Abstract
IntroductionThe psychological impact of snakebite on its victims, especially possible late effects, has not been systematically studied.ObjectivesTo assess delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD), and impairment in functioning, among snakebite victims.MethodsThe study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following snakebite from the North Central Province of Sri Lanka were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. Persons with no history of snakebite, matched for age, sex, geograpical location and occupation, acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist, Sheehan Disability Inventory and a structured questionnaire were administered. In the qualitative arm, focus group discussions among snakebite victims explored common somatic symptoms attributed to envenoming.ResultsPrevious snakebite victims (cases) had more symptoms than controls as measured by the modified Beck Depression Scale (mean 19.1 Vs 14.4; p<0.001) and Hopkins Symptoms Checklist (38.9 vs. 28.2; p<0.001). 48 (54%) cases met criteria for depressive disorder compared to 13 (15%) controls. 19 (21.6%) cases also met criteria for PTSD. 24 (27%) claimed that the snakebite caused a negative change in their employment; nine (10.2%) had stopped working and 15 (17%) claimed residual physical disability. The themes identified in the qualitative arm included blindness, tooth decay, body aches, headaches, tiredness and weakness.ConclusionsSnakebite causes significant ongoing psychological morbidity, a complication not previously documented. The economic and social impacts of this problem need further investigation.
Highlights
The psychological impact of snakebite on its victims, especially possible late effects, has not been systematically studied
In Sri Lanka, about 40000 persons were treated for snake bite in government hospitals each year [2]
We investigated the possible psychological impact of snakebite in 88 persons who had been envenomed 1 to 4 years ago in a rural agricultural area in Sri Lanka by using accepted measurements of psychological disability and group discussions among victims. 88 persons from the same areas who had not been bitten by a snake, but were of similar age, sex and occupation were assessed in a similar manner
Summary
The psychological impact of snakebite on its victims, especially possible late effects, has not been systematically studied. Snakebite is a significant health issue in the rural tropics. It has been estimated that at least 421,000 envenomings and 20,000 deaths occur due to snakebite each year each year, and that these numbers may even be as high as 1.8 million envenoming and 94 000 deaths [1]. Snakes are feared for their bite associated mortality and morbidity but only six of the 92 snake species in Sri Lanka are medically important. These are the Russell’s viper, cobra, the two kraits (common and Sri Lankan), saw scaled viper and hump nosed viper. The Russell’s viper, cobra and kraits account for most of the morbidity and mortality
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