Wild Jennifer, El-Salahi Shama, Tyson Gabriella, Lorenz Hjördis, Pariante Carmine M, Danese Andrea, Tsiachristas Apostolos, Watkins Edward, Middleton Benita, Blaber Amanda, Ehlers Anke
Department of Experimental Psychology, Oxford Centre for Anxiety Disorders and Trauma, University of Oxford, Oxford, UK.
Oxford Health NHS Foundation Trust, Oxford, UK.
BMJ Open. 2018 Dec 31;8(12):e022292. doi: 10.1136/bmjopen-2018-022292.
Emergency workers dedicate their lives to promoting public health and safety, yet suffer higher rates of post-traumatic stress disorder (PTSD) and major depression (MD) compared with the general population. They also suffer an associated increased risk for physical health problems, which may be linked to specific immunological and endocrine markers or changes in relevant markers. Poor physical and mental health is costly to organisations, the National Health Service and society. Existing interventions aimed at reducing risk of mental ill health in this population are not very successful. More effective preventative interventions are urgently needed. We first conducted a large-scale prospective study of newly recruited student paramedics, identifying two cognitive factors (rumination and resilience appraisals) that predicted episodes of PTSD and MD over a 2-year period. We then developed internet-delivered cognitive training for resilience (iCT-R), a supported online intervention, to modify cognitive predictors. This protocol is for a randomised controlled trial to evaluate the efficacy of the resilience intervention.
570 student paramedics will be recruited from participating universities. They will be randomly allocated to iCT-R or to supported online training of an alternative, widely available intervention or to training-as-usual. Follow-up will occur after the intervention/standard practice period and at 6, 12 and 24 months. Primary outcomes include rates of PTSD and MD and subsydnromal PTSD and MD, measured by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the Patient-Health Questionnaire-9 and the Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Secondary outcomes include measures of resilience, rumination, anxiety, psychological distress, well-being, salivary cortisol, plasma levels of C-reactive protein, smoking and alcohol use, weight gain, sleep problems, health-related quality of life, health resource utilisation and productivity.
The Medical Sciences Inter-Divisional Research Ethics Committee at the University of Oxford granted approval, reference: R44116/RE001. The results will be published in a peer-reviewed journal. Access to raw data and participant information will be available only to members of the research team.
ISRCTN16493616; Pre-results.
急救人员致力于促进公众健康与安全，但与普通人群相比，他们患创伤后应激障碍（PTSD）和重度抑郁症（MD）的几率更高。他们还面临身体健康问题的相关风险增加，这可能与特定的免疫和内分泌标志物或相关标志物的变化有关。身心健康不佳对组织、国民医疗服务体系和社会来说成本高昂。现有的旨在降低这一人群心理健康问题风险的干预措施并不十分成功。迫切需要更有效的预防性干预措施。我们首先对新招募的学生护理人员进行了一项大规模前瞻性研究，确定了两个认知因素（沉思和复原力评估），这两个因素可预测两年内PTSD和MD的发作情况。然后，我们开发了一种基于互联网的复原力认知训练（iCT-R），这是一种有支持的在线干预措施，用于改变认知预测因素。本方案用于一项随机对照试验，以评估复原力干预措施的效果。
将从参与研究的大学招募570名学生护理人员。他们将被随机分配到iCT-R组、接受另一种广泛可用的替代干预措施的支持性在线培训组或常规培训组。在干预/标准实践期结束后以及6个月、12个月和24个月时进行随访。主要结局包括PTSD和MD的发生率以及亚综合征PTSD和MD的发生率，通过《精神疾病诊断与统计手册》第五版的结构化临床访谈、患者健康问卷-9以及《精神疾病诊断与统计手册》第五版的创伤后应激障碍检查表进行测量。次要结局包括复原力、沉思、焦虑、心理困扰、幸福感、唾液皮质醇、血浆C反应蛋白水平、吸烟和饮酒情况、体重增加、睡眠问题、健康相关生活质量、健康资源利用和生产力的测量。
牛津大学医学科学跨部门研究伦理委员会已批准，编号：R44116/RE001。研究结果将发表在同行评审期刊上。原始数据和参与者信息仅向研究团队成员提供。
ISRCTN16493616；预结果。
