29 Symptoms of PTSD in a Burn Outpatient Clinic: Prevalence and Engagement Challenges for the Burn Team

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S21-S22
Author(s):  
Andrew McAleavey ◽  
Mariel Emrich ◽  
Adina R Jick ◽  
Collette L McGuire ◽  
JoAnn Difede

Abstract Introduction Psychological distress, including posttraumatic stress disorder, acute stress disorder, and depressive disorders, are common after burn injury. These conditions are major determinants of long-term quality of life and productivity loss among burn patients, yet are generally under treated. Among the many reasons for limited treatment are lack of accessible quality care, limited clinical staff expertise in assessing these conditions, and patient avoidance of effective services. Methods During December 2018 to September, 2019, patients awaiting outpatient visits at an urban burn center were asked to complete brief standardized self-report questionnaires assessing symptoms of posttraumatic distress, anxiety, and depression. Using pre-defined criteria, we attempted to reach individuals with greater than moderate distress using contact information provided voluntarily and engage these patients in outpatient mental health services. Results 747 questionnaires were completed by 511 individuals in the assessment period, and of these 98 (19.2%) individuals had a likely PTSD diagnosis. Visual analog scale assessments for current anxiety, depression and stress all suggested high average distress in the overall group. Using pre-defined criteria to identify potential distress, we identified 195 people (38.2%) to whom we would proactively offer services. Only 159 provided contact information, and several more were not eligible for available clinical services so were not contacted. We called 128 individuals (81%). This led to direct communication with 48 patients (37.5% of those contacted), but only 22 individuals (17.2% of all those contacted) still endorsed distress at the time of the phone call (which was planned to occur within one week of the patients’ report) and 11 individuals were interested in seeking mental health services. Of these, 4 were referred to other services, 3 declined specific offers of service, 4 were scheduled for appointments and only 2 individuals attended appointments with the in-hospital psychological trauma group. Conclusions Psychological distress is highly prevalent in the burn outpatient clinic, with roughly one in five patients likely meeting criteria for PTSD. However, engaging patients in psychological and psychiatric treatment remains a major challenge for the effective care in this population. We discuss strategies tried here and systemic barriers to overcome in future research and care. Applicability of Research to Practice High prevalence of PTSD in outpatient burn clinics and difficulty engaging patients in separate outpatient mental health services suggest co-located and collaborative care models would be highly helpful in this population.

2008 ◽  
Vol 25 (4) ◽  
pp. 136-140 ◽  
Author(s):  
Brendan D Kelly

AbstractObjective: This audit aimed to (a) systematically identify problems related to rates of attendance and non-attendance at one psychiatry outpatient clinic; (b) quantify these problems; (c) implement strategies to improve service delivery; and (d) re-audit after three months.Methods: Specific standards were set in relation to patterns of attendance at the outpatient clinic. Audit was performed over two weeks; changes to practice were agreed and implemented for three months; re-audit was performed.Results: The initial audit showed that (a) 93 people attended the clinic over two mornings with a non-attendance rate of 13.9%; (b) 30.1% of individuals who attended did not have an appointment; (c) 20.4% of attendances were ‘inappropriate’; (d) 2.2% did not live in the clinic's catchment area. Based on these results, the clinic introduced a protocol for individuals who attended without appointment; a protocol for streamlining the provision of prescriptions; and a renewed emphasis on transferring the care of individuals not residing in the catchment area. Three months later, re-audit showed that (a) the number attending over two mornings decreased from 93 to 43, but the non-attendance rate had not changed; (b) the proportion of individuals presenting without an appointment (9.3%) decreased significantly compared to the initial audit (30.1 %); (c) the proportion of ‘inappropriate’ attendances (9.3%) tended to decrease compared to the initial audit (20.4%) but this was not statistically significant; (d) there was no difference in the proportion of patients who did not live in the catchment area; these proportions were low in both the initial audit (2.2%) and re-audit (2.3%).Conclusions: A relatively simple audit such as this can result in a more efficient and appropriate delivery of outpatient mental health services. On this basis, there is a need to provide ongoing resources for further cycles of clinical audit in mental health services.


