Category: PTSD

Johns Hopkins University bioethicists say disaster-response planning has generally overlooked the special needs of people who suffer from pre-existing and serious mental conditions. Survivors already diagnosed with schizophrenia, dementia, addictions and bipolar disorder are vulnerable long before a disaster strikes, they point out.

In a commentary appearing in the June issue of the journal Biosecurity and Bioterrorism, faculty from the Johns Hopkins Berman Institute of Bioethics say that more attention should be devoted to triaging and managing those already identified as having mental disorders. This group must be given just as much consideration during the planning stage as is given those who will have physical injuries and more obvious anxiety-related reactions, such as post-traumatic stress disorder (PTSD).

"Disasters limit the availability of resources, and these groups are especially vulnerable because they cannot advocate for themselves," says Peter Rabins, M.D., M.P.H., a core faculty member at the Berman Institute. "But little attention has been given to the ethical challenges that arise when resources are limited, to the importance of identifying these ethical issues ahead of time, and for establishing mechanisms to address these moral dilemmas."

In the article, Rabins and Nancy Kass, Sc.D., the Berman Institute's deputy director for public health, say that many of the mentally ill are dependent on caretakers and aren't fully capable of making sound decisions on their own. Emergency planners are ethically obligated to ensure that immediate and adequate mental health services are provided alongside more traditional triage, the bioethicists state.

"Disaster-response managers and those on the front line are well aware that survivors may succumb to PTSD and other mental disorders," says Rabins, the Richman Family Professor for Alzheimer's and Related Diseases at the Johns Hopkins University School of Medicine. "But sudden devastation also puts people with both lifelong and acquired intellectual disabilities in grave danger as well."

Whether a disaster is natural, as in an earthquake, or is caused by man, as in war, the ethical obligation to treat those with mental disabilities in the aftermath is just as important as aiding those with flesh wounds, Rabins says.

One study the authors cite found that 22 percent of Hurricane Katrina survivors who had pre-existing mental disorders faced limited or terminated treatment after the disaster.

Beyond patients with dementia and others who are mentally impaired, the authors say that this vulnerable group includes those who suffer from chronic pain and may be dependent on opiates, as well as substance abusers who receive treatment in the form of powerful sedatives classified as benzodiazepines. Withdrawal can be life threatening, the authors note.

The authors acknowledge that drug and alcohol addicts are often seen as unworthy of focused attention during a state of emergency — and scarce resources — because their condition is widely perceived as "self-inflicted." But distinguishing between conditions that individuals have or don't have control over "is neither practical nor ethically justifiable, and in emergencies becomes wholly impractical," the authors assert.

Recommendations

As a first step, the authors recommend that disaster-response planners proactively identify and anticipate what needs might arise by meeting with clinicians and public health officials. Those discussions would then guide comprehensive advance planning.

Because licensed practitioners will likely be scarce immediately after a disaster, planners should consider training emergency medical technicians (EMTs) and other first-responders to identify those with pre-existing mental conditions and recognize those in need of prompt attention.

Acknowledging that first-responders may also be spread thinly post-disaster, the authors also suggest that planners consider turning to volunteers from the community, such as religious leaders and trained civilians, to distribute basic materials and temporary services to at-risk individuals.

To further make the best use of limited resources, the authors say that broad-based primary interventions, such as psychological debriefings, might be a lower priority than implementing potentially more effective "secondary prevention" measures, which seek to reduce long-term ill outcomes.

In particular, EMTs could be asked to responsibly distribute sedatives to manage short-term anxiety-related symptoms. But the authors say that policies would need to be developed to expand the list of those authorized to prescribe such drugs, as they are at present strictly regulated by federal law.

The authors note that sedatives were distributed in New York City immediately after the Sept. 11, 2001, terrorist attacks.

Ethical challenges

The authors also recommend that planners focus on ethical challenges likely to arise when assisting the mentally disabled during and after a disaster. These challenges may be partially addressed by adopting a "crisis standard of care" consistent with guidelines from the Institute of Medicine, they say.

Special attention should be given to assisted-living and long-term care facilities that house many residents with significant cognitive impairment, such as dementia. If these people are forced to evacuate, they may not fully comprehend the crisis and may be at risk for extreme emotional distress.

Hence, disaster-preparedness training for first-responders should also include information about how to interact with such individuals in a way that respects their dignity, the authors say.

