Can a brief psycho-social intervention reduce psychological morbidity among snakebite victims ?

Setting: Snake bite victims will be recruited at the time of the bite from medical wards of the Polonnaruwa and Kurunegala general hospitals. Duration The total duration of the study will be 24 months. Data collection will start from January 2011. Study Sample All snake bite victims admitted to the above hospitals during the stipulated time period and identified as being envenomed and requiring treatment with anti-venom will be eligible for the study. The recruits will then be randomized into three groups. Group 1 will be managed as at present and will receive no specific psycho-social intervention. This group will act as a control to the other groups receiving psycho-social interventions. The second group will receive a brief intervention in the form of psychological first aid and psycho-education at the time of discharge from hospital. The third group will receive the above brief intervention on discharge as well as a brief intervention for post traumatic stress disorder one month following the snakebite. All three groups will be assessed for psychological morbidity at one month and six months post snake bite, and the effectiveness of the psychological interventions evaluated• Group 1- Normal management (No psychological intervention) • Group 2 – Normal management + Psychological first aid + Psycho-education • Group 3 – Normal management + Psychological first aid + Psycho-education + Brief intervention for PTSD The psycho-social interventions will be conducted by trained pre-intern doctors. The rationale behind this is that we wish to develop a psychological intervention that can be administered by primary care physicians or junior ward doctors. The doctors conducting the intervention will be trained formally by a Psychiatrist on aspects pertaining to communication skills, specific psychological interventions and ethical issues in dealing with patients. The specific types of psycho-social interventions provided will include: 1) Psychological First Aid: • Comfort and consolation • Sharing experience • Facilitating a sense of being in control • Identification of those in need of further help 2) Psycho-education: • Discuss patients perceptions of snake bite and tackle myths related to snakebite and it’s consequences. • Educate patients and relatives on the actual physical impact of snakebite and when to seek medical help. • Make patients and family members aware of psychological symptoms of depression and post traumatic stress disorder and when to seek appropriate help. • Educate on maladaptive coping methods such as avoidance behavior and maintenance of sick role seen following snake bite and the importance of rehabilitation within community. • Brief trauma focused cognitive behavior therapy. 3) Brief Intervention for post traumatic stress disorder: • Trauma based cognitive behaviour therapy

Snakebite victims admitted to the Polonnaruwa General Hospital and Kurunegala Teaching Hospital with evidence of envenoming.

Those with preexisting psychiatric disorders.