Sante Ment Que. 2025 Fall-Winter;50(2):143-167.
ABSTRACT
Objectives Disasters are increasing in frequency and intensity worldwide. Individuals exposed to them are at risk of developing post-traumatic stress disorder (PTSD), insomnia or depression. A stepped care approach, in which the first levels offer interventions that are less costly in terms of specialized resources, could help in meeting the mental health needs of disaster-affected populations. A randomized controlled trial involving evacuees of the 2016 Fort McMurray (Alberta, Canada) wildfires with symptoms of PTSD, depression and insomnia demonstrated the efficacy of the RESILIENT self-treatment in reducing these symptoms. However, its impact among people with a probable diagnosis of PTSD has not been examined. This study aimed to evaluate the effectiveness of RESILIENT in reducing symptoms of PTSD, depression and insomnia in people with probable PTSD following a disaster. Method A secondary analysis was performed on a subsample of 38 participants from a randomized controlled trial of evacuees from the Fort McMurray wildfires. To be eligible, participants had to have probable PTSD. Sixteen people meeting the criteria were assigned to the treatment condition and 22 to the wait-list control condition. Participants had access to the RESILIENT treatment platform, a guided online self-treatment consisting of 12 therapeutic sessions offering evidence-based cognitive-behavioral strategies for PTSD, depression and insomnia. Participants completed validated self-report questionnaires measuring the severity of their symptoms of PTSD (PTSD Checklist for DSM-5), insomnia (Insomnia Severity Index) and depression (Patient Health Questionnaire; PHQ-9) pre- and post-treatment. Results Mixed-model analyses were performed. Intent-to-treat analyses failed to reach statistical significance for interaction effects (condition x time). However, subsequent analyses excluding those assigned to the treatment condition who did not access the treatment revealed clinically and statistically significant improvements for those who completed at least 1 treatment session compared with those assigned to the control condition. Conclusion These results support the efficacy of the RESILIENT platform in reducing symptoms of PTSD, depression and insomnia in people with probable PTSD following evacuation due to wildfires. These results demonstrate the relevance of the stepped care approach, offering primarily self-managed interventions for disaster-exposed populations.
PMID:41812171