More broadly, criteria for priority setting and the allocation of scarce resources can be based on objective factors, such as the likelihood of response to intervention, the prevention of chronic health problems, and the impact on public safety, the authors explain.

---

Journal Reference:

1. Peter Rabins, Nancy Kass, Lainie Rutkow, Jon Vernick and James Hodge. Challenges for Mental Health Services Raised by Disaster Preparedness: Mapping the Ethical and Therapeutic Terrain. Biosecurity and Bioterrorism, June 2011 DOI: 10.1089/bsp.2010.0068

Virtual reality offers returning soldiers 'psychotherapy by computer' to treat PTSD. For those soldiers worried about the stigma associated with seeing a therapist, virtual reality applications for the treatment of post-traumatic stress disorder (PTSD) may be the alternative to the traditional "talk therapy." A new paper¹, by Albert Rizzo from the University of Southern California, Institute for Creative Technologies, Los Angeles, and his team, reviews how virtual reality applications are being designed and implemented across various points in the military deployment cycle, to prevent, identify and treat combat-related PTSD.

Their findings are published online in the June issue² of Springer's Journal of Clinical Psychology in Medical Settings, specially dedicated to contemporary psychological advances as they apply to soldiers and their families.

The stressful experiences that characterize the Operation Iraqi Freedom/Operation Enduring Freedom war fighting environments have produced significant numbers of returning military personnel at risk of developing PTSD. At the same time, virtual reality (VR) has stepped into clinical practice, as a result of technological advances that have made it feasible and cost-effective to run VR systems on a personal computer.

What Rizzo and team's work shows is that VR is able to deliver exposure therapy — the number one therapy recommended for PTSD — by immersing returning soldiers in simulations of trauma-relevant environments. The emotional intensity of the scenes can be precisely controlled by the clinician in collaboration with the patients' wishes. VR allows multi-sensory and context-relevant cues that evoke the trauma without exclusively relying on the patient to actively remember and imagine actual experiences (as is required in traditional exposure approaches).

Rizzo and team review their immersive virtual reality exposure therapy (VRET) system for combat-related PTSD. Their application consists of a series of virtual scenarios, based on accounts by returning soldiers of what it is like out there in a war environment.

Their clinical results to date are encouraging. One test in particular found that 80 percent of those who completed treatment with this system showed clinically meaningful reductions in PTSD, anxiety and depressive symptoms. In addition, anecdotal evidence from patient reports suggests improvements in their everyday lives for at least three months after treatment.

The researchers are also exploring other applications for their system, including stress resilience training i.e. to teach soldiers coping strategies prior to deployment to better prepare them for the types of emotional challenges they are likely to encounter in the combat environment. Another area of interest for the system is the identification of those soldiers who are ready to get back into the field versus those who need further treatment or more time between deployments.

According to the authors, this new approach to psychotherapy has widespread ramifications: "The current generation of young military personnel, having grown up with digital gaming technology, may actually be more attracted to and comfortable with participation in virtual reality exposure therapy. The need for treatments to address the mental health needs of our military personnel, alongside the virtual revolution that has taken place, has led to a state of affairs which stands to transform the vision of future clinical practice and research."

---

Journal Reference:

1. Albert Rizzo, Thomas D. Parsons, Belinda Lange, Patrick Kenny, John G. Buckwalter, Barbara Rothbaum, JoAnn Difede, John Frazier, Brad Newman, Josh Williams, Greg Reger. Virtual Reality Goes to War: A Brief Review of the Future of Military Behavioral Healthcare. Journal of Clinical Psychology in Medical Settings, 2011; DOI: 10.1007/s10880-011-9247-2

Adversity, we are told, heightens our senses, imprinting sights and sounds precisely in our memories. But new Weizmann Institute research, which appeared in Nature Neuroscience this week, suggests the exact opposite may be the case: Perceptions learned in an aversive context are not as sharp as those learned in other circumstances. The findings, which hint that this tendency is rooted in our species' evolution, may help to explain how post-traumatic stress syndrome and other anxiety disorders develop in some people.

To investigate learning in unfavorable situations, Dr. Rony Paz of the Institute's Neurobiology Department, together with his student Jennifer Resnik, had volunteers learn that some tones lead to an offensive outcome (e.g. a very bad odor), whereas other tones are followed by pleasant a outcome, or else by nothing. The volunteers were later tested for their perceptual thresholds — that is, how well they were able to distinguish either the "bad" or "good" tones from other similar tones.

