Need to Know

Child Clinicians Use Unproven PTSD Therapies

2008-09-10T11:17:00.000-07:00

According to a study in the September 2008 American Journal of Preventive Medicine, there are only a few proven, effective practices for treating children with Post-Traumatic Stress Disorder. Yet more than 75% of mental health professionals may be practicing something else.

According to the meta-analysis conducted by the Task Force on Community Preventive Services, “evidence was insufficient to determine the effectiveness of play therapy, art therapy, pharmacologic therapy, psychodynamic therapy, or psychological debriefing in reducing psychological harm.”

On the other hand, Reuters reports:

"There is substantial research showing the effectiveness of group or individual cognitive behavioral therapy in treating children and teens experiencing the psychological effects of trauma," the CDC's Robert Hahn, who led the study, said in a statement. "We hope these findings will encourage clinicians to use the therapies that are shown to be effective."

Read the abstract or the Reuters article for more details.

Trauma, PTSD Shrink Hippocampus

2008-08-29T12:05:00.000-07:00

According to a meta-analysis of 19 studies, trauma and PTSD symptoms may precede a reduction in the size of the hippocampus, a part of the brain involved in learning and memory. The findings seem to support a physical, neurological component to PTSD.

Small hippocampi and PTSD have been linked in the past, but it has been difficult to disentangle cause and effect, according to BYU grad student and lead author Martin Woon.

"The big question about which came first, much like the chicken and the egg, has persisted... We found children’s hippocampi were intact after the onset of abuse, but somehow there was shrinkage in the group that had reached adulthood."

The study appeared in the August issue of the neuroscience journal Hippocampus.

The abstract and an article on the findings are available online.

PTSD Increases Heart Disease Risk

2008-07-14T07:07:00.000-07:00

As a risk factor for heart disease, Post-Traumatic Stress Disorder is like “smoking two to three packs of cigarettes per day for more than 20 years,” according to a Geisinger study published in the July issue of Psychosomatic Medicine. The study examined over 4,000 Vietnam veterans and found that those with PTSD were more than twice as likely to die of heart disease and those without.

Army War College Bibliography on PTSD

2008-04-10T10:15:00.000-07:00

"Post-Traumatic Stress Disorder and the Military: A Selected Bibliography" has just been uploaded to the US Army War College website. The bibliography is an update of a 2005 bibliography compiled by the same librarian, Lori Sekala. It includes government sources, along with scholarly journals and periodicals. From the preface:

Over the past several years, the topic of military mental healthcare has received renewed attention, both inside and outside the Armed Forces. This selected bibliography focuses on post-traumatic stress disorder (PTSD) and its presentation in military personnel. Included are references to books, documents, periodical articles, multimedia, and web sites related to this topic. A separate section concentrates on PTSD in members of the military and its relationship to age, gender, or ethnicity. This is followed by a section focusing on disability claims as the result of PTSD.

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Does the bibliography leave anything out? Leave a comment and tell us.

A Comprehensive PTSD Handbook

2008-03-11T08:45:00.000-07:00

In the American Journal of Psychiatry, Jonathan I. Bisson reviews the new Handbook on PTSD: Science and Practice, edited by Matthew J. Friedman, Terence M. Keane and Patricia A. Resickis. The review calls it a “comprehensive” and “highly readable volume that will undoubtedly be of great use to individuals specializing in traumatic stress.”

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Have you read this book? Post a comment and share your thoughts.

Veterans No Longer Need to "Re-Prove" PTSD

2008-02-25T10:11:00.000-08:00

Kelly Kennedy at the Air Force Times reports that the Veteran Affairs Department will no longer require veterans already diagnosed with Post-Traumatic Stress Disorder filing a disability claim ~~for Post-Traumatic Stress Disorder~~ to provide an additional written verification that they had witnessed or experienced a traumatic event.

