Stepped early psychological intervention for posttraumatic stress disorder, other anxiety disorders, and depression following serious injury

Authors

  • Meaghan L. O'Donnell,

    Corresponding author
    1. Australian Centre for Posttraumatic Mental Health, East Melbourne Victoria, Australia
    2. Department of Psychiatry, University of Melbourne, Parkville Victoria, Australia
    • Australian Centre for Posttraumatic Mental Health, Level 1, 340 Albert Street, East Melbourne, 3002, Victoria, Australia.
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  • Winnie Lau,

    1. Australian Centre for Posttraumatic Mental Health, East Melbourne Victoria, Australia
    2. Department of Psychiatry, University of Melbourne, Parkville Victoria, Australia
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  • Susannah Tipping,

    1. Foundation House, 6 Gardiner Street, Brunswick, Victoria, Australia
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  • Alexander C. N. Holmes,

    1. Department of Psychiatry, University of Melbourne, Parkville Victoria, Australia
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  • Steven Ellen,

    1. Monash Alfred Psychiatric Research Centre, Commercial Road, Prahran Victoria, Australia
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  • Rodney Judson,

    1. Department of Surgery, Royal Melbourne Hospital, Grattan St, Parkville, Victoria, Australia
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  • Tracey Varker,

    1. Australian Centre for Posttraumatic Mental Health, East Melbourne Victoria, Australia
    2. Department of Psychiatry, University of Melbourne, Parkville Victoria, Australia
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  • Peter Elliot,

    1. Australian Centre for Posttraumatic Mental Health, East Melbourne Victoria, Australia
    2. Department of Psychiatry, University of Melbourne, Parkville Victoria, Australia
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  • Richard A. Bryant,

    1. Department of Psychology, University of New South Wales, Sydney New South Wales, Australia
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  • Mark C. Creamer,

    1. Australian Centre for Posttraumatic Mental Health, East Melbourne Victoria, Australia
    2. Department of Psychiatry, University of Melbourne, Parkville Victoria, Australia
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  • David Forbes

    1. Australian Centre for Posttraumatic Mental Health, East Melbourne Victoria, Australia
    2. Department of Psychiatry, University of Melbourne, Parkville Victoria, Australia
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  • This research was supported by a National Health and Medical Research Council Program Grant (568970), a Victorian Trauma Foundation grant (#V-11), and a National Health and Medical Research Council Australian Clinical Research Fellowship (359284).

    An early version of this research was presented at the World International Congress of Psychiatry, Melbourne, Australia (30 Nov 2007).

Abstract

The best approach for implementing early psychological intervention for anxiety and depressive disorders after a traumatic event has not been established. This study aimed to test the effectiveness of a stepped model of early psychological intervention following traumatic injury. A sample of 683 consecutively admitted injury patients were screened during hospitalization. High-risk patients were followed up at 4-weeks postinjury and assessed for anxiety and depression symptom levels. Patients with elevated symptoms were randomly assigned to receive 4–10 sessions of cognitive–behavioral therapy (n = 24) or usual care (n = 22). Screening in the hospital identified 89% of those who went on to develop any anxiety or affective disorder at 12 months. Relative to usual care, patients receiving early intervention had significantly improved mental health at 12 months. A stepped model can effectively identify and treat injury patients with high psychiatric symptoms within 3 months of the initial trauma.

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