As expected from previous studies, in the neutral or positive conditions, the volunteers became better with practice at discriminating between tones. But surprisingly, when they found themselves exposed to a negative, possibly disturbing stimulus, their performance worsened.

The differences in learning were really very basic differences in perception. After learning that a stimulus is associated with highly unpleasant experience, the subjects could not distinguish it from other similar stimuli, even though they could do so beforehand, or in normal conditions. In other words, no matter how well they normally learned new things, the subjects receiving the "aversive reinforcement" experienced the two tones as the same.

Paz: "This likely made sense in our evolutionary past: If you've previously heard the sound of a lion attacking, your survival might depend on a similar noise sounding the same to you — and pushing the same emotional buttons. Your instincts, then, will tell you to run, rather than to consider whether that sound was indeed identical to the growl of the lion from the other day."

Paz believes that this tendency might be stronger in people suffering from post-traumatic stress syndrome. As an example, he points to the 9-11 terror attacks in New York. Many of those who witnessed the strikes on the towers developed post-traumatic stress syndrome, which, for many of them, can be triggered by tall buildings. Intellectually, they may know the building before them bears little similarity to the destroyed towers, but on a more fundamental, instinctive level, they might perceive all tall buildings to be the same and thus associate them with terrifying destruction.

The scientific team is now investigating this idea in continuing research, in which they hope, among other things, to identify the areas in the brain that are involved in setting the different levels of perception. Paz: "We think this is a trick of the brain that evolved to help us cope with threats, but is now dysfunctional in many cases. Besides revealing this very basic aspect of our perception, we hope to shed light on the development of such anxiety disorders as post-traumatic stress syndrome."

---

Journal Reference:

1. Jennifer Resnik, Noam Sobel, Rony Paz. Auditory aversive learning increases discrimination thresholds. Nature Neuroscience, 2011; DOI: 10.1038/nn.2802

 Military service members who screened positive for mental health disorders before deployment, or who were injured during deployment, were more likely to develop post-deployment posttraumatic stress disorder (PTSD) symptoms than their colleagues without these risk factors, according to a report in the May issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

"The relationship between preinjury psychiatric status and postinjury PTSD is not well understood because studies have used retrospective methods," write the authors. "The primary objective of our study was to prospectively assess the relationship of self-reported preinjury psychiatric status and injury severity with PTSD among those deployed in support of the conflicts in Iraq and Afghanistan." They study also sought to ascertain other demographic, military and deployment-related factors that exacerbate post-deployment PTSD.

Donald A. Sandweiss, M.D., M.P.H., from Naval Health Research Center, and colleagues, studied U.S. service members who participated in the Millennium Cohort Study, a program created in 2001 to examine the health status of military members before, during and after deployment. A total of 22,630 individuals completed a baseline questionnaire (which includes the PTSD Checklist-Civilian Version) before deploying and one or more follow-up questionnaires during or after their service. Information regarding deployment-related injuries was retrieved from the Joint Theater Trauma Registry (JTTR), a registry maintained by the U.S. Army Institute of Surgical Research, and the Navy-Marine Corps Combat Trauma Registry Expeditionary Medical Encounter Database (CTR EMED). The study cohort included participants from all branches of the U.S. armed forces, including the Reserves and the National Guard.

At baseline, 739 participants (3.3 percent) had at least one psychiatric disorder, defined as PTSD, depression, panic syndrome or another anxiety syndrome. Of the overall group, 183 individuals (0.8 percent) sustained a physical injury during deployment. Follow-up questionnaires showed that 1,840 participants (8.1 percent of the 22,630 subjects in the study population) had PTSD symptoms after deployment.

Participants who showed signs of PTSD at baseline had nearly five times the odds of developing the disorder after deployment. Similarly, among those who experienced other mental health issues were at baseline, the odds of post-deployment PTSD symptoms was 2.5 times more likely. Further, the study found each three-unit increase in Injury Severity Score (as assigned by the JTTR or CTR EMED) was associated with a 16.1 percent greater odds of having post-deployment PTSD symptoms. The authors note that baseline psychiatric status was a stronger predictor than injury severity.

