PLoS Neglected Tropical Diseases (Jan 2015)

A Randomized Controlled Trial of a Brief Intervention for Delayed Psychological Effects in Snakebite Victims.

  • Chamara A Wijesinghe,
  • Shehan S Williams,
  • Anuradhani Kasturiratne,
  • Nishantha Dolawaththa,
  • Piyal Wimalaratne,
  • Buddhika Wijewickrema,
  • Shaluka F Jayamanne,
  • Geoffrey K Isbister,
  • Andrew H Dawson,
  • David G Lalloo,
  • H Janaka de Silva

DOI
https://doi.org/10.1371/journal.pntd.0003989
Journal volume & issue
Vol. 9, no. 8
p. e0003989

Abstract

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BACKGROUND:Snakebite results in delayed psychological morbidity and negative psycho-social impact. However, psychological support is rarely provided to victims. AIM:To assess the effectiveness of a brief intervention which can be provided by non-specialist doctors aimed at reducing psychological morbidity following snakebite envenoming. METHOD:In a single blind, randomized controlled trial, snakebite victims with systemic envenoming [n = 225, 168 males, mean age 42.1 (SD 12.4) years] were randomized into three arms. One arm received no intervention (n = 68, Group A), the second received psychological first aid and psychoeducation (dispelling prevalent cultural beliefs related to snakebite which promote development of a sick role) at discharge from hospital (n = 65, Group B), while the third received psychological first aid and psychoeducation at discharge and a second intervention one month later based on cognitive behavioural principles (n = 69, Group C). All patients were assessed six months after hospital discharge for the presence of psychological symptoms and level of functioning using standardized tools. RESULTS:At six months, there was a decreasing trend in the proportion of patients who were positive for psychiatric symptoms of depression and anxiety from Group A through Group B to Group C (Chi square test for trend = 7.901, p = 0.005). This was mainly due to a decreasing trend for symptoms of anxiety (chi-square for trend = 11.256, p = 0.001). There was also decreasing trend in the overall prevalence of disability from Group A through Group B to Group C (chi square for trend = 7.551, p = 0.006), predominantly in relation to disability in family life (p = 0.006) and social life (p = 0.005). However, there was no difference in the proportion of patients diagnosed with depression between the three groups (chi square for trend = 0.391, p = 0.532), and the intervention also had no effect on post-traumatic stress disorder. CONCLUSIONS:A brief psychological intervention, which included psychological first aid and psychoeducation plus cognitive behavioural therapy that can be provided by non-specialist doctors appeared to reduce psychiatric symptoms and disability after snakebite envenoming, but not depression or post-traumatic stress disorder. TRIAL REGISTRATION:Sri Lanka Clinical Trials Registry: SLCTR/2011/003.