A Randomized Controlled Trial of a Brief Intervention for Delayed Psychological Effects in Snakebite Victims

Chamara A Wijesinghe, Shehan S Williams, Anuradhani Kasturiratne, Nishantha Dolawaththa, Piyal Wimalaratne, Buddhika Wijewickrema, Shaluka F Jayamanne, Geoffrey K Isbister, Andrew H Dawson, David G Lalloo and H Janaka de Silva

PLOS Neglected Tropical Diseases, 2015, vol. 9, issue 8, 1-12

Abstract: Background: Snakebite results in delayed psychological morbidity and negative psycho-social impact. However, psychological support is rarely provided to victims. Aim: To assess the effectiveness of a brief intervention which can be provided by non-specialist doctors aimed at reducing psychological morbidity following snakebite envenoming. Method: 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. Trial Registration: Sri Lanka Clinical Trials Registry: SLCTR/2011/003 Author Summary: Snakebite is an important health problem in many rural communities in tropical countries. However, little is known about the lasting physical and mental health effects following a bite. We recently reported that mental problems, with harmful social outcomes, can occur in many people after they are bitten by a snake. As the affected are often poor farmers or manual workers, this may affect their livelihoods. We, therefore, performed a trial which looked at the effectiveness of short psychological interventions, lasting about 15 and 20 minutes, which can be provided by even non-specialist doctors, in reducing these mental and social problems in people bitten by snakes. Our results show that such interventions may indeed be helpful to reduce some of these problems, but more research is needed to improve these interventions, especially so that they that can reduce post-traumatic stress disorder and depression after snakebite.

Date: 2015
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DOI: 10.1371/journal.pntd.0003989

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