Category: PTSD

Living a traumatic experience favors the persistence of fear associated with an aversive stimulus, known as fear conditioning. Scientists in the US and Spain have now found that such effect, in mice, can be suppressed with a single dose of 7,8-Dihydroxyflavone, a type of flavonoid which boosts the ability to acquire new emotional behaviors.

The findings were published in the American Journal of Psychiatry in a study carried out by researchers at Emory University and Universitat Autònoma de Barcelona (UAB), who consider that the drug could be used as an effective treatment of post-traumatic stress, panic and phobia disorders in humans.

Mice previously exposed to traumatic situations demonstrate a more persistent memory of fear conditioning — acquired by associating an acoustic stimulus with an aversive stimulus — and lack the ability to inhibit this fear. This phenomenon is similar to that of people who suffer from Post-Traumatic Stress Disorder (PTSD), an anxiety disorder which appears after being exposed to highly traumatic situations, such as a violent attack, a natural disaster or physical abuse. In the study, researchers verified that the 7,8-Dihydroxyflavone injected into mice previously subjected to a traumatic experience made them extinguish fear conditioning more quickly. The enhancement of this new learning is the result of 7,8-Dihydroxyflavone activating the TrkB receptors in the brain, probably those found in the amygdala, which are essential for emotional learning and memory.

7,8-dihydroxyflavone is a type of flavonoid. These chemical compounds are present in our diets in elements such as red wine, citrus, cereals, tea and chocolate (at least 70% cocoa), etc. Chronic administration of foods rich in flavonoids in lab animals has demonstrated neuroprotective effects in aged rodents, but the activation of TrkB receptors produced by these foods is probably low compared to the effects of 7,8-Dihydroxyflavone.

TrkB receptors in the brain are activated in mammals by the BDNF protein. There are different pathologies, such as depression or anxiety disorders, in which this protein shows alterations in its function. Unfortunately, administration of the BDNF protein as a drug is limited given that a large part of the amount injected does not permeate the blood-brain barrier and cannot access the brain. Very recent studies have demonstrated that 7,8-Dihydroxyflavone is the first drug to imitate BDNF actions and enter the brain with much more efficacy than the protein, thus revealing therapeutic actions in animal models suffering from Alzheimer's, strokes, Parkinson's and/or depression.

The results obtained in this study suggest that 7,8-Dihydroxyflavone as a drug could be an useful treatment for disorders based on fear such as PTSD, panic attacks and phobias. Researchers consider it convenient to study its effects combined with psychotherapy, administering the drug in fear extinction therapy sessions for anxiety disorders or even shortly after a person experiences a traumatic situation.

Led by Dr Kerry Ressler of Emory University, Atlanta, the study was developed with the participation of Dr Antonio Armario, researcher at the UAB Institute of Neuroscience and professor of the Department of Cell Biology, Physiology and Immunology, and Dr Raul Andero, researcher at Emory University. The article published in the American Journal of Psychiatry is part of Dr Andero's doctoral thesis.

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Journal Reference:

1. R. Andero, S. A. Heldt, K. Ye, X. Liu, A. Armario, K. J. Ressler. Effect of 7,8-Dihydroxyflavone, a Small-Molecule TrkB Agonist, on Emotional Learning. American Journal of Psychiatry, 2010; DOI: 10.1176/appi.ajp.2010.10030326

Nearly 10 years after the greatest human-made disaster in U.S. history– the destruction of the World Trade Center (WTC) towers — there has been little research documenting the attacks' consequences among those most directly affected — the survivors who escaped the World Trade Center towers.

In a study just released by Columbia University's Mailman School of Public Health, in conjunction with the New York City Department of Health and Mental Hygiene and the federal Agency for Toxic Substances Disease Registry (ATSDR), researchers found that of the 3,271 civilians who evacuated the Twin Towers, 95.6% of survivors reported at least one current posttraumatic stress symptom and 15% screened positive for Posttraumatic Stress Disorder (PTSD), two to three years after the disaster. While past studies have examined PTSD prevalence among rescue and recovery workers, Lower Manhattan residents, other downtown building occupants, and passersby, this is the first study to focus specifically on people who were inside the towers when they were struck.