As Kennedy reports:

In Iraq, troops joke about keeping a pen and paper on hand in case they witness a shooting or explosion or are injured themselves. That way, they can run around and have all their buddies sign a quick statement saying it really happened. The joke loses steam when a Marine has to prove he was involved in a traumatizing event when he had a hand blown off in that event, or when a soldier has to prove he watched his friends die to qualify for benefits.
“They don’t have to reprove their diabetes,” said Mary Ellen McCarthy, special projects counsel for the Senate Veterans’ Affairs Committee. “They don’t have to reprove a leg injury. I have never seen any other condition diagnosed in service [for which] people had to reprove their injury."

Under the new policy, a medical examination will be sufficient to prove PTSD, hopefully speeding up the already backlogged process of filing disability claims.

Update: Thanks to reader twocents for pointing out that Air Force Times had updated the article. The original didn't reflect that the change only affects veterans already diagnosed with PTSD by the military.

Trauma-Resistant Genes

2008-02-13T12:18:00.000-08:00

Researchers have isolated a gene whose variation may help explain why some victims of childhood abuse avoid adult depression. “Knowing what those variations are eventually could help clinicians individualize care for their patients by predicting who may be at risk or suggesting more precise avenues for treatment,” says National Institute of Mental Health Director Thomas R. Insel, M.D. The study was published in the Archives of General Psychiatry and funded by the NIMH.

For more information, the NIMH has a press release here, while Scientific American has a brief here, and the abstract of the original study is available here.

No Peace for Peacekeepers

2008-01-01T08:16:00.000-08:00

The Torontoist reports that a new study from the Canadian Journal of Psychiatry has found a 10% rate of probable PTSD and a 29% rate of probable depression among Canadian peacekeepers. "Peacekeeping has become more dangerous since evolving from observer operations to peace-enforcing missions in the 1990s," the Torontoist reports.

A PDF of the study is available here.

VA studies suicide

2007-11-01T16:38:00.000-07:00

The results from the Department of Veterans Affairs' latest study of suicide among veterans were released this week.

... the study finds that the predictors of suicide among veterans in depression treatment differ from those seen in the general American population, with younger, white, non-Hispanic men having the highest risk among the veterans.
Veterans with substance abuse issues, and those who had been hospitalized for psychiatric reasons in the year before their depression diagnosis, also had a higher suicide risk. Surprisingly, older veterans who had been diagnosed with post-traumatic stress disorder in addition to depression had a lower overall rate of suicide than those without a PTSD diagnosis, perhaps because they were more likely to receive care through Veterans Affairs PTSD programs.

Click here for a New York Times report on the study.

IOM study: more study needed

2007-10-19T16:36:00.000-07:00

The Institute of Medicine has completed its review of treatments for Post-Traumatic Stress Disorder and has found that the "effectiveness of most PTSD treatments is uncertain." The report suggests that more rigorous research is needed to determine which treatments should be used. Click here for the National Academies press release. Click here for a Washington Post story about the report.

Building Psychological Resiliency

2007-08-31T15:12:00.000-07:00

Why do some people exposed to trauma suffer serious psychological consequences such as PTSD while others don't? Hartford Courant reporter Lisa Chedekel profiles Dr. Steven Southwick, a psychiatry professor at Yale who has been studying the factors that lead to psychological resiliency ...

(Note: The story has been moved to the Courant's online archive, but you can still read it for free at VA Watchdog ...)

September 11 and Journalists' Health

2007-08-09T13:08:00.001-07:00

From Dart Ochberg Fellow David Handschuh, chair of New York Press Photographer Association's Inter-Governmental Relations Committee:

New York State passed a law that extends till 8/14/08 the time for "Rescue and Recovery Workers" to file for Workers Comp for injuries sustained while working at the World Trade Center. This is a VERY good thing that will help many people but unfortunately excludes Journalists, reporters, photographers, producers, correspondents and others in the media who covered the attack for months afterwards ... I need your assistance in getting a handle on how many media members have health concerns over their 9/11 exposure.

For details, see nyppa.org.

