Abstract
BackgroundResearch consistently reports elevated rates of exposure to traumatic events and post-traumatic stress disorder (PTSD) in people with severe mental illness (SMI). PTSD may be adequately managed with psychotherapy; however, there is a gap when it comes to management in culturally diverse settings like Botswana. This paper describes a study protocol whose aim is to culturally adapt the BREATHE intervention, a brief psychological intervention for people living with comorbid PTSD and SMI that was developed and tested in the USA; assess the feasibility and acceptability of the adapted BREATHE intervention and explore its efficacy.MethodsThe study will be conducted in three phases using a mixed methods approach. The first phase will identify and describe the most common traumatic experiences and responses to traumatic experiences, amongst patients with SMI, and patients’ and mental health care providers’ perceptions about suitable PTSD interventions for Botswana. The second phase will entail cultural adaption of the intervention using findings from phase 1, and the third phase will be a pilot trial to assess the feasibility and acceptability of the culturally adapted intervention and explore its efficacy. Quantitative and qualitative data will be analysed using basic descriptive statistics and thematic analysis, respectively.DiscussionLiterature highlights cultural variations in the expression and management of mental illness suggesting the need for culturally adapted interventions. The findings of this feasibility study will be used to inform the design of a larger trial to assess the efficacy of an adapted brief intervention for PTSD in patients with SMI in Botswana.Trial registrationClinicaltrials.gov registration: NCT04426448. Date of registration: June 7, 2020.
Highlights
Research consistently reports elevated rates of exposure to traumatic events and post-traumatic stress disorder (PTSD) in people with severe mental illness (SMI)
Anecdotal findings by the authors have revealed that a significant proportion of patients admitted at the referral hospital have a history of exposure to traumatic events and/or post-traumatic stress symptoms
Screening for trauma exposure and PTSD remains overlooked in the treatment of patients with SMI limiting the quality of care provided to patients with SMI
Summary
The first phase will collect formative data to inform the adaptation of BREATHE, including the perceptions of mental health clinicians (doctors, nurses, clinical psychologists and social workers) about trauma experiences amongst their clients (patients with SMI) and about the BREATHE intervention. Focus groups will be conducted with mental health clinicians based at SPH to explore perceptions towards traumatic experiences amongst patients they care for, interventions they use or know about for the management of PTSD and the proposed BREATHE intervention. For patients to be eligible to participate in the pilot trial, they should be at least 18 years old, able to understand Setswana or English, must meet the DSM-5 criteria for any SMI as categorised for this study and meet the criteria for post-traumatic stress disorder as assessed with the Post Traumatic Checklist-5 (PCL-5), and the MINI PLUS PTSD module. Each construct is assessed with four items which have been found to be valid and
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