The full study findings are currently online in the American Journal of Epidemiology.

PTSD is a psychiatric disorder that occurs after experiencing or witnessing events that threaten death or serious injury and that involves intense feelings of fear, helplessness, or horror and is the third most common anxiety disorder in the United States. The researchers report that five characteristics of direct exposure to the terrorist attacks were predictors of PTSD: a key driver was initiating evacuation late. Other predictors were being on a high floor in the towers, being caught in the dust cloud that resulted from the tower collapses, personally witnessing horror, and sustaining an injury. Working for an employer that sustained fatalities also increased risk. Each addition of an experience of a direct exposure resulted in a two-fold increase in the risk of PTSD.

The vast majority, 91% of survivors above the impact zone in 2 WTC, reported that they began evacuation after the first plane hit 1WTC. Overall, 60.8% were caught in the dust cloud from the tower collapses. Ninety-four percent witnessed horror, and 32% sustained an injury, ranging from a concussion to a sprain or strain. The overwhelming majority of survivors reported that the WTC was their usual place of work (95.8%).

The researchers found that women and minorities in particular were at an increased risk of PTSD, although the strongest demographic risk factor for PTSD in the study was low income. Survivors with incomes less than $25,000 per year were eight times more likely to have PTSD than those earning more than $100,000 per year.

The study was based on interviews with 3,271 English-speaking, civilian survivors who are enrolled in the WTC Health Registry, the largest post-disaster public health registry in U.S. history, tracking the health of more than 71,000 people directly exposed to the WTC disaster. Eligibility criteria for this particular study included a minimum age of 18 years, physical presence in either Tower 1 or 2 between the first plane impact and subsequent tower collapses, and no participation in WTC rescue/recovery activities.

In terms of other demographic characteristics of this cohort of survivors, 58.5% were men and 68.2% were white. However, the risk of PTSD was highest among Hispanics and African Americans. Sixty-seven percent of the survivors were college graduates and 60% had an annual household income greater than $75,000. Sixty-seven percent worked for an employer that sustained fatalities on 9/11.

Because this study targeted those with the greatest direct exposure, the burden of posttraumatic stress was higher for these survivors than that documented in previous 9/ 11 studies, and the number of cases of posttraumatic stress observed was directly related to the number of direct exposures reported.

"PTSD risk was greater among survivors who experienced serious life threat as defined by location in the towers, time of evacuation initiation, or dust cloud exposures," said Dr. Laura DiGrande, DrPH, MPH, Columbia's Mailman School of Public Health doctoral degree recipient for this research and first author of the study. "As one would expect, individuals who were exposed to several of the most troubling and life threatening events during the disaster were at the greatest risk of PTSD." Only 145 or four percent of survivors had no symptoms of PTSD.

"As the long-term effects of the WTC disaster emerge the results from this study suggest that some survivors of the WTC disaster will continue to report psychological symptoms years after their exposure to the events of 9/11. The implication of this finding is that the impact of terrorism on survivors, particularly those in low socioeconomic positions, could be substantial, as PTSD is known to be co-morbid with other disorders and harmful behaviors that affect daily functioning, wellness, and relationships," noted Dr. Sandro Galea, MD, chair of the Department of Epidemiology at Columbia's Mailman School of Public Health and study senior author.

"As disaster literature moves toward understanding long-term risks in the general population, this study reminds us that the relation between direct exposures and PTSD is clear and suggests potential avenues for planning policy to reduce the burden of terrorism-related psychopathology," noted Dr. Robert Brackbill, PhD, MPH, the Registry's founding principal investigator and study coauthor.

As the 10-year anniversary of the World Trade Center disaster approaches, Columbia researchers and the WTC Health Registry are continuing to ascertain even longer term implications.

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Journal Reference:

1. L. DiGrande, Y. Neria, R. M. Brackbill, P. Pulliam, S. Galea. Long-term Posttraumatic Stress Symptoms Among 3,271 Civilian Survivors of the September 11, 2001, Terrorist Attacks on the World Trade Center. American Journal of Epidemiology, 2010; DOI: 10.1093/aje/kwq372

A team of researchers at Mount Sinai School of Medicine has developed the first web-based screening tool for Traumatic Brain Injury (TBI). This instrument has recently been used by soldiers returning from the wars in Iraq and Afghanistan who participated in the Sixth Annual Road to Recovery Conference and Tribute in Orlando to determine if they sustained a TBI.