2000 ◽  
Vol 177 (1) ◽  
pp. 59-65 ◽  
Author(s):  
Jeroen Heijmens Visser ◽  
Jan Van Der Ende ◽  
Hans M. Koot ◽  
Frank C. Verhulst

BackgroundFor children referred to mental health services future functioning may be hampered.AimsTo examine stability and prediction of behavioural and emotional problems from childhood into adulthood.MethodA referred sample (n=789) aged 4–18 years was followed up after a mean of 10.5 years. Scores derived from the Child Behavior Checklist, Youth Self-Report and Teacher Report Form were related to equivalent scores for young adults from the Young Adult Self-Report and Young Adult Behavior Checklist.ResultsCorrelations between first contact (T1) and follow-up (T2) scores were 0.12–0.53. Young adult psychopathology was predicted by corresponding TI problem scores. Social problems and anxious/depressed scores were predictors of general problem behaviour.ConclusionsProblem behaviour of children and adolescents referred to outpatient mental health services is highly predictive of similar problem behaviour at young adulthood. Stability is higher for externalising than for internalising behaviour and for intra-informant than for inter-informant information. Stabilities are similar across gender. To obtain a comprehensive picture of the young adult's functioning, information from related adults may prove valuable.


2021 ◽  
pp. 1-14
Author(s):  
Nina Reinholt ◽  
Morten Hvenegaard ◽  
Anne Bryde Christensen ◽  
Anita Eskildsen ◽  
Carsten Hjorthøj ◽  
...  

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.


2011 ◽  
Vol 41 (4) ◽  
pp. 416-423 ◽  
Author(s):  
Lisa A. Brenner ◽  
Lisa M. Betthauser ◽  
Beeta Y. Homaifar ◽  
Edgar Villarreal ◽  
Jeri E.F. Harwood ◽  
...  

2001 ◽  
Vol 16 (3) ◽  
pp. 162-166 ◽  
Author(s):  
A.C. Schrier ◽  
B.J.M. van de Wetering ◽  
P.G.H. Mulder ◽  
J.P. Selten

SummaryObjectiveReports of an increased incidence of schizophrenia in some immigrant groups to The Netherlands are based exclusively on hospital data. The aims of our study were: 1) to determine the treated point prevalence of schizophrenia at outpatient mental health services in Rotterdam and to compare the results for immigrants to those for natives; and 2) to compare groups born in The Netherlands and immigrant groups in terms of the proportions of patients with a previous hospital admission.MethodWe included all patients aged between 20 and 64 who were treated for a non-affective psychosis at any of the outpatient mental health services in Rotterdam on October 1, 1994. The mental health professionals responsible reported on the socio-demographic and clinical characteristics of each patient.ResultsSeven hundred and thirteen patients with a diagnosis of schizophrenia (DSM-III-R) were identified (rate: 2.1 per 1000). The (treated) prevalence of schizophrenia in male immigrants from Surinam and Morocco and in female immigrants from Surinam, the Netherlands Antilles and Cape Verde was significantly higher than that in their native-born counterparts (odds ratios between 2 and 3). The (treated) prevalence was not significantly higher in immigrants from Turkey, female immigrants from Morocco or male immigrants from the Antilles. Proportions of patients with a previous hospital admission were similar in each ethnic group (81–93%).ConclusionThese findings are generally in line with earlier studies, based on the Dutch psychiatric registry, which has reported an increase in the (treated) incidence of schizophrenia in immigrants from Surinam and the Netherlands Antilles and in male immigrants from Morocco, and no increase in the (treated) incidence in immigrants from Turkey or female immigrants from Morocco.


1992 ◽  
Vol 19 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Brenda M. Booth ◽  
Cynthia A. Loveland Cook ◽  
Frederic C. Blow ◽  
Janice Y. Bunn

Author(s):  
Sarah R. Black ◽  
Mary A. Fristad ◽  
L. Eugene Arnold ◽  
Boris Birmaher ◽  
Robert L. Findling ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document