Dr Nika Fuchkan

Nika's research topic is "Burden of Posttraumatic Stress Disorder (PTSD) - health, social and economic impacts of exposure to the London bombings."

Posttraumatic Stress Disorder (PTSD) is a common disorder that causes significant health, social and economic burden for the individuals who suffer from it and consequently for society. However, little is known about these consequences of PTSD, and in particular there is a lack of empirical data in relation to its economic impact on individuals and health systems. The majority of completed studies have focused on anxiety disorders in general or on depression (NICE, 2005) while little is known about the exact economic impacts of PTSD or about the cost-effectiveness of its treatment (McCrone et al., 2003).

Early detection and treatment of PTSD are important in order to avoid it becoming a chronic condition with potentially profound consequences for individuals, their family and society as a whole. In order to ensure that, the screen and treat approach has been proposed in recent years. This approach focuses on identifying and screening all individuals exposed to a traumatic event in order to refer them to the evidence-based treatment if needed. However, the screen and treat approach had not been implemented and evaluated following a major disaster in the UK until the 2005 London bombings.

The work described in this thesis is nested within the Evaluation of the Clinical Effectiveness of NHS Trauma Response after the 2005 London bombings implemented in the form of a Screen and treat (ST) programme. The aim of Nika's thesis is to assess the health, social, and economic impacts of PTSD by focusing on individuals exposed to the London bombings (LB).

Upon reviewing the current evidence and measures of health, social and economic impact of PTSD, Nika has focused on exploring costs and outcomes of exposure to the LB from several perspectives. Firstly, she assessed the impact of the LB in terms of service use and the effects on health, social, and economic activity of those affected, and presented the costs and outcomes associated with exposure to the LB. In the next step, she explored costs and their relationship to participants' characteristics, exposure factors and service type.

Furthermore, Nika conducted economic evaluation of the ST programme in a form of three cost-effectiveness analyses in order to compare costs and outcomes for three distinct participants' groups. Finally, she explored the idea of screening for PTSD in a broader context. Nika presented these results and discussed policy implications from a qualitative study looking into feasibility of screening for PTSD within primary care services, in particular in the context of the Improving Access to Psychological Therapies (IAPT) programme.