"Traumatic brain injury is underdiagnosed, and left untreated can have long-term cognitive, behavioral and physical effects," said Wayne Gordon, PhD, the Jack Nash Professor of Rehabilitation Medicine and an Associate Director of the Department of Rehabilitation Medicine at Mount Sinai School of Medicine, who led the project. "If we can intervene and diagnose TBI early, then we can prevent further complications."

Dr. Gordon and his team began working on this screening tool 20 years ago. Working in local schools, they found a surprising number of students with TBI but never reported it nor received medical attention, often because the injuries were sustained as a result of abuse or assault. Dr. Gordon wanted to develop an anonymous screening tool to help people assess their risk and avoid long-term complications.

The Brain Injury Screening Questionnaire (BISQ) is a web-based tool that allows users to anonymously answer a series of questions about whether they sustained a blow to the head in which they were unconscious or dazed, confused or disoriented. Their symptoms include sleep disturbances, irritability, memory disturbances, difficulties organizing daily tasks, and difficulty concentrating. At the end of the survey, participants receive a computer-generated report. Those who are found to be at risk are advised to seek further evaluation from a qualified health care professional.

According to Mark Wiederhold, MD, who presented at the conference, TBI was diagnosed in 41 percent of patients being treated in the Walter Reed Army Medical Center in Washington, DC. Dr. Gordon hopes that more veterans' organizations will embrace the tool in this population so that they are treated early.

"I applaud the Coalition to Salute America's Heroes and The American Legion for taking the first step toward bringing this serious issue to the forefront, and encouraging veterans to get screened," said Dr. Gordon. "I hope more organizations around the country will follow suit."

It is estimated that about seven percent of people in the United States have diagnosed or undiagnosed TBI. Dr. Gordon and his team from the Department of Rehabilitation Medicine at Mount Sinai plan to conduct research using the screening tool in other populations as well. The researchers are using BISQ to assess TBI in the prison population in Texas to determine how the condition may contribute to criminality.

The software is $15.00. For more information visit http://www.mssm.edu/research/centers/traumatic-brain-injury-central.

In the first combat-zone study of its kind, a research team led by Michigan State University found that soldiers with a positive outlook in the most traumatic situations were less likely to suffer health problems such as anxiety and depression.

The study, which surveyed Army troops fighting in Iraq, could have implications for police officers, firefighters and others who regularly deal with traumatic events such as death. Training these first-responders to think in less catastrophic terms could help them better cope with distressing events and function more effectively in the long term, said MSU's John Schaubroeck, lead researcher on the project.

The study will be published in the January issue of the Journal of Occupational Health Psychology.

"There is evidence that if we can train people to be more psychologically resilient — that is, less catastrophic in their thinking and more optimistic and more hopeful — then they function better when they encounter traumatic situations," said Schaubroeck, John A. Hannah Distinguished Professor of psychology and management. "They may be less likely to experience symptoms of post traumatic stress disorder down the line, although we don't know that for sure."

Schaubroeck added that people who have high levels of resiliency still experience stress and symptoms of health problems. "It's just that resiliency means they get over the event relatively quickly, while a low-resiliency person might have a hard time letting go."

The study was based on a survey of 648 soldiers in nine combat units fighting in Iraq in 2004. This was about 15 months after the end of major combat operations were declared, but during a period of heavy fighting against insurgents in particular areas. The information was collected in Iraq by Lt. Col. Everett Spain, an Army officer and then instructor and assistant professor at the United States Military Academy.

Many researchers have studied the psychological effects of combat after the fact, but this appears to be the first study to scientifically investigate resilience during wartime. The study analyzed traits including hopefulness, optimism and ego resilience, which basically means how well a person maintains psychological well-being during difficult times.

According to the study, the more stressful the combat situation, the more important the resiliency traits became. "Resiliency really shows itself when the chips are down," Schaubroeck said. "This is different than the way we often think about it. We often think about resiliency as having the same level of effects regardless of the level of stress."

