Advancing PTSD Diagnosis, Treatment, and Dissemination of Trauma Care in Humanitarian Emergencies – A Proof-of-Concept Clinical Trial

Abstract

Decentralised health systems in low- and middle-income countries impacted by humanitarian crises lack resources and a qualified workforce to attend to the overwhelming demand for mental health care in emergencies. Cross-cultural screening and diagnostic tools, alongside innovative treatment approaches that are safe, cost-effective, and scalable are needed. The primary aims of this study included (1) examining the clinical validity of a new screener, the Global Psychotrauma Screen (GPS), among refugees; (2) identifying candidate cognitive and electrophysiological diagnostic markers of combined clinical and subclinical PTSD; and (3) investigating the preliminary efficacy of a novel trauma-focused mobile App intervention via changes in clinical symptomatology, cognitive performance and electrophysiological brain activity. A non-randomised clinical trial was conducted with 70 African refugees in Australia. Participants completed clinical interviews, neuropsychological tests, quantitative electrophysiology (qEEG) recordings, and the seven-day App intervention from home. On the eighth day, participants returned to the lab to repeat all baseline assessments, followed by 1-, 3-, 6-, and 12-month interviews. The GPS demonstrated high sensitivity and specificity in detecting a probable diagnosis of PTSD, depression, and dissociative subtype. Baseline analyses indicated that the PTSD group had increased qEEG power across multiple brain regions, and faster rapid visual information processing. The intervention was associated with significant reductions in PTSD severity and related comorbidities, and changes in qEEG and cognitive performance. In conclusion, this study (1) indicated that the GPS may be a useful screening tool for refugees; (2) identified novel diagnostic and prognostic markers for clinical and subclinical PTSD, and (3) provided preliminary evidence for the efficacy of the proposed App in reducing PTSD severity and comorbid symptomatology. Randomised trials are recommended to further develop mobile-based screening, diagnostic and prognostic features, and determine the App’s cross-cultural efficacy in emergency settings.