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冲突后背景下针对遭受酷刑和战争创伤受害者的新型生物-心理-社会康复方法:科索沃的一项随机对照试验试点研究

A novel bio-psycho-social approach for rehabilitation of traumatized victims of torture and war in the post-conflict context: a pilot randomized controlled trial in Kosovo.

作者信息

Wang Shr-Jie, Bytyçi Ardiana, Izeti Selvi, Kallaba Melita, Rushiti Feride, Montgomery Edith, Modvig Jens

机构信息

Danish Institute against Torture (DIGNITY), Copenhagen, Denmark.

Kosova Rehabilitation Centre for Torture Victims (KRCT), Pristina, Kosovo ; Department of Psychology, University of Pristina, Pristina, Kosovo.

出版信息

Confl Health. 2017 Feb 8;10:34. doi: 10.1186/s13031-016-0100-y. eCollection 2016.


DOI:10.1186/s13031-016-0100-y
PMID:28191034
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5297130/
Abstract

BACKGROUND: Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for treating war-related trauma, but it remains unclear whether this approach is applicable to civilians living in resource-poor countries affected by war. In 2012-14, Danish Institute against Torture (DIGNITY) conducted a randomized controlled trial (RCT), in partnership with Kosova Rehabilitation Centre for Torture Victims (KRCT), to examine the effects of multidisciplinary intervention among victims of torture and war in Kosovo. METHODS: A single-center, randomized, parallel-arm, single-masked, waiting-list controlled trial was implemented in northern Kosovo. Thirty-four participants meeting the recruiting criteria were randomized to either intervention group, which received integrated treatments plus a once-daily multivitamin, or the waiting list group, which received multivitamin alone. The integrated treatments consisted of 10 weekly individual 60-min sessions of cognitive behavioral therapy (CBT), based on an adapted prolonged exposure therapy manual, an individual 20-min breathing exercise with an emWave biofeedback device, and 90-min group physiotherapy. The waiting list group also received the same treatment after the intervention group had completed their sessions. Outcome assessments were conducted at 3, 6 and 9 months after baseline assessment. Outcomes measures consisted of 4 subtypes: mental, emotional, physical health, functioning and social outcomes, i.e. PTSD, depression, anxiety, chronic pain, anger and hatred expression, body mass index, handgrip strength, standing balance, income, employment rate and disability score. RESULTS: Over 1/3 of PTSD cases were successfully treated. Inconsistent patterns with mental health and chronic pain outcomes were observed while there was a definite impact of intervention on functioning and social outcomes, i.e. the employment rate, which increased nearly 15 %, and the monthly wage, which rose 45-137 %. There was also a noticeable improvement in handgrip strength and disability score; the feelings of anger and hatred diminished. However, most of these changes did not reach statistical significance. CONCLUSIONS: The impact of bio-psycho-social intervention is likely sensitive to the context of post-war economy in Kosovo and the treatment goals. The potential for improving the emotional well-being and employment outcome in victims was demonstrated. A larger scale RCT in a similar setting is needed, with close monitoring of treatment integrity and data reliability. TRIAL REGISTRATION: Clinicaltrials.gov (NCT01696578).

摘要

背景:一些证据表明,西方国家的多学科康复治疗对战争相关创伤有效,但这种方法是否适用于生活在受战争影响的资源匮乏国家的平民仍不清楚。2012年至2014年,丹麦反酷刑协会(DIGNITY)与科索沃酷刑受害者康复中心(KRCT)合作,进行了一项随机对照试验(RCT),以研究多学科干预对科索沃酷刑和战争受害者的影响。 方法:在科索沃北部开展了一项单中心、随机、平行组、单盲、等待列表对照试验。34名符合招募标准的参与者被随机分为干预组和等待列表组,干预组接受综合治疗加每日一次的多种维生素,等待列表组仅接受多种维生素。综合治疗包括基于改编的延长暴露疗法手册进行的每周10次、每次60分钟的个体认知行为疗法(CBT)、使用emWave生物反馈设备进行的20分钟个体呼吸练习以及90分钟的团体物理治疗。干预组完成疗程后,等待列表组也接受相同治疗。在基线评估后的3个月、6个月和9个月进行结果评估。结果测量包括4个亚型:心理、情绪、身体健康、功能和社会结果,即创伤后应激障碍(PTSD)、抑郁、焦虑、慢性疼痛、愤怒和仇恨表达、体重指数、握力、站立平衡、收入、就业率和残疾评分。 结果:超过1/3的PTSD病例得到成功治疗。心理健康和慢性疼痛结果呈现不一致的模式,而干预对功能和社会结果有明确影响,即就业率提高了近15%,月工资增长了45%至137%。握力和残疾评分也有明显改善;愤怒和仇恨情绪有所减轻。然而,这些变化大多未达到统计学意义。 结论:生物心理社会干预的影响可能对战后科索沃经济背景和治疗目标敏感。已证明有改善受害者情绪健康和就业结果的潜力。需要在类似环境中开展更大规模的RCT,并密切监测治疗的完整性和数据的可靠性。 试验注册:Clinicaltrials.gov(NCT01696578)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b446/5297130/4339f5f562a9/13031_2016_100_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b446/5297130/44bc9797c12f/13031_2016_100_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b446/5297130/03808cf0c5a6/13031_2016_100_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b446/5297130/4339f5f562a9/13031_2016_100_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b446/5297130/44bc9797c12f/13031_2016_100_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b446/5297130/6fa943cbc96b/13031_2016_100_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b446/5297130/03808cf0c5a6/13031_2016_100_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b446/5297130/4339f5f562a9/13031_2016_100_Fig4_HTML.jpg

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本文引用的文献

[1]
Socio-Cultural Context and Feelings of Hatred and Revenge in War Veterans with Post-Traumatic Stress Disorder 15 Years after War in Kosovo.

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