The authors suggest that such screening might help to better protect service members during their time in the field. Checking pre-deployment mental health, they conclude, "might be useful to identify a combination of characteristics of deployed military personnel that could predict those most vulnerable or, conversely, those most resilient to post-deployment PTSD, thereby providing an opportunity for the development of pre-deployment interventions that may mitigate post-deployment mental health morbidity."

---

Journal Reference:

1. Donald A. Sandweiss; Donald J. Slymen; Cynthia A. LeardMann; Besa Smith; Martin R. White; Edward J. Boyko; Tomoko I. Hooper; Gary D. Gackstetter; Paul J. Amoroso; Tyler C. Smith; for the Millennium Cohort Study Team. Preinjury Psychiatric Status, Injury Severity, and Postdeployment Posttraumatic Stress Disorder. Arch Gen Psychiatry, 2011; 68 (5): 496-504 DOI: 10.1001/archgenpsychiatry.2011.44

Men who are abused by their female partners can suffer significant psychological trauma, such as post-traumatic stress disorder, depression and suicidal thoughts, according to two new papers published by the American Psychological Association.

Although most reported domestic abuse is committed by men against women, a growing body of research has picked up on the prevalence and significance of domestic violence perpetrated against men, says research published in the April issue of Psychology of Men & Masculinity. "Given the stigma surrounding this issue and the increased vulnerability of men in these abusive relationships, we as mental health experts should not ignore the need for more services for these men," said British researcher Anna Randle, PsyD, lead author of a paper summarizing two decades of research into domestic violence effects on men.

Approximately 8 percent of men and 25 percent of women reported being sexually or physically assaulted by a current or former partner, according to the National Violence against Women Survey, which polled 8,000 men and 8,000 women and was published by the National Institute of Justice in 1998. While this survey did not indicate the sex of the perpetrator, it provided the most up-to-date comprehensive interpersonal violence statistics at the time of the study, according to the researchers. One analysis of the survey's results showed that male victims were just as likely to suffer from PTSD as female victims of domestic abuse. In addition, psychological abuse was just as strongly associated with PTSD as was physical violence in these male victims. "This raises questions and concerns for male victims of domestic violence, given findings that women are more likely to perpetrate psychological than physical aggression toward male partners," wrote Randle.

Randle noted one study showing that abuse rates among same-sex couples are similar to those of heterosexual couples. However, the depth of research on male same-sex couples is limited when compared to studies of heterosexual couples, she said.

In the second study, led by Denise Hines, PhD, from Clark University, researchers looked at two independent sample groups totaling 822 men between the ages of 18 and 59. The first sample was composed of 302 men who had sought professional help after being violently abused by their female partners. The authors called this "intimate terrorism," characterized by much violence and controlling behavior.

The second sample was composed of 520 men randomly recruited to participate in a national phone survey in which they were asked questions about their relationship. Of this general community, 16 percent said they had sustained minor acts of violent and psychological abuse during arguments with their female partners. This type of abuse was referred to in the research as "common couple violence," in which both partners lashed out physically at each other.

The researchers found that in both groups of men, there were associations between abuse and post-traumatic stress symptoms. However, the "intimate terror victims" who had sought professional help were at a much greater risk of developing PTSD than the men from the general community group who said they had engaged in more minor acts of violence with their partners, according to the researchers.

"This is the first study to show that PTSD is a major concern among men who sustain partner violence and seek help," said Hines.

Research has shown severe underreporting of spousal or partner abuse of men, according to Randle. For example, men are not as likely to report serious injuries due to abuse, and psychological or less violent abuse is more likely to go unreported to authorities. In addition, police are less likely to arrest female suspects accused of violence than male suspects, according to another study cited by Randle.

The lack of reliable data has led to some confusion in the literature on domestic violence effects on men, the researchers said. They suggest more rigorous research focusing specifically on male victims.

---

Journal References:

1. Anna A. Randle, Cynthia A. Graham. A review of the evidence on the effects of intimate partner violence on men. Psychology of Men & Masculinity, 2011; 12 (2): 97 DOI: 10.1037/a0021944
2. Denise A. Hines, Emily M. Douglas. Symptoms of posttraumatic stress disorder in men who sustain intimate partner violence: A study of helpseeking and community samples. Psychology of Men & Masculinity, 2011; 12 (2): 112 DOI: 10.1037/a0022983

The process we use to store memories is more complex than previously thought, New York University neuroscientists have found. Their research, which appears in the journal the Proceedings of the National Academy of Sciences, underscores the challenges in addressing memory-related ailments, such as post-traumatic stress disorder.

