Category: PTSD

NewsPsychology (Mar. 7, 2012) — Anyone who has ever been subject to chronic stress knows that it can take a toll on emotions and the ability to think clearly. Now, new research uncovers a neural mechanism that directly links repeated stress with impaired memory. The study, published by Cell Press in the March 8 issue of the journal Neuron, also provides critical insight into why stress responses can act as a trigger for many mental illnesses.

Stress hormones are known to influence the prefrontal cortex (PFC), a brain region that controls high level “executive” functions such as working memory and decision making. “Previous work has shown that chronic stress impairs PFC-mediated behaviors, like mental flexibility and attention. However, little is known about the physiological consequences and molecular targets of long-term stress in PFC, especially during the adolescent period when the brain is more sensitive to stressors,” explains the author this study, Dr. Zhen Yan, from the State University of New York at Buffalo. “

Dr. Yan and colleagues examined whether repeated stress had a negative influence on glutamate receptors in juvenile rats. Glutamate signaling plays a critical role in PFC function. They found that in response to repeated stress, there was a significant loss of glutamate receptors, which resulted in a deficit of PFC-mediated cognitive processes. The researchers went on to identify the molecular mechanisms that linked stress with the decrease in glutamate receptors and demonstrated that if they blocked these mechanisms, the stress-induced decrease in both glutamate receptors and recognition memory could be prevented.

Taken together, the findings identify a loss of glutamate receptors as an important target of repeated stress and link chronic stress with abnormal PFC function. “Since PFC dysfunction has been implicated in various stress-related mental disorders, delineating molecular mechanisms by which stress affects the PFC should be critical for understanding the role of stress in influencing the disease process,” concludes Dr. Yan.

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Story Source:

The above story is reprinted from materials provided by Cell Press, via EurekAlert!, a service of AAAS.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

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Journal Reference:

1. Eunice Y. Yuen, Jing Wei, Wenhua Liu, Ping Zhong, Xiangning Li, Zhen Yan. Repeated Stress Causes Cognitive Impairment by Suppressing Glutamate Receptor Expression and Function in Prefrontal Cortex. Neuron, 2012 DOI: 10.1016/j.neuron.2011.12.033

Use of torture around the world has not diminished but the techniques used have grown more complex and sophisticated, according to new research from Queen Mary, University of London.

The study suggests that these emerging forms of torture, which include various types of rape, bestiality and witnessing violent acts, are experienced by people seeking asylum in the UK.

In many cases the techniques cause no visible effect but are responsible for a variety of serious mental health problems. The researchers say that their findings are vital for understanding what many asylum seekers have endured and for ensuring the correct medical treatments are available.

The majority of countries signed a UN convention banning all forms of torture almost thirty years ago but the new research joins a body of evidence showing that the use of torture not only persists but is also widespread.

The researchers, led by Dr Nasir Warfa, based their study on asylum seekers who were being detained at Oakington Immigration Centre in Cambridgeshire. They carried out an audit of reports of torture over a six-month period. The results showed that 17 per cent of people at the Centre reported that they were tortured in their home countries.

Some reported cases of physical methods of torture such as being beaten with blunt objects, barbed wire, or fire. Other physical torture included various types of stabbing, covering with sugar water then exposed to insects, burning, finger or toenail extraction and foreign objects placed under nails.

Others experienced sexual torture including rape, forced bestiality, genital mutilation and forced abortion. Others still were suffocated or immersed in water, or forced to witness rape, violence or murder.

The majority of those who reported such incidents were fleeing African countries. Others had come from Asia, the Middle East and Europe.

"The torture reported by these people is horrific," said Kate Izycki, Senior Nurse who specialises in Transcultural Psychiatry. "This highlights that the use of torture continues and that the perpetrators are finding more elaborate methods; some of which often leave no physical mark."

Dr Warfa's previous research has shown that victims of torture are highly likely to suffer from severe mental health problems including post-traumatic stress disorder, depression, anxiety and feeling suicidal.