JAMA Focuses on Human Rights Research

2007-08-01T11:48:00.000-07:00

The current issue of the Journal of the American Medical Association targets issues concerning violence and human rights, including depression intervention for young war survivors, abuse of children during parents' military service, and trauma symptoms among child soldiers.

Panel proposes trauma care changes

2007-07-26T09:31:00.000-07:00

A presidential panel headed by Sen. Bob Dole and former Health and Human Services Director Donna Shalala has recommended vital improvements to the health care system for veterans - including stronger support for those suffering from post-traumatic stress disorder. For coverage and links to the full report, see NPR.

NI police to receive PTSD compensation

2007-06-29T16:42:00.000-07:00

A judge has ruled that Northern Ireland police officers with PTSD resulting from duty during the Troubles are now entitled to receive compensation. The ruling came in a class-action suit brought by more than 5,000 current and former officers. Coverage here: BBC News video, AP report.

Media death toll worse than 2006

2007-06-29T14:51:00.000-07:00

Last year was a record year for media deaths, but 2007 may be even worse. The International News Safety Institute reports that: "83 journalists and 17 other media professionals have died covering news stories between 1 January and 26 June, compared with 68 at the same time last year ..."

New DoD study finds problems in Iraq

2007-05-07T09:39:00.000-07:00

The Department of Defense has released its latest study of the mental health of soldiers and marines in Iraq. The fourth Mental Health Advisory Team report (MHAT-IV; "emm hat four"), among other findings, confirms that multiple and lengthened deployments for soldiers and marines are causing increased mental health problems for troops.

The report is long -- 89 pages with 20 appendices -- and contains a wealth of information about what troops are enduring in Iraq. The report's findings include:

Soldier and marine morale is worsening (this is a problem because low morale leads to poor "unit cohesion" which is a risk factor for developing Post-Traumatic Stress or other mental health problems);
about 20 percent of soldiers met screening criteria for a mental health problem (anxiety, depression or acute stress) -- an increase from previous years;
the "linear relationship" between combat exposure and subsequent mental health problems was further confirmed (nearly one third of troops who had seen "high combat" met criteria for a mental health problem);
troops with a mental health problem are not likely to seek help because a perceived stigma against such problems -- of the 20 percent of solders who met screening criteria for a mental health problem, only 42 percent sought help.

The report was written in November 2006, and was released to the public May 4, 2007. (While some find that 6-month delay suspicious, it's worth noting that the MHAT-IV was released much more quickly than the MHAT-II, which was delayed 8 months, and the MHAT-III, which was delayed a full year.)

Covering homicide: A new approach

2007-02-21T17:15:00.000-08:00

The Los Angeles Times this month launched a new blog--"The Homicide Report"--that documents every homicide in L.A. County. This is an attempt, the blog's author Jill Leovy writes, "to reverse an age-old paradox of big-city crime reporting, which dictates that only the most unusual and statistically marginal homicide cases receive press coverage, while those cases at the very eye of the storm -- those which best expose the true statistical dimensions of the problem of deadly violence -- remain hidden."

More: On the Media's Brooke Gladstone interviews Leovy.

Workshop: international humanitarian law

2007-02-16T20:55:00.000-08:00

The Crimes of War Project is accepting applications for "an intensive one-day training workshop for mid-career professional journalists on the laws of armed conflict and how they apply in the circumstances of contemporary warfare." The workshop is scheduled for March 28, 2007, at the National Press Club in Washington, D.C. More information here.

Record year for media deaths in Iraq

2006-12-22T17:13:00.000-08:00

In 2006, according to the Committee to Protect Journalists, 32 journalists were killed in Iraq. This was "the deadliest year for the press in a single country that the Committee to Protect Journalists has ever recorded." Click here for the complete analysis.

"A very dangerous profession"

2006-11-16T09:27:00.000-08:00

At a recent event at London's Frontline Club, the psychiatrist Anthony Feinstein, author of the book "Journalists under Fire: The Psychological Hazards of Covering War," spoke with BBC correspondent Allan Little about the emotional impact war has on the people reporting it and the lack of support from news agencies.