On a practical note, Schaubroeck said leaders can play a crucial role in shaping a message of hope and optimism. It's especially important to target individuals experiencing trauma for the first time. If a rookie police officer witnesses a colleague get killed, for example, the officer needs to understand that an emotionally-charged reaction is normal, Schaubroeck said.

"The fact that you're crying because you saw someone get shot and you can't help them — it's not unusual to be in that situation if you are a police officer," Schaubroeck said. "Leaders need to be sensitive to this when debriefing people and not depend entirely on health professionals. Oftentimes when you bring in health professionals, it's too late; the psychological situation has already gotten out of hand for the individual."

Schaubroeck's co-researchers include Ann Chunyan Peng from MSU and Laura Riolli from California State University-Sacramento.

Combat-related post-traumatic stress disorder (PTSD) symptoms appear to be associated with longer-term physical (headache, tinnitus), emotional (irritability) and cognitive (diminished concentration or memory) symptoms, according to a report in the January issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Conversely, concussion/mild traumatic brain injuries (MTBI) do not appear to have long-term negative effects on troops.

"Nearly 2 million troops have been deployed to Operation Enduring Freedom and Operation Iraqi Freedom since 2001," the authors write as background information in the article. "High levels of combat exposure have been documented among Operation Enduring Freedom/Operation Iraqi Freedom-deployed soldiers, with increased risk of blast exposure and injury and development of post-deployment mental and physical health problems."

Although there has been a focus by the Department of Defense and the Veterans Administration on early identification of concussion, little data exist on the long-term, functional effects of concussion on returning soldiers. To examine the associations between concussion and PTSD symptoms reported during deployment and long-term psychosocial outcomes, Melissa A. Polusny, Ph.D., of the Minneapolis Veterans Affairs Health Care System and the University of Minnesota Medical School, Minneapolis, and colleagues, surveyed 953 combat-deployed U.S. National Guard Soldiers.

Consistent with demographics of infantry soldiers deployed to Iraq, 92.5 percent of participants were male, 87.1 percent were white, 46.4 percent were younger than 30 and 86.5 percent were enlisted rank. Soldiers were surveyed in Iraq one month before returning home, and again one year later.

At the time of the first survey, 7.6 percent of all participating soldiers met criteria for probable PTSD. This rate increased to 18.2 percent at the time of the second survey. Change in PTSD symptoms between the two surveys was no different for those who reported concussion in the first survey and those who did not. Reporting of PTSD at the time of survey one strongly predicted post-deployment symptoms, including memory and balance problems, difficult concentrating and irritability.

The rate of reported concussion at the time of the first survey was 9.2 percent and increased to 22 percent at the second survey. Of those reporting concussion at the first survey, 30.2 percent had probable PTSD at the time of the second survey. Additionally, of the 22 percent who reported concussion during the second survey, 30.4 percent also had probable PTSD at that time. Soldiers with a history of reported concussion were also more likely to report post-concussive symptoms after deployment; however, after adjusting for PTSD symptoms, the association between these symptoms and concussion was not significant.

"Although combat-related PTSD was strongly associated with post-concussive symptoms and psychosocial outcomes one year after soldiers return from Iraq, there was little evidence of a long-term negative impact of concussion/mild traumatic brain injury history on these outcomes after accounting for PTSD," the authors conclude. "These findings and the two-fold increase in reports of deployment-related concussion/MTBI history have important implications for screening and treatment."

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Journal Reference:

1. M. A. Polusny, S. M. Kehle, N. W. Nelson, C. R. Erbes, P. A. Arbisi, P. Thuras. Longitudinal Effects of Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Comorbidity on Postdeployment Outcomes in National Guard Soldiers Deployed to Iraq. Archives of General Psychiatry, 2011; 68 (1): 79 DOI: 10.1001/archgenpsychiatry.2010.172

Post-traumatic stress disorder (PTSD) more than doubles a veteran's risk of death from any cause and is an independent risk factor for cardiovascular disease, according to research presented at the American Heart Association's Scientific Sessions 2010.