The researchers looked at memory consolidation and reconsolidation. Memory consolidation is the neurological process we undergo to store memories after an experience. However, memory is dynamic and changes when new experiences bring to mind old memories. As a result, the act of remembering makes the memory vulnerable until it is stored again — this process is called reconsolidation. During this period, new information may be incorporated into the old memory.

It has been well-established that the synthesis of new proteins within neurons is necessary for memory storage. More specifically, this process is important for stabilizing memories because it triggers the production of new proteins that are required for molecular and synaptic changes during both consolidation and reconsolidation.

The purpose of the NYU study was to determine if there were differences between memory consolidation and reconsolidation during protein synthesis. Similar comparative studies have been conducted, but those focused on elongation, one of the latter stages of protein synthesis; the PNAS research considered the initiation stage, or the first step of this process.

Using laboratory rats as subjects, the researchers used mild electric shocks paired with an audible tone to generate a specific associative fear memory and, with it, memory consolidation. They played the audible tone one day later — a step designed to initiate recall of the earlier fear memory and bring about reconsolidation. During both of these steps, the rats were injected with a drug designed to inhibit the initiation stage of protein synthesis.

Their results showed that the inhibitor could effectively interfere with memory consolidation, but had no impact on memory reconsolidation.

"Our results show the different effects of specifically inhibiting the initiation of protein synthesis on memory consolidation and reconsolidation, making clear these two processes have greater variation than previously thought," explained Eric Klann, a professor at NYU's Center for Neural Science and one of the study's co-authors. "Because addressing memory-related afflictions, such at PTSD, depends on first understanding the nature of memory formation and the playback of those memories, finding remedies may prove even more challenging than is currently recognized."

The study's other co-authors included: Kiriana Cowansage, Joseph LeDoux, and Charles Hoeffer, who now holds an appointment at NYU School of Medicine.

 Disasters — both natural and humanmade — can strike anywhere and they often hit without warning, so they can be difficult to prepare for. But what happens afterward? How do people cope following disasters? In a new report in Psychological Science in the Public Interest, a journal of the Association for Psychological Science, George Bonanno, Chris R. Brewin, Krzysztof Kaniasty, and Annette M. La Greca review the psychological effects of disasters and why some individuals have a harder time recovering than do others.

Individuals exposed to disaster may experience a number of psychological problems including PTSD, grief, anxiety, and increased substance abuse, but the evidence shows that less than 30% of adults experience severe, lasting levels of these problems. The majority of people exposed to a disaster experience passing distress but return to psychological health. In other words, people tend to be psychologically resilient.

But why do individuals respond to disasters so differently?

There may be a number of factors that influence how people react following disasters, such as age and socioeconomic status. For example, children react to disasters differently than do adults: Initially they tend to show more extreme psychological distress than do adult disaster survivors, but as with adults, such severe psychological problems are often only temporary. At the other end of the age spectrum, older adults tend to overcome disasters with fewer psychological costs than do younger adults. Economic resources may also play a role in people's outcomes to disasters. Low socioeconomic status is consistently identified as a predictor of PTSD. Economically underdeveloped areas' lack of infrastructure hampers the ability of emergency response teams to provide aid and death tolls tend to be larger in poorer nations than in wealthier nations following natural disasters.

How can disaster survivors be helped?

The most commonly used psychological intervention immediately following a disaster consists of a single session, known as critical incident stress debriefing(CISD). Although it is widely used, there is not much evidence supporting its effectiveness and multiple studies suggest it may actually be psychologically harmful. Less intrusive forms of immediate psychological aid may be useful, such as psychological first aid (PFA). PFA focuses on providing practical help to survivors and promoting a sense of safety, connectedness, and hope. PFA is promising, although more studies are needed to evaluate its effectiveness. Research suggests that psychological interventions following disasters may be most effective during short- and long-term recovery periods (1 month to several years post-disaster), especially when used in combination with screening for at-risk individuals.

---

Journal Reference:

1. George Bonanno, Chris R. Brewin, Krzysztof Kaniasty, and Annette M. La Greca. Weighing the Costs of Disaster: Consequences, Risks, and Resilience in Individuals, Families, and Communities. Psychological Science in the Public Interest, 

— For troubled war veterans, a friendly bartender can be the source of more than just drinks and a sympathetic ear.