Click here to watch the video ...

Study sheds light on course of PTSD

2006-10-06T15:34:00.000-07:00

An article in this month's American Journal of Psychiatry studies the mental health of American veterans who were injured in Iraq or Afghanistan. Veterans were surveyed three times: one month, four months and seven months after deployment. The authors report that rates of PTSD and depression were higher after each interval.

At one month after deployment, 4.2 percent met criteria for PTSD; 4.4 percent met criteria for depression; 2.0 percent met criteria for both PTSD and depression.

Seven months after deployment, 12 percent met criteria for PTSD; 9.3 percent met criteria for depression; 6.3 percent met criteria for both PTSD and depression.

The study found a high level of variability in the course and onset of PTSD and depression. Half of the veterans with PTSD or depression at one month no longer met criteria for the disorders at seven months. Half of the veterans who met criteria for the disorders at seven months had not done so at one month.

Trauma's impact on Iraqi children

2006-09-19T16:59:00.000-07:00

Institute for War and Peace Reporting contributor Sahar Al-Haidery reports on what some fear may be a "lost generation" of children in Iraq. Al-Haidery writes:

Almost half of Iraq’s population is under 18, and the daily violence they have witnessed – not only on television but on the streets – has had a devastating impact on their lives and well-being.Three wars since 1980, population displacement, the loss of family members, car bombs, suicide attacks and the constant presence of troops, tanks and guns are taking their toll on the mental welfare of the younger generation.Though it is hard to obtain exact data on the number of children affected, an April 2003 report by the United Nations children’s agency UNICEF estimated that half a million Iraqi children were traumatised by conflict.

Al-Haidery also notes that Iraqi children are often themselves the target of violence:

A report issued by Iraq’s education ministry earlier this year stated that 64 children had been killed and 57 injured in 417 attacks on schools within a four-month period. More than 47 youngsters were kidnapped on their way to or from school in the same period. The report also noted that 311 teachers and government employees had been killed and another 158 wounded in attacks.

New look at Vietnam vets' PTSD data

2006-08-17T16:13:00.000-07:00

A report published Friday in the journal Science has found "very little evidence of falsification" by Vietnam veterans with Post-Traumatic Stress Disorder. The researchers selected a sample of 260 participants from the 1988 National Vietnam Veterans Readjustment Study (based on data from surveys of 1,200 veterans) and used military records to verify traumatic events reported by the veterans.

The authors of the new study also found rates of PTSD that differed from the NVVRS estimates. The NVVRS found that 15.2 percent of veterans had PTSD at the time of the study; 30.9 had PTSD at some point during their lifetime. The new analysis finds 9.1 percent with a "current" diagnosis and 18.7 percent with a "lifetime" diagnosis.

Dr. Matthew J. Friedman, executive director of the National Center for Post-Traumatic Stress Disorder for the Department of Veterans Affairs (and a member of the Dart Center advisory council), told New York Times reporter Benedict Carey that "We can quibble about the numbers but the point is that it’s a lot of people." Harvard psychologist Richard McNally--a long-time and outspoken critic of the NVVRS estimates--said that the new numbers "should not be used as a justification for short-changing services that are needed to help veterans." (Click here for an NPR report about the new study.)

UPDATE (Friday, 11:30 am): The study (subscription required) goes a long way toward refuting critics who claim that the NVVRS PTSD-prevalence estimates are inflated by the fraudulent claims of benefit-seeking veterans. Using military records, military histories and newspaper accounts, the authors report that they were able to confirm "the exposure to traumatic stressors of most of the subsample veterans."