PTSD is more than a psychological disorder, and the study suggests that physicians should provide early and aggressive evaluation and treatment of cardiovascular risk factors in patients with PTSD, said Naser Ahmadi, M.D., M.S., and Ramin Ebrahimi, M.D., co-principal investigators of the study. PTSD is a cluster of symptoms that can include emotional numbing, avoidance of certain situations, hyperarousal, sleep disruptions and impaired concentration.

"This study for the first time appears to point to the mechanism for the cardiovascular part of that excess mortality risk: accelerated atherosclerosis," said Ahmadi, a research scientist at the Greater Los Angeles Veterans Administration (VA) Medical Center. "Our trial is the first to make a direct association between PTSD and atherosclerotic coronary disease as measured by coronary artery calcification (CAC), a standard test that is commonly used in studies such as ours because it can be measured non-invasively."

Researchers studied the electronic medical records of 286,194 veterans (average age 63, 85.1 percent male) treated at VA medical centers in southern California and Nevada. The veterans participated in conflicts dating back to the Korean War.

During an average follow-up of nearly 10 years and after adjusting for age, gender, and common cardiovascular risk factors, the researchers found that veterans diagnosed with PTSD had 2.41 times the rate of death from all causes compared to non-PTSD veterans — making PTSD an independent predictor of death from all causes.

PTSD patients made up 10.6 percent (30,460) of the entire group of veterans, but 28.9 percent of veterans who died had PTSD, said Ahmadi, who is also a member of the research faculty at the Greater Los Angeles VA Health Care System.

In a 637-veteran sub-study that used a non-invasive technique to measure the amount of coronary artery calcium, researchers found that 76.1 percent of veterans with PTSD showed at least some CAC, compared to 59 percent of non-PTSD veterans. As a group, the PTSD veterans had more severe disease of their arteries with an average CAC score of 448 compared to 332 in non-PTSD veterans.

The researchers sorted the subgroup according to their calcium buildup. After controlling for known cardiovascular risk factors and mental status, they found that at every level of calcium buildup, the PTSD veterans had a higher risk of all-cause mortality. Among veterans with calcium buildup, those with PTSD had a 48 percent greater risk of death from any cause and a 41 percent greater risk of death due to cardiovascular disease compared to non-PTSD veterans.

"The current PTSD treatment protocol is to provide relief of symptoms alone," Ahmadi said. "PTSD is a very debilitating disorder. It makes the patient feel hopeless. These patients constantly struggle with many different (psychological) problems."

The study's findings are important because they show that PTSD predicts death independently of known cardiovascular risk factors, Ahmadi said. "We also believe we have found a mechanism by which PTSD could increase the risk of cardiovascular events via atherosclerosis. If we focus on early detection and management of cardiovascular risk factors in veterans with PTSD, we might be able to delay the onset of cardiovascular disease."

Co-authors are Fereshteh Hajsadeghi, M.D.; Harmoz Babaei Mirshkarlo, M.D.; Rachel Yehuda, Ph.D.; and Ramin Ebrahimi, M.D. (co-principal investigator).

The computer game Tetris may have a special ability to reduce flashbacks after viewing traumatic images not shared by other types of computer game, Oxford University scientists have discovered in a series of experiments.

In earlier laboratory work the Oxford team showed that playing Tetris after traumatic events could reduce memory flashbacks in healthy volunteers. These are a laboratory model of the types of intrusive memories associated with post-traumatic stress disorder (PTSD).

In this new experimental study, the researchers compared the effectiveness of Tetris at reducing flashbacks with Pub Quiz Machine 2008, a word-based quiz game. They found that whilst playing Tetris after viewing traumatic images reduced flashbacks by contrast playing Pub Quiz increased the frequency of flashbacks.

A report of the research is published in this week's edition of the journal PLoS ONE.

In two separate experiments, the team showed a film to healthy volunteers that included traumatic images of injury from a variety of sources, including adverts highlighting the dangers of drink driving — a recognised way to study the effects of trauma in the laboratory.

In the first experiment, after waiting for 30 minutes, 20 volunteers played Tetris for 10 minutes, 20 played Pub Quiz, in which they had to select one of four on-screen answers, for 10 minutes and 20 did nothing. Those who had played Tetris experienced significantly fewer flashbacks of the film than those who did nothing, whilst those who played Pub Quiz experienced significantly more flashbacks.

