Terry J. Lewin

Stress debriefing and patterns of recovery following a natural disaster

Stress debriefing has been used extensively following traumatic events; however, there is little evidence of its effectiveness. This paper reports the effects of stress debriefing on the rate of recovery of 195 helpers (e.g., emergency service personnel and disaster workers) following an earthquake in Newcastle, Australia (62 debriefed helpers and 133 who were not debriefed). Post-trauma stress reactions (Impact of Event Scale) and general psychological morbidity (General Health Questionnaire: GHQ-12) were assessed on four occasions over the first 2 years postearthquake. There was no evidence of an improved rate of recovery among those helpers who were debriefed, even when level of exposure and helping-related stress were taken into account. More rigorous investigation of the effectiveness of stress debriefing and its role in posttrauma recovery is urgently required.

Psychosocial sequelae of the 1989 Newcastle earthquake: I. Community disaster experiences and psychological morbidity 6 months post-disaster

A stratified random sample of 3007 Australian adults completed a screening questionnaire 6 months after the 1989 Newcastle earthquake. Information was obtained on initial earthquake experiences and reactions, use of specific services, social support, coping strategies and psychological morbidity. This questionnaire was the first phase of the Quake Impact Study, a longitudinal project investigating the psychosocial impact of the earthquake. Two weighted indices of exposure were developed: a threat index, which measured exposure to injury or the possibility of injury; and a disruption index, which measured experiences of property damage, displacement and other losses. Levels of exposure to threat and disruption events were significant predictors of morbidity on both the General Health Questionnaire and Impact of Event Scale, as were coping style and gender. Effects of exposure to threat and disruption were largely additive, with higher exposure being associated with greater use of support services, higher perceived stressfulness and more severe psychological morbidity. Use of avoidance as a coping strategy, female gender, lower social support and being older were also associated with higher post-disaster psychological distress. It was estimated that 14.8% of the population was exposed to high levels of threat or disruption, of whom approximately 25% experienced moderate to severe psychological distress as a direct result of the disaster. It was further estimated that 18.3% of those exposed to high levels of threat were at risk of developing post-traumatic stress disorder, representing approximately 2% of the citys adult population.

Australian adolescents' perceptions of their parents

We examined the characteristics of a self-report measure for assessing perceptions of parents, the Parental Bonding Instrument (PBI), in an adolescent community sample (N = 2,147; mean age = 15.4 years). Using factor analysis, three PBI dimensions were identified — the original Care factor and two Protection factors: perceived social control and personal intrusiveness. Important sex differences were found which were not evident in the two factor structure recommended by Parker [1, 2]. Relative to sons, daughters saw their fathers as more personally intrusive and their mothers as less socially controlling and much more caring. Overall, adolescents perceived mothers as more caring but more personally intrusive than fathers. Adolescents who saw their father as uncaring and their mother as controlling tended to have the least positive psychosocial profiles.

An improved brief measure of cannabis misuse: the Cannabis Use Disorders Identification Test-Revised (CUDIT-R).

BACKGROUND Cannabis is widely used and significant problems are associated with heavier consumption. When a cannabis misuse screening tool, the CUDIT, was originally published it was noted that although it performed well there was concern about individual items. METHODS 144 patients enrolled in a clinical trial for concurrent depression and substance misuse were administered an expanded CUDIT, containing the original 10 items and 11 candidate replacement items. All patients were assessed for a current cannabis use disorder with the SCID. RESULTS A revised CUDIT-R was developed containing 8 items, two each from the domains of consumption, cannabis problems (abuse), dependence, and psychological features. Although the psychometric adequacy of the original CUDIT was confirmed, the CUDIT-R was shorter and had equivalent or superior psychometric properties. High sensitivity (91%) and specificity (90%) were achieved. CONCLUSIONS The 8-item CUDIT-R has improved performance over the original scale and appears well suited to the task of screening for problematic cannabis use. It may also have potential as a brief routine outcome measure.

Randomized controlled trial of cognitive-behavioural therapy for coexisting depression and alcohol problems: short-term outcome

AIMS Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone. The present study (Depression and Alcohol Integrated and Single-focused Interventions; DAISI) aimed to compare the effectiveness of brief intervention, single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems. METHODS Participants (n = 284) with current depressive symptoms and hazardous alcohol use were assessed and randomly allocated to one of four individually delivered interventions: (i) a brief intervention only (single 90-minute session) with an integrated focus on depression and alcohol, or followed by a further nine 1-hour sessions with (ii) an alcohol focus; (iii) a depression focus; or (iv) an integrated focus. Follow-up assessments occurred 18 weeks after baseline. RESULTS Compared with the brief intervention, 10 sessions were associated with greater reductions in average drinks per week, average drinking days per week and maximum consumption on 1 day. No difference in duration of treatment was found for depression outcomes. Compared with single-focused interventions, integrated treatment was associated with a greater reduction in drinking days and level of depression. For men, the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning. Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment. CONCLUSIONS Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems, at least in the short term. Gender differences between single-focused depression and alcohol treatments warrant further study.

