unmet mental health needs associated with major terrorist attacks, or what outcomes are achievable with evidence-based treatment. This article reports the usage, diagnoses and outcomes associated with the 2-year Trauma Response Programme (TRP) for those affected by the 2005 London bombings.MethodFollowing a systematic and coordinated programme of outreach, the contact details of 910 people were obtained by the TRP. Of these, 596 completed a screening instrument that included the Trauma Screening Questionnaire (TSQ) and items assessing other negative responses. Those scoring ≥6 on the TSQ, or endorsing other negative responses, received a detailed clinical assessment. Individuals judged to need treatment (n=217) received trauma-focused cognitive-behaviour therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR). Symptom levels were assessed pre- and post-treatment with validated self-report measures of post-traumatic stress disorder (PTSD) and depression, and 66 were followed up at 1 year.
Case finding relied primarily on outreach rather than standard referral pathways such as primary care. The effect sizes achieved for treatment of DSM-IV PTSD exceeded those usually found in randomized controlled trials (RCTs) and gains were well maintained an average of 1 year later.
Outreach with screening, linked to the provision of evidence-based treatment, seems to be a viable method of identifying and meeting mental health needs following a terrorist attack. Given the failure of normal care pathways, it is a potentially important approach that merits further evaluation.
对于如何弥补与重大恐怖袭击相关的未满足的心理健康需求，或者通过循证治疗可以实现哪些结果，人们知之甚少。本文报告了 2005 年伦敦爆炸事件后，使用为期 2 年的创伤反应计划（TRP）治疗受影响人群的使用情况、诊断和结果。
在系统和协调的外展计划之后，TRP 获得了 910 人的联系方式。其中，596 人完成了一项包括创伤筛查问卷（TSQ）和评估其他负面反应的项目的筛查工具。TSQ 得分≥6 分或有其他负面反应的人接受详细的临床评估。判断需要治疗的个体（n=217）接受创伤聚焦认知行为疗法（TF-CBT）或眼动脱敏再处理（EMDR）。在治疗前和治疗后使用经过验证的创伤后应激障碍（PTSD）和抑郁自评量表评估症状水平，66 人在 1 年后进行了随访。
病例发现主要依赖于外展，而不是初级保健等标准转诊途径。DSM-IV PTSD 的治疗效果大小超过了随机对照试验（RCT）中通常发现的效果，并且在平均 1 年后仍保持良好。
通过筛查进行外展，并结合提供循证治疗，似乎是一种可行的方法，可以在恐怖袭击后识别和满足心理健康需求。鉴于常规护理途径的失败，这是一种潜在重要的方法，值得进一步评估。
