A Randomized Controlled Trial of a Brief Intervention for Delayed Psychological Effects in Snakebite Victims.
BACKGROUND
Snakebite results in delayed psychological morbidity and negative psycho-social impact. However, psychological support is rarely provided to victims.


OBJECTIVE
To assess the effectiveness of a brief intervention which can be provided by non-specialist doctors aimed at reducing psychological morbidity following snakebite envenoming.


METHODS
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.


BACKGROUND
Sri Lanka Clinical Trials Registry: SLCTR/2011/003.
Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Chamara A
CA
Wijesinghe
Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Shehan S
SS
Williams
Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Anuradhani
A
Kasturiratne
District General Hospital, Polonnaruwa, Sri Lanka.
Nishantha
N
Dolawaththa
District General Hospital, Polonnaruwa, Sri Lanka.
Piyal
P
Wimalaratne
Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Buddhika
B
Wijewickrema
Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Shaluka F
SF
Jayamanne
South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka; Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia.
Geoffrey K
GK
Isbister
South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
Andrew H
AH
Dawson
Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
David G
DG
Lalloo
Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
H Janaka
HJ
de Silva
D000328:Adult; D000818:Animals; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*; D012909:Snake Bites / Q000523:psychology* / Q000628:therapy; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy; D016896:Treatment Outcome