The effect of flexible cognitive–behavioural therapy and medical treatment, including antidepressants on post-traumatic stress disorder and depression in traumatised refugees: pragmatic randomised controlled clinical trial

Buhmann, Caecilie; Nordentoft, Merete; Ekstroem, Morten; Carlsson, Jessica; Mortensen, Erik Lykke

doi:10.1192/bjp.bp.114.150961

Cited by 83 publications

(91 citation statements)

References 38 publications

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“…A previous randomized clinical trial of eye movement desensitization and reprocessing vs fluoxetine showed no differences 12 weeks after treatment, 12 and a study comparing a hybrid traumafocused exposure-based acceptance and commitment therapy and medical management (sertraline supplemented with a sleep aid), or their combination, showed no significant differences after treatment. 9 Finally, prolonged exposure therapy resulted in statistically higher rates of remission of PTSD compared with paroxetine, but the combination of prolonged exposure therapy and paroxetine did not differentiate from either alone. 11 Importantly, this study was designed to deliver sertraline and prolonged exposure therapy plus sertraline under matched conditions that included rigorous training and ongoing supervision of psychotherapists and pharmacotherapists.…”

Section: Discussionmentioning

confidence: 92%

Efficacy of Prolonged Exposure Therapy, Sertraline Hydrochloride, and Their Combination Among Combat Veterans With Posttraumatic Stress Disorder

et al. 2019

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IMPORTANCE Meta-analyses of treatments for posttraumatic stress disorder (PTSD) suggest that trauma-focused psychotherapies produce greater benefits than antidepressant medications alone. OBJECTIVE To determine the relative efficacy of prolonged exposure therapy plus placebo, prolonged exposure therapy plus sertraline hydrochloride, and sertraline plus enhanced medication management in the treatment of PTSD.

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Section: Discussionmentioning

confidence: 92%

Efficacy of Prolonged Exposure Therapy, Sertraline Hydrochloride, and Their Combination Among Combat Veterans With Posttraumatic Stress Disorder

et al. 2019

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“…From a clinical perspective, it is possible that the assessment of symptoms among refugees has been excessively constrained to those of core PTSD. In that regard, it is notable that some studies undertaken among refugees in resettlement countries have documented a poor symptom response to conventional treatments for PTSD and depression (49, 50). The chronicity and complexity of the cases that receive treatment at specialized refugee-mental health services in these settings raise important questions whether the difficulties encountered in providing effective treatment relate in part to a failure to acknowledge the extent of the TS response which extends beyond core PTSD to encompass symptoms defined in ICD-11 as C-PTSD.…”

Section: Discussionmentioning

confidence: 99%

The Relationship of Complex Post-traumatic Stress Disorder and Post-traumatic Stress Disorder in a Culturally Distinct, Conflict-Affected Population: A Study among West Papuan Refugees Displaced to Papua New Guinea

et al. 2017

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Background: Controversy continues about the validity of the construct of complex post-traumatic stress disorder (C-PTSD). In particular, questions remain whether C-PTSD can be differentiated from post-traumatic stress disorder (PTSD) and, secondarily, other common mental disorders. The examination of these issues needs to be expanded to populations of diverse cultural backgrounds exposed to prolonged persecution. We undertake such an inquiry among a community sample of West Papuan refugees exposed to extensive persecution and trauma. Methods:We interviewed over 300 West Papuan refugees using the Refugee-Mental Health Assessment Package to record symptoms of PTSD, C-PTSD, major depressive disorder (MDD), and complex grief (CG). We used first-and second-order confirmatory factor analysis (CFA) to test aspects of the convergent and discriminant validity of C-PTSD.results: The CFA analysis supported both a one-factor and two-factor model of PTSD and C-PTSD. Nested model comparison tests provide support for the parsimonious one-factor model solution. A second-order CFA model of PTSD and C-PTSD produced a poor fit. The modified three-factor multi-disorder solution combining a traumatic stress (TS) factor (amalgamating PTSD and C-PTSD), MDD, and CG yielded a good fit only after removing three CG domains (estrangement, yearning, and behavioral change), a model that produced large standardized residuals (>0.20).conclusion: The most parsimonious model yielded a single TS factor combining symptom domains of C-PTSD and PTSD in this culturally distinct community exposed to extensive persecution and conflict-related trauma. There may be grounds for expanding the scope of psychological treatments for refugees to encompass this wider TS response. Our findings are consistent with theoretical frameworks focusing on the wider TS reaction of refugees exposed to human rights-related traumas of mass conflict, persecution, and displacement.

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“…Nonetheless, two published papers describing the trauma-affected refugees at the time of referral to CTP, from the same period find that the mean number of years since the first trauma was 22 years and the mean number of years with mental health problems as recalled by the patients were 14.7 years, similar to the time of arrival in Denmark. From these studies we expect that the number of years with mental health problems is substantial when admitted to treatment [51, 52]. …”

Section: Discussionmentioning

confidence: 99%

Somatic comorbidity among migrants with posttraumatic stress disorder and depression – a prospective cohort study

et al. 2016

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BackgroundIn a cohort of migrants in Denmark, we compared somatic disease incidence among migrants diagnosed with posttraumatic stress disorder (PTSD) and depression with migrants without a diagnosed psychiatric disorder.MethodsThe study builds on a unique cohort of migrants who obtained residence permit in Denmark from 1993 to 2010 (N = 92,104). The association with somatic disease was explored via register linkage. We used Poisson regression to model incidence rate ratios (IRR) adjusted for age, sex, income and region of origin. The Danish Data Protection Agency granted authorisation for the implementation of the project (No 2012-41-0065).ResultsOur results showed that migrants diagnosed with PTSD and depression had significantly higher rates of somatic diseases compared with migrants without diagnosed psychiatric disorders – especially, infectious disease (IRR, 1.89; 95% CI, 1.45–2.48; p < 0.01), neurological disease (IRR, 2.35; 95% CI, 1.91–2.91; p < 0.01) and pulmonary disease (IRR, 1.69; 95% CI, 1.37–2.00; p < 0.01). We further saw differences in the IRRs according to region of origin.ConclusionMigrants with PTSD and depression had a significantly higher rates of somatic comorbidity compared with migrants without a diagnosed psychiatric disorder. The rates were especially high for infectious, neurological and pulmonary diseases. Our results further suggest difference in the rates of somatic comorbidity according to region of. Preventive and treatment services should pay special attention to improve the overall health of migrants with PTSD and depression.

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The effect of flexible cognitive–behavioural therapy and medical treatment, including antidepressants on post-traumatic stress disorder and depression in traumatised refugees: pragmatic randomised controlled clinical trial

Abstract: In a pragmatic clinical setting, there was no effect of flexible CBT and antidepressants on PTSD, and there was a small-to-moderate effect of antidepressants and psychoeducation on depression in traumatised refugees.

Cited by 83 publications

References 38 publications

Efficacy of Prolonged Exposure Therapy, Sertraline Hydrochloride, and Their Combination Among Combat Veterans With Posttraumatic Stress Disorder

Efficacy of Prolonged Exposure Therapy, Sertraline Hydrochloride, and Their Combination Among Combat Veterans With Posttraumatic Stress Disorder

The Relationship of Complex Post-traumatic Stress Disorder and Post-traumatic Stress Disorder in a Culturally Distinct, Conflict-Affected Population: A Study among West Papuan Refugees Displaced to Papua New Guinea

Somatic comorbidity among migrants with posttraumatic stress disorder and depression – a prospective cohort study

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