Abstracts
Résumé
Objectifs Les catastrophes sont de plus en plus fréquentes et intenses à l’échelle mondiale. Les individus qui y sont exposés sont à risque de développer un trouble de stress post-traumatique (TSPT), d’insomnie ou de dépression. Une approche de soins par paliers, dont les premiers niveaux offrent des interventions moins coûteuses en termes de ressources spécialisées, permettrait de répondre efficacement et de manière adaptée aux besoins de santé mentale des populations affectées par des catastrophes. Un essai contrôlé randomisé mené auprès de personnes évacuées des feux de forêt de Fort McMurray (Alberta, Canada) de 2016 présentant des symptômes de TSPT, de dépression et d’insomnie a démontré l’efficacité de l’autotraitement RESILIENT pour réduire ces symptômes. Cependant, son impact auprès de personnes présentant un diagnostic probable de TSPT n’a pas été examiné. Ainsi, cette étude vise à évaluer l’efficacité de RESILIENT à réduire les symptômes de TSPT, de dépression et d’insomnie chez les personnes présentant un TSPT probable à la suite d’une catastrophe.
Méthode Une analyse secondaire a été réalisée à partir d’un sous-échantillon de 38 participants d’un essai contrôlé randomisé mené auprès de personnes évacuées des feux de forêt de Fort McMurray. Pour être admissibles, les participants devaient présenter un TSPT probable. Seize personnes répondant aux critères avaient été assignées à la condition traitement et 22 à la condition témoin de type liste d’attente. Les participants ont eu accès à la plateforme de traitement RESILIENT, un autotraitement guidé en ligne composé de 12 séances thérapeutiques offrant des stratégies cognitivo-comportementales validées par les données probantes pour le TSPT, la dépression et l’insomnie. Les participants ont rempli les versions anglaises validées de questionnaires autorapportés mesurant la sévérité de leurs symptômes de TSPT (PTSD Checklist for DSM-5), d’insomnie (Insomnia Severity Index) et de dépression (Patient Health Questionnaire ; PHQ-9) au pré et au post-traitement.
Résultats Des analyses à modèles mixtes ont été réalisées. Les analyses sur la base d’intention de traiter n’ont pas atteint le seuil de signification statistique pour les effets d’interaction (condition x temps). Les analyses subséquentes, excluant les personnes assignées à la condition traitement n’ayant pas accédé au traitement, ont toutefois révélé des améliorations cliniquement et statistiquement significatives pour les personnes ayant assisté au moins à 1 séance du traitement comparativement aux personnes assignées à la condition témoin.
Conclusion Ces résultats soutiennent l’efficacité de la plateforme RESILIENT pour réduire les symptômes de TSPT, de dépression et d’insomnie auprès de personnes présentant un TSPT probable après avoir été évacuées à cause de feux de forêt. Ces résultats démontrent la pertinence de l’approche de soins par paliers, offrant en premier lieu des interventions autogérées pour les populations exposées à des catastrophes.
Mots-clés :
- catastrophe,
- trouble de stress post-traumatique,
- dépression,
- insomnie,
- autotraitements
Abstract
Objectives Disasters are increasing in frequency and intensity worldwide. Individuals exposed to them are at risk of developing post-traumatic stress disorder (PTSD), insomnia or depression. A stepped care approach, in which the first levels offer interventions that are less costly in terms of specialized resources, could help in meeting the mental health needs of disaster-affected populations. A randomized controlled trial involving evacuees of the 2016 Fort McMurray (Alberta, Canada) wildfires with symptoms of PTSD, depression and insomnia demonstrated the efficacy of the RESILIENT self-treatment in reducing these symptoms. However, its impact among people with a probable diagnosis of PTSD has not been examined. This study aimed to evaluate the effectiveness of RESILIENT in reducing symptoms of PTSD, depression and insomnia in people with probable PTSD following a disaster.
Method A secondary analysis was performed on a subsample of 38 participants from a randomized controlled trial of evacuees from the Fort McMurray wildfires. To be eligible, participants had to have probable PTSD. Sixteen people meeting the criteria were assigned to the treatment condition and 22 to the wait-list control condition. Participants had access to the RESILIENT treatment platform, a guided online self-treatment consisting of 12 therapeutic sessions offering evidence-based cognitive-behavioral strategies for PTSD, depression and insomnia. Participants completed validated self-report questionnaires measuring the severity of their symptoms of PTSD (PTSD Checklist for DSM-5), insomnia (Insomnia Severity Index) and depression (Patient Health Questionnaire; PHQ-9) pre- and post-treatment.
Results Mixed-model analyses were performed. Intent-to-treat analyses failed to reach statistical significance for interaction effects (condition x time). However, subsequent analyses excluding those assigned to the treatment condition who did not access the treatment revealed clinically and statistically significant improvements for those who completed at least 1 treatment session compared with those assigned to the control condition.
Conclusion These results support the efficacy of the RESILIENT platform in reducing symptoms of PTSD, depression and insomnia in people with probable PTSD following evacuation due to wildfires. These results demonstrate the relevance of the stepped care approach, offering primarily self-managed interventions for disaster-exposed populations.
Keywords:
- disaster,
- post-traumatic stress disorder,
- depression,
- insomnia,
- self-treatment
Appendices
Bibliographie
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