The British Journal of Psychiatry (2010) 196: 69-74. doi: 10.1192/bjp.bp.109.066266
© 2010 The Royal College of Psychiatrists
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TENTS guidelines: development of post-disaster psychosocial care guidelines through a Delphi process

Jonathan I. Bisson, DM, FRCPsych and Behrooz Tavakoly, PhD

Department of Psychological Medicine and Neurology, Cardiff University, University Hospital of Wales, Cardiff, UK

Anke B. Witteveen, PhD

Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands

Dean Ajdukovic, PhD

Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia

Louis Jehel, MD, PhD

Department of Psychiatry, Hopital TENON, Paris, France

Venke J. Johansen, PhD and Dag Nordanger, PhD

National Centre for Disaster Psychiatry, Helse Bergen Helseforetak, Haukeland Universitets, Bergen, Norway

Francisco Orengo Garcia, MD

Sociedad Española de Psicotraumatología, Estrés Traumático y Disociación, Madrid, Spain

Raija-Leena Punamaki, PhD

Docent Trauma Psychology, Helsinki Collegium of Advanced Studies, University of Helsinki, Finland

Ulrich Schnyder, MD

Department of Psychiatry, University Hospital Zurich, Switzerland

A. Ufuk Sezgin, PhD

Kocaeli University, Psychosocial Trauma Education, Research and Treatment Unit, Kocaeli, Turkey

Lutz Wittmann, PhD

Department of Psychiatry, University Hospital Zurich, Switzerland

Miranda Olff, PhD

Center for Psychological Trauma, Psychiatry Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Correspondence: Correspondence: Jonathan I. Bisson, Cardiff University, Monmouth House, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK. Email: bissonji{at}cf.ac.uk

Declaration of interest

None.

Background

How best to plan and provide psychosocial care following disasters remains keenly debated.

Aims

To develop evidence-informed post-disaster psychosocial management guidelines.

Method

A three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others’ responses in the subsequent rounds.

Results

A total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement ‘all responses should provide access to pharmacological assessment and management’ did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cognitive–behavioural therapy (CBT) is recommended for acute stress disorder or acute post-traumatic stress disorder, with other treatments with an evidence base for chronic post-traumatic stress disorder being made available if trauma-focused CBT is not tolerated.

Conclusions

The Delphi process allowed a consensus to be achieved in an area where there are limitations to the current evidence.


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