He adds: "Finding yourself in a foreign country where you must negotiate a difficult asylum system, where you cannot work and where you may not be able to speak the language would be difficult for anyone. Then add mental health problems caused by torture and the ever-present possibility of deportation."

"This new study clearly shows that we need to identify and address the health needs of those who have fled to the UK following torture in their home countries."

 Women recently diagnosed with breast cancer have higher survival rates than those diagnosed in previous decades, according to the American Cancer Society. However, survivors continue to face health challenges after their treatments end. Previous research reports as many as 50 percent of breast cancer survivors are depressed. Now, University of Missouri researchers in the Sinclair School of Nursing say a meditation technique can help breast cancer survivors improve their emotional and physical well-being.

Yaowarat Matchim, a former nursing doctoral student; Jane Armer, professor of nursing; and Bob Stewart, professor emeritus of education and adjunct faculty in nursing, found that breast cancer survivors' health improved after they learned Mindfulness-Based Stress Reduction (MBSR), a type of mindfulness training that incorporates meditation, yoga and physical awareness.

"MBSR is another tool to enhance the lives of breast cancer survivors," Armer said. "Patients often are given a variety of options to reduce stress, but they should choose what works for them according to their lifestyles and belief systems."

The MBSR program consists of group sessions throughout a period of eight to ten weeks. During the sessions, participants practice meditation skills, discuss how bodies respond to stress and learn coping techniques. The researchers found that survivors who learned MBSR lowered their blood pressure, heart rate and respiratory rate. In addition, participants' mood improved, and their level of mindfulness increased after taking the class. Armer says, for best results, participants should continue MBSR after the class ends to maintain the positive effects.

"Mindfulness-based meditation, ideally, should be practiced every day or at least on a routine schedule," Armer said. "MBSR teaches patients new ways of thinking that will give them short- and long-term benefits."

Armer says the non-pharmaceutical approach works best as a complement to other treatment options such as chemotherapy, radiation and surgery.

"Post diagnosis, breast cancer patients often feel like they have no control over their lives," Armer said. "Knowing that they can control something — such as meditation — and that it will improve their health, gives them hope that life will be normal again."

The study, "Effects of Mindfulness-Based Stress Reduction (MBSR) on Health Among Breast Cancer Survivors," was published in the Western Journal of Nursing Research.

Prolonged exposure therapy, cognitive therapy, and delayed prolonged exposure therapy, appear to reduce posttraumatic stress disorder symptoms in patients who have experienced a recent traumatic event, according to a report published Online First by Archives of General Psychiatry, one of the JAMA/Archives journals.

"Chronic PTSD is tenacious and disabling. Short-term interventions without prior assessment or diagnosis have failed to prevent PTSD," the authors write as background information in the study. "Preventing posttraumatic stress disorder (PTSD) is a pressing public health need."

Arieh Y. Shalev, M.D., and colleagues from Hadassah University Hospital, Jerusalem, Israel, conducted a study to compare early and delayed exposure-based, cognitive and pharmacological interventions for preventing PTSD. Study participants were selected from consecutively admitted survivors of traumatic events at Hadassah Hospital in Jerusalem, through a telephone-based interview a mean (average) 9.61 days after the traumatic event occurred. Patients identified as having symptoms of acute stress disorder during the telephone interview were referred for clinical assessment, and those who met PTSD symptom criteria during assessment were invited to receive treatment.

The authors randomly assigned consenting patients to one of four intervention groups: prolonged exposure (PE), cognitive therapy (CT), a double-blind comparison of treatment with a selective serotonin reuptake inhibitor (SSRI) vs. placebo, or a waiting list (WL) control group. The study design allowed participants to decline treatment options they did not desire, and to be randomly assigned to one of the remaining treatment groups. Participants in the WL group who met PTSD criteria at the five-month follow-up received PE at that time, to compare the effects of a delayed intervention on PTSD symptoms. Prolonged exposure included psychoeducation, training in breathing control, prolonged imaginal exposure to traumatic memories and in vivo exposure to avoided situations. Cognitive therapy included identifying and challenging negative automatic thoughts and modifying underlying cognitive schemas. Participants in each of these groups received 12 weekly 1.5-hour sessions administered by clinical psychologists with prior PTSD treatment experience. PTSD prevalence was determined using the Clinician-Administered PTSD Scale (CAPS).

Following randomization, 63 participants started PE, 40 started CT, 93 were placed on the waiting list and 46 were in the SSRI and placebo subgroups (23 in each group). At the five-month follow-up, the prevalence of PTSD in the PE and CT groups (21.4 percent and 18.2 percent, respectively) were significantly less than in the WL, SSRI and placebo groups (58.2 percent, 61.9 percent and 55.6 percent, respectively). The analysis showed significant group differences in CAPS and mean (average) PTSD Symptom Scale-Self Report scores at five months, showing fewer PTSD symptoms in the PE and CT groups compared with the WL, SSRI and placebo groups. At the five-month follow-up, 57 WL participants had PTSD and were eligible for delayed PE and 41 started treatment at that time.

At the nine-month follow-up, the prevalence of PTSD in the PE, CT and WL groups were 21.2 percent, 22.8 percent, and 22.9 percent, respectively while rates for the SSRI and placebo subgroups (42.1 percent and 47.1 percent, respectively) remained higher. Analysis also showed significant group differences in CAPS and mean PTSD Symptom Scale-Self Report scores at nine months, showing fewer PTSD symptoms in the PE, CT and WL groups compared with the SSRI and placebo groups. Participants with partial PTSD before treatment onset did similarly well with and without treatment.

"The results of our study show that there are significant and similar preventive effects of PE and CT," the authors conclude. "Our finding suggests that delaying the intervention does not increase the risk of chronic PTSD…Thus, a delayed intervention is an acceptable option when early clinical interventions cannot be provided (e.g., during wars, disasters, or continuous hostilities)."

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Journal Reference:

1. Arieh Y. Shalev; Yael Ankri; Yossi Israeli-Shalev; Tamar Peleg; Rhonda Adessky; Sara Freedman. Prevention of Posttraumatic Stress Disorder by Early Treatment: Results From the Jerusalem Trauma Outreach and Prevention Study. Archives of General Psychiatry, 2011; DOI: 10.1001/archgenpsychiatry.2011.127

— Children who witness domestic violence are more likely to be in abusive intimate relationships and experience psychological problems such as post traumatic stress disorder (PTSD) in adulthood, according to the Centers for Disease Control and Prevention. A University of Missouri researcher has found that certain protective factors foster resilience and increase the likelihood that the cycle of violence will end for women who, as children, were exposed to their mothers' battering.

Kim Anderson, associate professor in the MU School of Social Work, found that women are less likely to suffer from PTSD if they are more resilient, or better able to overcome adversity. In regard to childhood protective factors that increase adult resilience, Anderson found that mothers who were employed full-time had a positive influence on their children's recovery from witnessing domestic violence.

"Mothers who work full-time, even in adverse situations, create economic stability and model a strong work ethic, independence and competence," Anderson said. "This shows the importance of the bond between mothers and children and the importance of positive adult role models in the lives of children who have experienced abuse."

The study also identified risk factors for PTSD in women who as children witnessed the abuse of their mothers, including the mental health status of their mothers and police involvement in violent incidents. In particular, children of mothers who had mental health problems were more likely to develop PTSD later in life, as were children who witnessed the arrest of family members during violent incidents.

"The mental health status of mothers affects how they recover from abuse and their parenting style," Anderson said. "Children whose mothers do not experience mental health problems are less likely to have mental health problems of their own."

Anderson says recent financial cuts in domestic violence services and advocacy programs have made it difficult to provide abused women with the resources they need to recover from violent incidents. She recommends advanced job training and opportunities for higher education to help abused women attain sustainable employment.

"Most of the time, the immediate goal is to find women work rather than help them acquire skills that fit their interests," Anderson said. "Those jobs are often low-paying and don't provide the economic sustainability that going back to school and getting a higher education would."

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Journal Reference:

1. Kim M. Anderson, Eun-Jun Bang. Assessing PTSD and resilience for females who during childhood were exposed to domestic violence. Child & Family Social Work, 2011; DOI: 10.1111/j.1365-2206.2011.00772.xts staff.

An estimated 18 American military veterans take their own lives every day — thousands each year — and those numbers are steadily increasing. Even after weathering the stresses of military life and the terrors of combat, these soldiers find themselves overwhelmed by the transition back into civilian life. Many have already survived one suicide attempt, but never received the extra help and support they needed, with tragic results. A team of researchers from the Perelman School of Medicine at the University of Pennsylvania and colleagues found that veterans who are repeat suicide attempters suffer significantly greater mortality rates due to suicide compared to both military and civilian peers.

The research was published this month in BMC Public Health.

The study is the largest follow-up of suicide attempters in any group in the United States, and is unique even among the relatively few studies on veteran suicide: "We looked at suicide among veterans who had already attempted suicide one time," notes study author Douglas J. Wiebe, PhD, assistant professor of Epidemiology. The findings, he says, "should have us very concerned about current veterans in the more contemporary era."

Wiebe, along with Janet Weiner of Penn's Leonard Davis Institute of Health Economics and Therese S. Richmond of the School of Nursing, teamed with Joseph Conigliaro of the New York University School of Medicine to conduct a study of military veterans who received inpatient treatment at a Department of Veterans Affairs (VA) medical center for a suicide attempt between 1993 and 1998. Using additional data from the VA, as well as the National Center of Health Statistics, these veterans were followed for incidence, rate, and cause of mortality through the end of 2002.

Among the total of 10,163 veterans treated for a suicide attempt between 1993-1998, 1,836 died during the follow-up period through 2002, with heart disease, cancer, accidents, and suicide accounting for over 57% of those deaths. Suicide, however, was the second- leading cause of death among the male veterans, and the leading cause among females, accounting for just over 13% of all the deaths in the study cohort. In comparison, suicide accounted for only 1.8% of deaths in the general U.S. population during those years.

Wiebe and his colleagues discovered that veterans who have attempted suicide not only have an elevated risk of further suicide attempts, but face mortality risks from all causes at a rate three times greater than the general population. The so-called "healthy soldier effect," that military personnel should be healthier than an average person of the same sex and age because they have passed military fitness requirements, does not protect veterans from death from chronic disease, and does not appear to mitigate their risk of suicide. "The 'healthy soldier effect' is no reason to think that veterans should be more emotionally and mentally resilient than anyone else," says Wiebe. "The consequences of military service can include both physical and emotional health challenges that veterans continue to face long after their 'war' is no longer on the front page."

The current study strongly emphasizes the increased need for more intensive and vigorous efforts to identify and support veterans who are at risk, especially those who have already actually attempted suicide, say the authors. With military personnel now facing combat in numbers not seen since the Vietnam War, developing better strategies for suicide prevention is more important than ever. "Almost all of today's soldiers are seeing combat and repeated tours, so that could be a reason to be even more concerned about veteran populations in the years moving forward," Wiebe says.

Wiebe's next step is to analyze the collected data to identify more specific risk factors for suicide or other premature causes of death. Although he argues that "we need to be more tuned into this problem in America in general," he is hopeful that examples of successful suicide prevention programs, particularly one conducted by the U.S. Air Force, could provide an inspiration and foundation for new efforts. "A major part of the success of that program was just changing the climate around how people think and talk about suicide," he says. "There's evidence out there to suggest that could work among veterans too. The time to get started is now."

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Journal Reference:

1. Janet Weiner, Therese S Richmond, Joseph Conigliaro, Douglas J Wiebe. Military veteran mortality following a survived suicide attempt. BMC Public Health, 2011; 11 (1): 374 DOI: 10.1186/1471-2458-11-374

Iraq and Afghanistan veterans who visited a U.S. Veterans Administration (VA) integrated care clinic were much more likely to undergo initial mental health and social work evaluations than veterans who visited a standard VA primary care clinic, according to a study led by a San Francisco VA Medical Center researcher.

The increase was especially significant for women veterans, younger veterans, veterans with mental health diagnoses, and veterans who screened positive for traumatic brain injury.

The study was published on June 7, 2011 in the electronic Online First section of the Journal of General Internal Medicine.

The decisive factor was the integrated care model, itself, said the lead author of the study, Karen Seal, MD, MPH, co-founder and co-director of the Integrated Care Clinic at the San Francisco VA Medical Center, which was the site of the study.

Under the conventional VA model, patients are seen by a primary care physician and, if they screen positive for mental illness according to the VA's standard protocol, are referred to a mental health provider. That referral appointment would not necessarily be available the same day, nor in the same clinic.

Under the integrated care model, all patients are referred immediately by their primary care physician to a mental health provider, called the "Post-Deployment Stress Specialist," and a social worker, called the "Combat Case Manager." All visits take place during the same appointment, in the same clinic, with no waiting.

"This demonstrates the value of the integrated care clinic model for our veterans, especially those who may be more vulnerable," said Seal, who is also an associate professor in residence of medicine and psychiatry at the University of California, San Francisco.

The study also showed, however, that the rate of follow-up mental health care — the number of subsequent visits with mental health providers that took place after initial evaluation — was not any higher under the integrated care model than under standard care.

"We are really good at initial engagement, but unfortunately, we are not as successful at helping veterans stay with and complete a course of mental health treatment," said Seal. "We need to learn how to help veterans stick with the more difficult first few sessions of PTSD treatment, so they can get through to the other side when they really start to feel better." Seal explained that successful PTSD treatment usually takes nine to 12 sessions.

The study examined the medical records of 526 Iraq and Afghanistan veterans who came to SFVAMC between 2005 and 2009 for their first primary care visit after returning from combat deployment. Veterans who visited after April 1, 2007 — the date that the Integrated Care Clinic was founded — were given an appointment at either the Integrated Care Clinic or a conventional care clinic.

The 30-day mental health evaluation rate was 92 percent for the integrated care patients versus 59 percent for standard care patients. The rate for social work evaluation was 77 percent versus 56 percent.

For women veterans, the rate of initial mental health evaluations in integrated care was three times the conventional care rate. "This is good news, because women veterans have a high burden of mental health problems, and, at the same time, a disproportionate number of barriers to care, such as child care issues and other logistical constraints," said Seal.

Seal noted that the overall rate of initial mental health evaluations was higher in the integrated care model even after allowing for an overall VA systemwide improvement in first-time mental health evaluations that occurred after 2007.

She speculated that one promising approach to helping veterans complete their course of PTSD treatment might be the VA Patient Aligned Care Team (PACT) model, a new team-based method of providing primary care in the VA system. "One member of the patient care team could be assigned to make reminder phone calls for example, to encourage veterans to stick with and complete their mental health treatment," Seal said.

Co-authors of the study are Greg Cohen, MSW, and Daniel Bertenthal, MPH, of SFVAMC; Beth E. Cohen, MD, MAS, and Shira Maguen, PhD, of SFVAMC and UCSF; and Aaron Daley, MA, of SFVAMC.

The study was supported by funds from the US Department of Defense that were administered by the Northern California Institute for Research and Education.

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Journal Reference:

1. Karen H. Seal, Greg Cohen, Daniel Bertenthal, Beth E. Cohen, Shira Maguen, Aaron Daley. Reducing Barriers to Mental Health and Social Services for Iraq and Afghanistan Veterans: Outcomes of an Integrated Primary Care Clinic. Journal of General Internal Medicine, 2011; DOI: 10.1007/s11606-011-1746-1

— New research has shown that children's risk for learning and behavior problems and obesity rises in correlation to their level of trauma exposure, says the psychiatrist at the Stanford University School of Medicine and Lucile Packard Children's Hospital who oversaw the study. The findings could encourage physicians to consider diagnosing post-traumatic stress disorder rather than attention deficit/hyperactivity disorder, which has similar symptoms to PTSD but very different treatment.

The study examined children living in a violent, low-income neighborhood and documented an unexpectedly strong link between abuse, trauma and neglect and the children's mental and physical health: It reported, for instance, that children experiencing four types of trauma were 30 times more likely to have behavior and learning problems than those not exposed to trauma.

"In communities where there is violence, where children are exposed to events such as shootings in their neighborhoods, kids experience a constant environmental threat," said senior author Victor Carrion, MD, associate professor of psychiatry and behavioral sciences at Stanford. "Contrary to some people's belief, these children don't get used to trauma. These events remain stressful and impact children's physiology."

The new study is being published online June 8 in the journal Child Abuse & Neglect. Carrion collaborated on the research with scientists at the University of New Orleans and the Bayview Child Health Center, part of San Francisco's California Pacific Medical Center.

The findings provide compelling evidence that pediatricians should routinely screen children for trauma exposures, said Carrion, who is also a child psychiatrist at Packard Children's.

"As simple as it may seem, physicians do not ask about trauma," he said. "And kids get the wrong diagnoses."

The study builds on earlier work that linked worsening health in adults with their dose of exposure to nine types of adverse childhood events, including being subject to various kinds of abuse or neglect; having a household member who abused alcohol or drugs, was incarcerated or was mentally ill; having a mother who was treated violently; and not living in a two-parent household. Middle-class men exposed to more of these events had more chronic diseases in adulthood, the prior research found. The results of the current study highlight the need for early identification of such adversity-associated health problems, and early intervention. Obesity, for example, may act as a mediator to other health problems such as diabetes, cardiac risk and inflammatory illness.

To perform the study, the researchers evaluated medical records from 701 children treated at a primary-care clinic in Bayview-Hunter's Point, a San Francisco neighborhood with high rates of poverty and violence. About half the children were African-American; the rest came from other ethnic backgrounds. Each child's exposure to adverse events was scored on a scale from 0 to 9, with one point given for each type of adversity. The researchers also evaluated the medical records for evidence of obesity and learning or behavior problems.

Two-thirds of the children in the study had experienced at least one category of adversity, and 12 percent experienced four or more categories. An adversity score of 4 or higher left kids 30 times as likely to show learning and behavior problems and twice as likely to be obese as those with a score of 0. Children with an adversity score of 1 were 10 times as likely to have learning and behavior problems as those not exposed to trauma.

Prior research has shown that about 30 percent of children in violent communities have symptoms of post-traumatic stress disorder, which can include the learning and behavior problems detected in the current study, Carrion noted. However, a physician unaware of the fact that a child experienced trauma, and noting the child's physiological hyperarousability and cognitive difficulties, may diagnose ADHD instead of PTSD. That's a problem because the two disorders have opposite treatments, he said. Kids with PTSD need psychotherapy, not the stimulant medications given for ADHD.

"Children can recover from PTSD with the appropriate treatment, which is one of approach and not avoidance," Carrion said. "By not asking about trauma, we're utilizing avoidance. We're perpetuating PTSD."

As part of their efforts to address the long-term health problems that stem from childhood trauma, Carrion, his collaborators and several San Francisco community partners are working to launch the Center for Youth Wellness, a one-stop health and wellness center for urban children and families in San Francisco. The Center for Youth Wellness will combine pediatrics with mental health services, educational support, family support, research and best practices in child-abuse response under one roof. With both public and private support, the center will coordinate the services of multiple agencies to give children a safe and accessible place to increase their resilience to adverse life experiences and improve their well-being.

The center, which aims to begin operation by mid-2012, is a partnership between California Pacific Medical Center's Bayview Child Health Center, San Francisco Child Abuse Prevention Center, San Francisco District Attorney's Office, Stanford's Early Life Stress Research Program at Lucile Packard Children's Hospital and Tipping Point Community. Nadine Burke, MD, director of the Bayview center, is also a co-author of the study.

"We need to create trauma-informed systems," Carrion concluded, adding that the Center for Youth Wellness hopes to function as a model for such systems across the nation. People working for the welfare of children need to be on the lookout for trauma and know how to intervene, and how to work with the family and with schools, he said. "If trauma goes untreated, it's very costly for the individuals involved and for society in general."

The research was funded by the Lennar Urban Corp. and awards to Carrion from the National Institute of Mental Health and the Evans Foundation.

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Journal Reference:

1. Nadine J. Burke, Julia L. Hellman, Brandon G. Scott, Carl F. Weems, Victor G. Carrion. The impact of adverse childhood experiences on an urban pediatric population. Child Abuse & Neglect, 2011; DOI: 10.1016/j.chiabu.2011.02.006

— Women service members who experience combat are apparently as resilient as the men they serve alongside, according to a study published by the American Psychological Association.

Men and women deployed to Iraq and Afghanistan in 2007 and 2008 experienced very similar levels of combat-related stress and post-deployment mental health impacts during the first year following return from deployment, researchers reported in the Journal of Abnormal Psychology, published by APA.

"Contrary to popular belief, women who go to war respond to combat trauma much like their male counterparts," said lead author Dawne Vogt, PhD, of the Veterans Administration National Center for PTSD and Boston University School of Medicine. "And with the unpredictable guerilla tactics of modern warfare, barring women from ground combat is less meaningful."

The findings are particularly significant given the recent call for the Pentagon to reverse its longstanding policy that bars women from ground combat, Vogt said. As of 2009, more than 750 women had been wounded or killed in action during Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom, the paper states.

The research was based on survey responses from 595 service members drawn from a random sample from the Defense Manpower Data Center roster. It included 340 women and 252 men from active duty, National Guard, and Reserve forces. The women, on average, were three years younger and more likely to belong to a racial/ethnic minority group. The men were more likely to be married, living with children, have higher incomes and to have served in the Marine Corps during their deployment.

Researchers used stress measures that included exposure to combat involving firing a weapon, being fired on, and witnessing injury and death; experiencing consequences of combat, such as observing or handling human remains and dealing with detainees; enduring difficult living situations in the war zone; and fearing for one's safety and well-being.

As expected, men reported more exposure to combat and battle aftermath, as well as difficult living conditions. "The fact that these differences were relatively small, however, suggests that women's exposure to these stressors in [Iraq and Afghanistan] may be, on average, only slightly lower than men's exposure on average," the study states.

Few gender differences were reported in post-deployment mental health. Specifically, levels of post-traumatic stress, mental health functioning, and depression were similar, though scores on substance abuse were higher for men than women.

The findings could reflect improved training of female service members in recent years and that combat duty may equalize risk due to its persistent level of threat, according to the study.

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Journal Reference:

1. Dawne Vogt, Rachel Vaughn, Mark E. Glickman, Mark Schultz, Mari-Lynn Drainoni, Rani Elwy, Susan Eisen. Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF veterans.. Journal of Abnormal Psychology, 2011; DOI: 10.1037/a0023452

 After 17 years of researching traumatic stress with war-afflicted populations (veterans and civilians) and job stress in the medical profession, Teresa McIntyre, a research professor in the department of psychology and the Texas Institute for Evaluation, Measurement and Statistics (TIMES), at the University of Houston (UH), decided to study another high risk occupation, middle school teachers in seventh and eighth grade.

"Teaching is a highly stressful occupation," McIntyre said. "Teacher stress affects various aspects of teacher health and may influence how effective teachers are in the classroom, with potential consequences for their students' behavior and learning.

