Skip to main content

Table 1 Summary of World Health Organization mhGAP guidelines for management of conditions related to stress

From: Challenges for the implementation of World Health Organization guidelines for acute stress, PTSD, and bereavement: a qualitative study in Uganda

Condition

Intervention

Client

Recommendation

Acute stress symptoms

Psychological

Adults

CBT-T recommended. No recommendation for EMDR, “stand-alone” problem-solving counseling, or psychoeducation. Stress management may be used if CBT not available along with PFA.

Children

No specific recommendationa. PFA may be considered.

Pharmacological

Adults

Benzodiazepines and antidepressants should not be offered.

Children

Benzodiazepines and antidepressants should not be offered.

Secondary acute insomnia

Psychological

Adults

Relaxation technique and sleep hygiene advice should be provided through existing cultural practices recommended.

Children

No specific recommendationa. Relaxation techniques and sleep hygiene advice may be safe and effective in adolescents.

Pharmacological

Adults

Benzodiazepines should not be offered apart from exceptional cases in which short-term use (3–7) days may be considered.

Children

Benzodiazepines and antidepressants should not be offered.

Secondary nonorganic enuresis

Psychological

Children

Psychoeducation and skills training for parents recommended.

Dissociative disorders

Psychological

Adults

No specific recommendationa. PFA and the use of culturally appropriate interventions that are not harmful may be considered.

Children

Hyperventilation

Psychological

Adults

No specific recommendation for rebreathing into a paper baga.

Children

Rebreathing into paper bag should not be considered.

PTSD

Psychological

Adults

Group or individual CBT-T, EMDR, and stress management are recommended.

Children

Group or individual CBT-T and EMDR are recommended. Stress management may be beneficial.

Pharmacological

Adults

SSRIs and TCAs should not be offered as first-line treatment but may be considered if psychological interventions are not available or if there is co-occurring depression.

Children

Antidepressants should not be used.

Bereavement

Psychological

Adults

Structured psychological interventions should not be universally offered. General principles of care (providing and mobilizing social support, encouraging culturally appropriate mourning) should be used.

Children

Pharmacological

Adults

Benzodiazepines should not be offered for individuals who do not meet criteria for a mental disorder.

Children

  1. Abbreviations: PFA psychological first aid, EMDR eye movement desensitization and reprocessing, CBT-T cognitive behavioral therapy with trauma focus, SSRI selective serotonin reuptake inhibitor, TCA tricyclic antidepressant
  2. aNo recommendation could be given due to insufficient evidence