Psychological Medicine

  • Psychological Medicine / Volume 40 / Issue 12 / December 2010, pp 2049-2057
  • Copyright © Cambridge University Press 2010. The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <>. The written permission of Cambridge University Press must be obtained for commercial re-use.
  • DOI: (About DOI), Published online: 09 March 2010

Original Articles

Outreach and screening following the 2005 London bombings: usage and outcomes

C. R. Brewina1 c1, N. Fuchkana1, Z. Huntleya1, M. Robertsona2, M. Thompsona2, P. Scragga2, P. d'Ardennea3 and A. Ehlersa4

a1 Clinical, Educational and Health Psychology, University College London, UK

a2 Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, UK

a3 Institute of Psychotrauma, East London NHS Foundation Trust, London, UK

a4 Centre for Anxiety Disorders and Trauma, Institute of Psychiatry, London, UK


Background Little is known about how to remedy the unmet mental health needs associated with major terrorist attacks, or what outcomes are achievable with evidence-based treatment. This article reports the usage, diagnoses and outcomes associated with the 2-year Trauma Response Programme (TRP) for those affected by the 2005 London bombings.

Method Following a systematic and coordinated programme of outreach, the contact details of 910 people were obtained by the TRP. Of these, 596 completed a screening instrument that included the Trauma Screening Questionnaire (TSQ) and items assessing other negative responses. Those scoring ≥6 on the TSQ, or endorsing other negative responses, received a detailed clinical assessment. Individuals judged to need treatment (n=217) received trauma-focused cognitive-behaviour therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR). Symptom levels were assessed pre- and post-treatment with validated self-report measures of post-traumatic stress disorder (PTSD) and depression, and 66 were followed up at 1 year.

Results Case finding relied primarily on outreach rather than standard referral pathways such as primary care. The effect sizes achieved for treatment of DSM-IV PTSD exceeded those usually found in randomized controlled trials (RCTs) and gains were well maintained an average of 1 year later.

Conclusions Outreach with screening, linked to the provision of evidence-based treatment, seems to be a viable method of identifying and meeting mental health needs following a terrorist attack. Given the failure of normal care pathways, it is a potentially important approach that merits further evaluation.

(Received October 05 2009)

(Revised January 15 2010)

(Accepted January 18 2010)

(Online publication March 09 2010)


c1 Address for correspondence: Dr C. R. Brewin, Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK. (Email: