World Health Organization guidelines for management of acute stress, PTSD, and bereavement : key challenges on the road ahead

Tol, Wietse A. ; Barbui, Corrado ; Bisson, Jonathan ; Cohen, Judith ; Hijazi, Zeinab ; Jones, Lynne ; De Jong, Joop T. V. M. ; Magrini, Nicola ; Omigbodun, Olayinka ; Seedat, Soraya ; Silove, Derrick ; Souza, Renato ; Sumathipala, Athula ; Vijayakumar, Lakshmi ; Weissbecker, Inka ; Zatzick, Douglas ; Van Ommeren, Mark (2014-12)

CITATION: Tol, W.A. et al. 2014. World Health Organization guidelines for management of acute stress, PTSD, and bereavement: Key challenges on the road ahead. PLoS Medicine, 11(12):e1001769, doi:10.1371/journal.pmed.1001769.

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The implementation of new WHO mental health guidelines for conditions and disorders specifically related to stress is likely to face obstacles, particularly in low- and middle-income countries. N Formulation of evidence-based guidelines is complicated by limited knowledge regarding (a) the effectiveness of commonly implemented interventions, (b) the effectiveness of established evidence-based interventions when used in situations of ongoing adversity, and (c) the effectiveness of widely used cultural practices in LMICs. The application of the guidelines requires improved knowledge on how to reduce potentially harmful practices that are widely applied. N The implementation of recommendations regarding psychotherapeutic interventions will require an approach that balances (a) strengthening the availability and capacity of specialists to train and supervise and (b) shifting to the delivery of psychotherapy by non-specialists. N The strengthening of evidence for managing these conditions will require collaborative efforts by researchers and practitioners in a manner that is mindful of local sociocultural and health system realities.

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