The construction and characteristics of an instrument to measure personal hopefulness

This paper describes the construction, refinement and implementation of a self-administered measure of personal hopefulness, the Hunter Opinions and Personal Expectations Scale (HOPES). Initial state and trait versions of the HOPES instrument were utilized in three separate studies, comprising a medical student sample (N = 211), an adolescent male sample (N = 280) and a psychiatric hospital staff sample (N = 318). A revised 20-item, two factor, trait version of the scale was then utilized in a prospective, longitudinal investigation (N = 753) of the psychosocial sequelae of the earthquake which struck Newcastle (Australia) in December, 1989. Data from all four studies provide strong support for the HOPES instruments construct, concurrent and predictive validity. Global personal hopefulness (GPH) was shown to be an enduring characteristic of individuals, with a test-retest correlation of r = + 0.71 (over 64 weeks). The association between GPH and trait anxiety (r = -0.64) raised the possibility of redefining anxiety as hope under threat. The hope subscale (HS) and the despair subscale (DS) were moderately negatively correlated (r = -0.32), suggesting that hope and despair are not simply polar opposites. There were no gender differences in GPH scores, however, there were relatively clear age effects, with those aged 70 years and over reporting the lowest levels of personal hopefulness. GPH was negatively correlated with post-earthquake scores on the General Health Questionnaire (r = -0.33), the Impact of Event Scale (r = -0.33), the Beck Depression Inventory (r = -0.54) and the global symptom index from the SCL-90-R (r = -0.43). Overall, the contribution made by personal hopefulness to post-earthquake morbidity was equal to the contributions made by initial exposure to disruption and threat experiences.

Psychosocial sequelae of the 1989 Newcastle earthquake : III. Role of vulnerability factors in post-disaster morbidity

BACKGROUND This paper examines the contributions of dispositional and non-dispositional factors to post-disaster psychological morbidity. Data reported are from the 845 participants in the longitudinal component of the Quake Impact Study. METHODS The phase 1 survey was used to construct dimensional indices of threat and disruption exposure. Subsequently, a range of dispositional characteristics were measured, including neuroticism, personal hopefulness and defence style. The main morbidity measures were the General Health Questionnaire (GHQ-12) and Impact of Event Scale (IES). RESULTS Dispositional characteristics were the best predictors of psychological morbidity throughout the 2 years post-disaster, contributing substantially more to the variance in morbidity (12-39%) than did initial exposure (5-12%), but the extent of their contribution was greater for general (GHQ-12) than for post-traumatic (IES) morbidity. Among the non-dispositional factors, avoidance coping contributed equally to general and post-traumatic morbidity (pr = 0.24). Life events since the earthquake (pr = 0.18), poor social relationships (pr = -0.25) and ongoing earthquake-related disruptions (pr = 0.22) also contributed to general morbidity, while only the latter contributed significantly to post-traumatic morbidity (pr = 0.15). CONCLUSIONS Medium-term post-earthquake morbidity appears to be a function of multiple factors whose contributions vary depending on the type of morbidity experienced and include trait vulnerability, the nature and degree of initial exposure, avoidance coping and the nature and severity of subsequent events.

Manic Symptoms in Young Males With ADHD Predict Functioning But Not Diagnosis After 6 Years

OBJECTIVE To compare the outcome in early adulthood of males who met criteria for attention-deficit/hyperactivity disorder (ADHD) and mania, ADHD alone, or no psychiatric disorder when aged 9-13 years. METHOD Males who met criteria at baseline assessment conducted in the period 1992-1994 for mania+ADHD (n = 15), ADHD without mania (n = 65), or no psychiatric diagnosis (n = 17) were reevaluated after 6 years using computer-assisted structured interviews for Axis I and Axis II disorders, questionnaires about functioning and service utilization, and a clinician-rated assessment of global functioning. RESULTS There were no group differences in the prevalence of Axis I or Axis II disorders, with the exception of alcohol abuse, which was higher in controls. Manic symptoms persisted in only one mania+ADHD subject, while three (5%) of the ADHD subjects had new-onset manic symptoms. There were no clear cases of bipolar disorder. The groups were not distinguished on levels of service utilization or criminal behavior, but global functioning was significantly lower at follow-up in the mania+ADHD group compared with controls. CONCLUSIONS Although a pilot study in scope, the findings cast doubt on a link between mania symptoms associated with ADHD in childhood and later bipolar disorder.

THE PSYCHOSOCIAL IMPACT OF AN EARTHQUAKE ON THE ELDERLY

The psychosocial effects of an earthquake which occurred in Newcastle, Australia in 1989 are the focus of the Quake Impact Study, a four‐phase community survey conducted over 2 years. Comparisons were made between adults aged less than 65 years (N=2371) and those aged 65 years and older (N=636). Results revealed that older subjects reported fewer threat and disruption experiences and used fewer general and disaster‐related support services. However, older subjects reported higher overall levels of post‐traumatic stress symptoms on the Impact of Event Scale (IES) compared with younger subjects. On both the IES and a general measure of morbidity (General Health Questionnaire: GHQ‐12) the effects of earthquake exposure were more marked among the elderly. Within the older group, subjects who had high levels of post‐traumatic stress symptoms (IES>25,N=117) were more likely to be female, report higher levels of exposure and use behavioural and avoidance coping styles. Although psychological distress declined with time, post‐traumatic stress symptoms remained higher for the high exposure group throughout the study. We conclude that older people may be more at risk for experiencing post‐traumatic stress reactions despite having fewer disaster‐related experiences. They may also underutilize support services following a disaster. Older women in particular and people with an avoidance coping style appear to be most vulnerable.

Motivational interviewing among psychiatric in-patients with substance use disorders.

Baker A, Lewin T, Reichler H, Clancy R, Carr V, Garrett R, Sly K, Devir H, Terry M. Motivational interviewing among psychiatric in‐patients with substance use disorders. Acta Psychiatr Scand 2002: 106: 233–240.