Prevention of Mental Health Problems in People Exposed to a Recent Highly Stressful Event: a Randomized Controlled Study

Highly stressful events are alterations in the life history of an individual that require an adaptation effort. Available studies warn that about 82 to 90% of the general population will be exposed to some type of traumatic event at some time in their lives. Chile, for example, is constantly prone to suffer highly stressful events of massive order, due to the high frequency of natural disasters that affect it from time to time: earthquakes, volcanic eruptions, floods, floods, as well as stressors that individually affect such as criminal violence, sexual abuse or threatening diseases. This makes the probability that a person has to be exposed to an event of this type is high, developing from it various consequences.

Although the majority will not develop long-term negative consequences, a significant percentage may develop different mental health problems, such as post-traumatic symptoms, and depression. It is estimated, for example, that 25% of people exposed to the 2010 Chile earthquake in the Bío Bío region developed a post-traumatic stress disorder. Likewise, 13.5% of adolescents exposed to the same earthquake developed high levels of depressive symptomatology.

However, there are also more adaptive responses after living these events, one of them is to grow from the negative experience. This possibility has been called posttraumatic growth [PTG], defined as the perception of positive changes that a person experiences as a result of the process of fighting a trauma. Although this growth is the result of an event that caused people to feel unwell, which explains the high relationship between PTSD and PTG in some cross-sectional studies, in multivariate studies and longitudinal different predictors are observed, and in prospective studies it has been determined that the highest PTG is associated in the long term with a higher level of well-being and a decrease in posttraumatic and depressive symptomatology, as well as a better quality of life.

Prevention and promotion actions are gaining increasing importance in all areas of the health field, including difficulties that occur in emergencies and post-emergencies. It is therefore important to determine the factors that contribute to a higher level of subjective well-being and PTG or a lower level of post-traumatic or depressive symptoms after experiencing a highly stressful event. Research that has been conducted to determine the predictors of these responses has shown their association with perceived severity, rumination, emotional self-regulation, religious coping or other coping strategies, such as the search for social support and the active coping.

In a study carried out by García in 2016-2017 with people facing a highly stressful event such as an accident at work intrusive rumination, brooding, deliberate rumination were determined as early predictors of posttraumatic symptomatology. Subjective severity of the event, negative religious coping and positive reinterpretation (inverse predictor), brooding, negative religious coping and positive religious coping (reverse predictor) were determined as early predictors of depressive symptomatology. Regarding positive responses, deliberate rumination and positive religious coping were determined as predictors of PTG, but only initial well-being was a predictor of subsequent subjective well-being. The strength of this study is that it evaluated the predictors less than a month after the event occurred, and continued its evolution at six months and one year after the accident occurred. Thus arises the possibility, supported by current empirical data, to develop intervention programs that encourage cognitive reassessment, deliberate rumination on the event, positive religious coping, active coping, the search for social support and initial well-being, in addition to reduce expressive suppression, intrusive and negative rumination, and negative religious confrontation.