The authors also examined the "conundrum" frequently cited by critics of the NVVRS: only 15 percent of troops in Vietnam were classified as having "combat exposure" but 30.9 percent eventually had PTSD. The authors were able to establish that "non-combat" soldiers in Vietnam were, in fact, exposed to significant, verifiable stressors. The authors found a strong relationship (stronger than was identified by the NVVRS, in fact) between PTSD symptoms and exposure to war-zone stressors, which the authors note is a "relationship that cannot be due to biases in self-reports of exposure."

The authors also address the disparity between the PTSD prevalence figures of the NVVRS and those of the Centers for Disease Control study, which "reported rates of 14.7% lifetime PTSD and 2.2% current PTSD 11 to 12 years after the Vietnam war ended." This disparity, the authors say, is not due to flaws in the NVVRS (as critics have contended) but because the CDC used a partial version of a survey that has since been found to underestimate PTSD. The authors explain:

The CDC used about half of the items from a newly developed module from the Diagnostic Interview Schedule (DIS) to diagnose lifetime and current PTSD on the basis of responses to closed questions asked by lay interviewers. This version of the DIS PTSD module has been found to diagnose much lower rates of PTSD in the general population than the other diagnostic instrument that is most widely used by lay interviewers. Against this background, it is not surprising that the abbreviated CDC adaptation of the DIS PTSD module was found in the NVVRS to miss 78% of veterans who had diagnosable PTSD, according to the SCID clinicians. These results suggest that PTSD is under-diagnosed in both military and civilian samples when this version of DIS PTSD is used.

The authors conclude:

The message from the NVVRS has been that the Vietnam War took a severe psychological toll on U.S. veterans. Our results provide compelling reasons to take this message seriously.

UPDATE 2 (Friday, 3:00 pm): Why are the rates of PTSD in this new study lower than the NVVRS rates?

Seven veterans with PTSD were removed from the sample group: "four veterans with prewar onset, two missing onset information, and one missing sampling weight." Once these seven were removed from the analysis, "unadjusted" rates of PTSD were found (22.5 percent "lifetime"; 12.2 percent "current"). Then, these rates were adjusted for "impairment of functioning" (the current criteria require that symptoms cause a certain level of impairment before PTSD can be diagnosed; the criteria in place at the time of the NVVRS did not) and "documentation of exposure" (eight veterans in the sample group with PTSD reported stressors that could not be confirmed by independent sources; of these eight, the authors write, "Record information was contradictory for only two").

One point likely to be noted by critics of this study is the exclusion of veterans with prewar onset of PTSD. A prewar diagnosis doesn't necessarily invalidate a war-time stressor. The authors do not reveal whether those veterans' re-experiencing symptoms (nightmares, flashbacks) are of the prewar trauma, or of the war-zone trauma. If the nightmares and flashbacks of a veteran with a prewar diagnosis were mainly of war-time stressors, it would be hard to say that veteran's PTSD was not "war-related."

UK to pardon "Shot at Dawn" soldiers

2006-08-17T12:15:00.000-07:00

In the early years of World War One, "Shell Shocked" soldiers were thought to be suffering physical damage to the brain or nervous system brought on by the atmospheric force of exploding shells. After study, however, mental health practitioners realized that most victims of "Shell Shock" were in fact suffering a psychological disorder brought on by the stress of combat. It was also deduced that many soldiers charged with cowardice or desertion were also suffering a combat stress reaction.

The development of this understanding--along with new, more effective treatment methods--was of great benefit to soldiers in the Allied armies during the last years of the war. But these discoveries came too late for the 306 British soldiers executed (shot at dawn) for cowardice or desertion during the Great War.

Now, after a long campaign by families of the victims, the British government has announced that it will posthumously pardon the 306 soldiers. Des Browne, the Secretary of Defence, said in a statement: "Although this is a historical matter, I am conscious of how the families of these men feel today. They have had to endure a stigma for decades. That makes this a moral issue too, and having reviewed it, I believe it is appropriate to seek a statutory pardon."

For more about the history of combat stress and military psychiatry, read "Psychiatric Lessons of War," the first chapter of the Army's War Psychiatry textbook.