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