"I started to research the literature on stress and teachers in the U.S. and found very little information. There was no comprehensive study of teachers' stress or even an audit of the percentage of teachers who are stressed. I saw a void here and a need to study."

McIntyre serves as primary investigator for a $1.6 million grant funded by the Institute of Education Sciences (IES), U.S. Department of Education, titled, "Using Longitudinal and Momentary Analysis to Study the Impact of Middle School Teachers' Stress on Teacher Effectiveness, Student Behavior and Achievement."

The research study starts at the beginning of this coming school year and follows 200 seventh-and eighth-grade social studies, science or math teachers in 20 middle schools in H.I.S.D. and thousands of students over a three-year period. The research team intends to identify predictors and outcomes of job stress in middle school teachers, linking teacher stress to student behavior and achievement via teacher effectiveness. The results of the data can be used to guide further development of interventions to mitigate teacher stress and, consequently, improve teacher effectiveness and student behavior and learning.

"Middle school is probably the most difficult level to teach because student-teacher interactions are more difficult during this time, and this kind of difficulty in teacher-student interactions is a major source of stress for teachers at this level," McIntyre said. "For students it's a time of adolescence and many changes developmentally, and that is going to affect the dynamics of learning, as well as the social relationships and climate in the classroom. It's going to affect the teachers as well. Our premise is that if the teacher is stressed, their behavior will be different with students, and they will perform differently with students."

McIntyre conducted a pilot study in the Greater Houston area in 2010 that indicated that at least one third of middle school teachers may be significantly stressed.

The UH research team will combine an innovative multi-method approach to assessing stress and teacher effectiveness, which involves ecological momentary assessment or real-time assessment, concurrent physiological measurements that will monitor blood pressure and heart rate, and in-classroom observational ratings. The researchers will use the most current technology to assess stress, which includes self-report on a Teacher Stress Diary using an iPod Touch platform, and teacher effectiveness ratings on an iPad. Data will be collected on students in the teachers' classroom using teacher stress diaries, archival school records and observational ratings. The innovative software programs are being developed by Sean Woodward at TIMES and the novel statistical methodologies required to analyze the intensive longitudinal data generated by real time assessment will be provided by TIMES and the UH department of psychology faculty Paras Mehta. The methodological and technical support provided by the UH's TIMES, directed by David Francis, as well as its expertise in education research, are key to the implementation of this type of study.

"With this study we will be able to get a more dynamic picture of how teachers respond to stress in real time," McIntyre said. "And that's what this ecological momentary assessment does — it assesses stress through the person's diary report of stress when things are happening, very close to the event. Teachers will be able to report their emotions — positive, negative; how their cognitive functions are affected by stress; and what's happening at the moment in terms of social interactions, social conflict, demands on the job, the time pressure and whether they feel they are in control of their situation. They also report on effectiveness in instruction and classroom management, an on their student's behavior in the classroom"

McIntyre notes the larger contribution of the study is to take the pulse of the educational system and see what's happening in challenging economic times and to evaluate what impact this has on teachers and students, "The study addresses a key issue in contemporary education: how to improve teacher quality in the face of increasing demands in the education system; it is all about supporting teachers, students and school administrators at a time of depleted resources."

The results of the study may be used to guide further development of interventions to mitigate teacher stress and, consequently, improve teacher effectiveness and student behavior and learning. The data collected will be useful for school administrators and principals to know, such as what factors are causing teachers to be more stressed and less effective, and what resources can be arranged to change that trajectory into a positive one.

The research project is a collaborative effort with UH, the University of Houston-Clear Lake (UH-CL), the University of Pittsburgh, School of Medicine, and the Houston Independent School District (H.I.S.D.). UH collaborators are Paras Mehta, David Francis, Angelia Durand and Pat Taylor (psychology and TIMES), and Scott McIntyre (UH-CL); UH advisory board members are Christiane Spitzmueller and Qian Lu (psychology), and Chris Wolters (educational psychology); consultant is Dr. Thomas Kamarck, University of Pittsburgh.