A pilot study suggests that some bartenders may be in a good position to identify veterans in need of mental health services and help connect them to the appropriate agency.

Researchers at Ohio State University surveyed 71 bartenders employed at Veterans of Foreign Wars posts in Ohio.

The results showed that bartenders felt very close to their customers and that these customers shared their problems freely with them, said Keith Anderson, lead author of the study and assistant professor of social work at Ohio State.

"Many of the bartenders said that their customers were very much like family," Anderson said.

"Given the closeness of the relationships, these bartenders are in a really great position to help these veterans — if they are given the right training and the right tools."

Anderson conducted the study with Jeffrey Maile and Lynette Fisher, former undergraduate students at Ohio State. The study appears in the current issue of the Journal of Military and Veterans' Health.

The researchers sent surveys to 300 randomly selected VFW posts in Ohio. They received responses from 71 bartenders working at 32 different VFW posts.

Of the bartenders surveyed, 73 percent said their role with their customers was "like family." And about 70 percent of the bartenders said that the veterans they interacted with "always" or "often" shared their problems with them.

Encouragingly, 80 percent of the bartenders said they would be willing to refer veterans to services at the U.S. Department of Veterans Affairs.

These results show why bartenders may be especially well-suited to help troubled veterans, Anderson said.

"We need to find the veterans where they are. Many of them may not be willing to go to a VA clinic to seek out help on their own. The VFW bartenders may be one of our best chances to reach some of these veterans," he said.

In addition, Anderson said he suspects that these bartenders may actually know more than anyone else about the problems of some veterans.

"Some veterans will tell things to bartenders that they wouldn't even tell their spouses or family," he said.

"And bartenders can probably say things to the veterans that a spouse would be reluctant to say — like 'I think you need to get some professional help.'"

That doesn't mean that VFW bartenders should be practicing therapy or be expected to be mental health counselors, Anderson emphasized.

About two-thirds of those surveyed rated their ability to recognize depression in their patrons as "moderate," while the remaining third rated their ability as "high."

Only 14 percent rated their ability to recognize symptoms of post-traumatic stress disorder as "high" while 43 percent rated their ability as low.

But about 60 percent said they would be interested in additional training on how to spot physical and mental health problems in their customers, if the training was offered through the VFW.

That's one reason Anderson said he selected bartenders at the VFW for the study, rather than bartenders at public bars or nightclubs. Nearly all the customers are veterans, so bartenders are familiar with their problems and struggles and may even be familiar with VA services that may be available to them.

Anderson said he has contacted the national VFW headquarters to see if he and his colleagues can put together a brief online training program for their bartenders. Such a program would teach bartenders the symptoms of mental health problems, the resources available to veterans, and techniques for referring veterans to services in a way that does not alienate them.

Anderson said he suspects some people will be concerned about any program that addresses mental health issues in an environment where alcohol is served. But he said it is appropriate to have bartenders offer assistance.

"If the person who needs help is at a bar, that is where the outreach has to occur," Anderson said. "It doesn't make any sense to discard bartenders as potential helpers just because they are serving alcohol."

---

Journal Reference:

1. Keith A Anderson, Jeffrey J Maile, Lynette G Fisher. The Healing Tonic: A Pilot Study of the Perceived Ability and Potential of Bartenders. Journal of Military and Veterans' Health, 2010; 18 (4)

A new study at Rochester Institute of Technology indicates that the incidence of maltreatment, including neglect and physical and sexual abuse, is more than 25 percent higher among deaf and hard-of-hearing children than among hearing youths. The research also shows a direct correlation between childhood maltreatment and higher rates of negative cognition, depression and post-traumatic stress in adulthood.

The study, which was presented at the 2010 annual meeting of the Association of Behavioral and Cognitive Therapies, is one of the first to compare childhood maltreatment between deaf and hearing children.

"By providing clear data on the high rate of childhood maltreatment in the deaf community, we hope to shine a light on the issue and provide mental-health professionals with the necessary data to better treat both children and adults suffering from mental and behavioral disorders," notes Lindsay Schenkel, assistant professor of psychology at RIT and director of the research team.

