Snakebites change your life. Emotionally, many people say they will not be the same again...
Snakes bite, which is the most normal thing if, by accident, you put your bare foot on top of them but, the calvary many patients / families have to go through to get (and often don't get) a treatment may be much more painful than the bite itself.
I've started a search on what has been published in India since some years ago. Scientific articles etc and I'm looking at the news too. Just started.
I'm linking you to the address of the site I've found a few hours ago, move forward as it is not the first new, keep scrolling till you reach it:
Apathy. After the serpent's sting. By Suhit Kelkar
And this is not isolated, it is common to South Asia, Africa, some countries of South America...
Here is a study done in Sri Lanka on the impact of snakebites as depression and / PTSD.
Delayed Psychological Morbidity Associated with Snakebite Envenoming
Shehan S. Williams1*, Chamara A. Wijesinghe1, Shaluka F. Jayamanne2, Nicholas A. Buckley3,4, Andrew H.
Dawson3,4, David G. Lalloo5, H. Janaka de Silva2
1 Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka, 2 Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka, 3 South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka, 4 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia, 5 Liverpool School of Tropical Medicine, Liverpool, United Kingdom
Dawson3,4, David G. Lalloo5, H. Janaka de Silva2
1 Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka, 2 Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka, 3 South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka, 4 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia, 5 Liverpool School of Tropical Medicine, Liverpool, United Kingdom
August 2011 I Volume 5 I Issue 8 I e1255
This is an Open Access article. Please refer always to the original as this is a summary.
ABSTRACT
Introduction:
The psychological impact of snakebite on its victims, especially possible late effects, has not been systematically studied.
Objectives:
To assess delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD), and impairment in functioning, among snakebite victims.
Methods:
The study has 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, geographical 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 somtic symptoms attributed to envenoming.
Results:
Previous 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.
Conclusions:
Snakebite causes significant ongoing psychological morbidity, a complication not previously documented. The economical and social impacts of this problem need further investigation.
INTRODUCTION:
In Sri Lanka, about 40,000 persons are treated for snakebite in government hospitals each year. The actual number of bites is likely to exceed this number, as many of the victims seek traditional forms of treatment. 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. Russell's viper, cobra and kraits account for most of the morbidity and mortality.
There are very little data on the long term physical and psychological consequences experienced by victims of snakebite. This is unfortunate, as most snakebite victims are in the economically productive age group, and the economic impact of any disability is likely to be high.
Snakebites are sudden and unexpected, and the element of surprise and the associated threat to life may cause extreme stress and anxiety in the victim.
The objective of our study was to assess stress and anxiety: particularly symptoms of anxiety and depression, post-traumatic stress disorder*, somatisation and impairment in functioning, at least 12 months following snakebite envenoming.
PTSD DEFINITION: Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event. Most people who go through traumatic events may have temporary difficulty adjusting and coping, but with time and good self-care, they usually get better. If the symptoms get worse, last for months or even years, and interfere with your day-to-day functioning, you may have PTSD. Souce: Mayo Clinic
For the study, the Polonnnaruwa district of the North Central Province of Sri Lanka was selected. It is a dry zone, with predominantly rural agricultural population. The highest numbers of snakebite envenoming in Sri Lanka are reported from this region. Mental health services in this area are pooly developed.
DESIGN:
Quantitative arm: n= 200 persons (cases) over 18 years of age, with history of snakebite envenoming treatment at least 12 months previously.
Letters (in Sinhala, vernacular language used in the district) were sent out to those selected inviting them to participate in the study.
Structured questionnaire: Demographic characteristics, circumstances of the bite, hospital stay, perceived severity of the bite, return to work and functioning. Physical examination and psychological scales (modified Sinhala version of the Beck depression inventory, Post-traumatic Stress Symptoms Scale-Self Report, Hopkins symptoms checklist and Sheehan Disability inventory) were administered by experienced psychiatrists on these tools.
Hospital attendees Control group matching age, sex, geographical location and occupation without history of SB.
Qualitative branch: 5 focus group discussions consisting of 6-10 snake bite victims.
RESULTS:
Of the 200 snakebite victims to whom the letters of invitation were sent, 88 (74 males and 14 females) responded and participated in the study. No significant differences between responders and non-responders were found.
Results are best seen on table 2
A negative effect on their subsequent employment resulting in less skilled or fewer hours of work was claimed by 24 (27%) of victims; nine (10%) had stopped working after the incident.
Qualitative findings
Various physical symptoms were attributed to the snake envenoming. Five main themes were identified: Poor vision, tooth decay, body aches, headaches, weakness and tiredness of the body. Poor vision, body aches and tiredness were the most frequently occurring observations.
(If you remember the article on socio-economic impact in Tamil Nadu, patients complaints are the same! tiredness, loose of vision and watery eyes...)
DISCUSSION:
The findings show significant psychological morbidity one to four years after snakebite envenoming. This study demonstrate depressive symptoms in more than 50% of snake bite victims who had been treated for serious envenoming, more than 1 year after the index episode (control group 15%). There are almost no studies on the consequences of animal bites in children or adults published on literature worldwide.
The population of the study was composed by young adults (mean age 41), with young families, living in poverty (daily income less than US$ 7.5) and often working under difficult conditions in farms and rice fields.
COMPARISON WITH PSYCHOLOGICAL MORBIDITY AFTER OTHER TRAUMA:
This association is very creative! It's a great idea that helps a lot to understand!
 |
| Naga Raksha (Cobra Mask). Sri Lanka Jorge Láscar Wiki Commons |
Following the tsunami that affected Sri Lanka in 2001, PTSD and depression rates were 21% and 16% respectively. In a study at car crashes, 23% of the hospitalized passengers and 11% of the drivers had significant levels os stress 18 months after the accident. Following war trauma in a civilian population in Lanka, 27% reported PTSD, 25% major depression, 41% somatization and 26% anxiety disorders.
PTSD prevalence in the snakebite victims of the study is comparable to the rates seen following the tsunami and car crashes, and lower than that reported following war trauma in Sri Lanka.
Like in many parts of South Asia, in Sri Lanka too snakes are revered, and particularly the cobra is considered sacred. Stories of protection as well as vengeful attacks by snakes for past atrocities even in a previous birth, based on a belief of re-birth as animals, abound.
Further exploration of the overall impact of snake bite in the rural tropics and the direct and indirect cost associated with the psychological sequelae and loss of employment is warranted.
ॐ लोकाः समस्ताः सुखिनो भवन्तु ॥
Om Lokah Samasthah Sukhino Bhavantu
May all beings everywhere be happy and peaceful
No comments:
Post a Comment