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. 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. © 2015 wijesinghe et al.