The group, which also included undergraduate psychology student Danielle Burnash and Gail Rothman-Marshall, associate professor of liberal studies at RIT's National Technical Institute for the Deaf, conducted a survey of 425 college students, 317 hearing and 108 deaf, asking them to describe any maltreatment they had experienced prior to the age of 16.

Seventy-seven percent of deaf and hard-of-hearing respondents indicated experiencing some form of child maltreatment, compared with 49 percent among hearing respondents. In addition, respondents with more severe hearing loss indicated an increased rate and severity of maltreatment.

"Interestingly, having a deaf parent or a family member who signs, or being part of the deaf community, did not reduce the risk of childhood maltreatment," Burnash notes.

The team also found that deaf and hard-of-hearing respondents who had suffered maltreatment had higher rates of negative cognitions about themselves, others and the future compared with hearing individuals who had suffered maltreatment. The rate of depression and post-traumatic stress was also higher among all deaf and hard-of-hearing respondents regardless of maltreatment.

Schenkel, Rothman-Marshall and Burnash plan to continue to examine the issue of child maltreatment in deaf and hard-of-hearing individuals and the impact this has on mental-health functioning with the goal of developing standardized assessments and more effective treatments for this population.

"For example, our research shows that individuals who are active members of the deaf community report fewer depressive and post-traumatic stress symptoms," Schenkel adds.

The research was funded by RIT's National Technical Institute for the Deaf and the U.S. Department of Education's McNair Scholars program.

Living through a natural disaster is a traumatic experience for everyone, but especially for children. A new study by University of Miami Psychologist Annette La Greca and her collaborators, indicate that some children who directly experience a devastating hurricane still show signs of posttraumatic stress (PTS) almmost two years after the event. The findings suggest that new models for intervention to help children after a natural disaster are needed.

The study, titled "Hurricane-Related Exposure Experiences and Stressors, Other Life Events, and Social Support: Concurrent and Prospective Impact on Children's Persistent Posttraumatic Stress Symptoms," is published online in the Journal of Consulting and Clinical Psychology and will be in print in the December 2010 issue.

Previous research mainly has focused on children during the few months after a major hurricane, or two years or more after the event. Most of the existing post-hurricane interventions are designed for children experiencing PTS two years or more after the storm. The new study "picks up where others left off," assessing children during the in-between period, at nine months (Time One) and then at 21 months after a hurricane (Time Two), explains La Greca, professor of Psychology and Pediatrics in the college of Arts and Sciences at UM and principal investigator of the study.

"There have been no tested interventions developed for children who still show significant symptoms of PTS almost a year after a devastating hurricane," says La Greca. "What this study shows is that there may be a need to test intervention programs to be used from several months to two years post-disaster, to keep kids from developing persistent stress."

The researchers studied 384 children, in second to fourth grade that lived through Hurricane Charley, a strong category four hurricane that struck Charlotte County, in Southwest Florida in 2004. The storm caused 35 deaths, extensive damage of more than $16.3 billion and prolonged school closures.

According to the study, 35 percent of the children reported moderate to very severe levels of PTS at Time One, and 29 percent were still reporting these levels of stress at Time Two. Although previous studies have shown that children stress symptoms decline the first year after the hurricane, this study shows that children who are still showing signs of stress towards the end of the first year are likely to persist having symptoms another year later.

"It's more common than not for most children to overcome, on their own, the effects of exposure to a severe hurricane," says Wendy Silverman,professor of Psychology and Director of the Child Anxiety and Phobia Program at FIU.

Florida International University (FIU) and co-author of this study. Our findings that posttraumatic stress symptoms continued in such a high percentage of children almost two years after Hurricane Charley were somewhat unexpected."

The symptoms the children experience range from reoccurring dreams about the hurricane, to being tense, more distracted, feeling like nobody understands them, more difficulty sleeping, and feeling more sad or fearful than before the disaster. In addition to experiences directly related to the hurricane, other events in the life of a child during the recovery period, such as parents' separation or an illness in the family, have a "cascading effect" that magnifies the child's difficulties

"Finding that hurricane related stressors could contribute to other major life events was not necessarily counterintuitive, but, as far as I know, not documented before, and from that perspective, is a significant finding," says Silverman.

Interestingly, social support from peers was found to be very important in helping to protect the child from the psychological impact of the hurricane. "For children that have experienced a destructive hurricane, restoring contact with friends provides a buffer to the negative experiences, helping kids have greater resilience and to adjust better to life after the disaster," says La Greca.