Children in the ambulance: how do paramedics go about psychosocial care?

“The beer they gave Casper in the ambulance, calmed him down” she says.

The presenter is recounting the story of a boy who broke his leg in a swimming pool accident.

What? Is alcohol the latest innovation in professional care for children?

It keeps the audience in suspense for a while. Until it turns out presenter meant to say (teddy) ‘bear’, not ‘beer’. That presenter was me by the way 🙂 we had a good laugh about it.

Ambulance staff are often the first at the scene when a child is seriously injured. What do they know about children’s stress reactions? Have they had any training in psychological first aid? And how confident are they about providing it? Continue reading

Posttraumatic stress disorder a greater risk in rich countries

By New Zealand Defence Force from Wellington New ZealandOne would think that people with few friends and living in poverty are more at risk for PTSD than those with a strong support network and many resources.

And that’s true.

However, it is a different story when you look at the country-, rather than the individual level. Countries with more resources, such as the USA and the Netherlands, have higher levels of PTSD than countries with fewer resources (e.g. Colombia, South Africa).

This is the key finding of our latest study, which has just been published in the British Journal of Psychiatry. For the analyses, we made use of international data on trauma exposure, PTSD and country vulnerability. They had been collected in 24 different studies, published between 2005 and 2014.

The information on exposure and PTSD came from one, well-established and (evidently) widely used measure, the Composite International Diagnostic Interview. The country resources, or vulnerability, information came from the annual World Risk Report. It includes a mix of country characteristics, such as number of hospital beds, malnutrition, and gross domestic product per capita.

Both trauma exposure and vulnerability were major determinants of PTSD, but the latter in an unexpected way. While a higher percentage of trauma exposure in the country related to higher levels of PTSD, more vulnerability was associated with less PTSD.

Michel Dückers, the lead author of the study, calls it the “vulnerability paradox”. Continue reading

Dysfunctional posttraumatic cognitions: Can we reduce the gap between research and practice?

Anke de Haan A new guestpost!

Anke de Haan from the University Children’s Hospital in Zurich talks about the place that children’s post-trauma cognitions have in clinical practice:

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Posttraumatic cognitions have been a topic in child trauma research for a few years now. Nevertheless, my impression is that they have not yet been established in clinical practice.

Why not? Are they not practically relevant? Are they too difficult to assess? Before I discuss these questions, I will briefly describe what I mean with dysfunctional posttraumatic cognitions. Continue reading

Refugees in Europe: A crisis?

Fresh Eyes on the Refugee Crisis - image by Tom Turley

Over 1 million people arrived in Europe by sea in 2015. And since the conflict in Syria continues, this influx will not halt.

It is the biggest refugee crisis since World War II according to the UNHCR. The journey by sea is dangerous, the circumstances in refugee camps and asylum seeker centers are far from ideal – to say the least – and tensions between host countries make it difficult to find constructive solutions.

With such big numbers and their political, social and logistical complexities, it’s easy to feel powerless as an individual.

Still, there are opportunities. As Margaret Mead has famously been quoted:

“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it’s the only thing that ever has.”

Continue reading

Getting rid of the Ghost People

child soldierPatrick became a child soldier at the age of 13. He was abducted by Ugandan rebels, who kept him for 3 years.

Schultz and Weisaeth (2015) describe Patrick’s story, his mental health problems, and his treatment, a local cleansing ritual. They conclude that the ritual is safe, effective, and perhaps even more powerful than Western-style therapy. That sounds fascinating and important, right?

In interviews Patrick told about his experiences, including an attack on a convoy:

“Everybody was screaming…The road was all red from the blood… My body was shaking, but I managed to appear calm. If not they would have killed me. The next day I experienced the Ghost People for the first time. I could see them get chopped up and sliced apart with axes. I saw the same scenes over and over again.”

The Ghost People only showed up when Patrick was alone, and scared him enormously. He also suffered from concentration problems and sleeping difficulties. He was clinically depressed and had moderate to severe PTSD.

When his nightmares were occurring twice a week and he saw the Ghost People every day – about 8 years after the convoy attack –, he stated that his life was ruined. He wanted to do a cleansing ritual. Continue reading