In the second experiment, this wait was extended to four hours, with 25 volunteers in each group. Those who played Tetris again had significantly fewer flashbacks that the other two groups. In both experiments, all groups were equally able to recall specific details of the film.

'Our latest findings suggest Tetris is still effective as long as it is played within a critical six-hour window after viewing a stressful film,' said Dr Emily Holmes of Oxford University's Department of Psychiatry, who led the work. 'Whilst playing Tetris can reduce flashback-type memories without wiping out the ability to make sense of the event, we have shown that not all computer games have this beneficial effect — some may even have a detrimental effect on how people deal with traumatic memories.'

These latest findings support how the team believes the approach works:

The mind is considered to have two separate channels of thought: one is sensory and deals with our direct perceptual experience of the world through sight, sound, smell, taste and touch. The other channel is conceptual, and is responsible for putting together these perceptual experiences in a meaningful way — putting them into context. Generally, these two channels work in balance with each other, for example, we would use one channel to see and hear someone talk and the other to comprehend the meaning of what they are saying.

However, when someone is exposed to traumatic information, these channels are thought to function unequally so that the perceptual information is emphasised over the conceptual information. This means we are less likely to remember the experience of being in a high-speed road traffic collision as a coherent story, and more likely to remember it by the flash of headlights and noise of a crash. This perceptual information then pops up repeatedly in the victim's mind in the form of flashbacks to the trauma causing great emotional distress, as little conceptual meaning has been attached to them.

Research tells us that there is a period of up to six hours after the trauma in which it is possible to interfere with the way that these traumatic memories are formed in the mind. During this time-frame, certain tasks can compete with the same brain channels that are needed to form the memory. This is because there are limits to our abilities in each channel: for example, it is difficult to hold a conversation while doing maths problems.

The Oxford team reasoned that recognising the shapes and moving the coloured building blocks around in Tetris competes with the images of trauma in the perceptual information channel. Consequently, the images of trauma (the flashbacks) are reduced. The team believe that this is not a simple case of distracting the mind with a computer game, as answering general knowledge questions in the Pub Quiz game increased flashbacks. The researchers believe that this verbal based game competes with remembering the contextual meaning of the trauma, so the visual memories in the perceptual channel are reinforced and the flashbacks are increased.

Dr Holmes said: 'Whist this work is still experimental, and any potential treatment is a long way off, we are beginning to understand how intrusive memories/flashbacks are formed after trauma, and how we can use science to explore new preventative treatments.'

The group will continue to develop this approach further as a potential intervention to reduce the flashbacks experienced in PTSD, but emphasise that the research is still in the early stages, and careful steps need to be taken before this can be tested clinically.

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Journal Reference:

1. Holmes EA, James EL, Kilford EJ, Deeprose C. Key Steps in Developing a Cognitive Vaccine against Traumatic Flashbacks: Visuospatial Tetris versus Verbal Pub Quiz. PLoS ONE, 2010; 5 (11): e13706 DOI: 10.1371/journal.pone.0013706

A child who grows up in the midst of political conflict, such as war or terrorism, can exhibit severe emotional scars. But certain qualities, which psychologists call "resilience factors," can help overcome this adversity.

Prof. Michelle Slone of Tel Aviv University's Department of Psychology has now developed a program to help children develop these resilience factors and avoid the psychological disabilities that may arise from stress. Her method — and her inspiring results — were recently described in the Journal of Child Psychology and Psychiatry and International Journal of Behavioral Development.

A lesson plan for resilience

Because children are surprisingly resilient, if given the proper tools, they can move past traumatic experiences more easily than adults.

Prof. Slone studied children who underwent daily rocket attacks from Gaza or other forms of political violence. She compared children who appeared more well-adjusted to those who exhibited more severe psychological trauma, and determined which qualities made the difference. With the results of this research, she developed a series of workshops to enhance those elements that helped children deal with the stress of conflict.

After the workshops, children who attended were better able to stand up in front of their peers and candidly discuss their anxieties about the conflict they experienced, engaging with the group to form strategies for dealing with problems that arose. This exercise dramatically improved their psychological healing process, she says.

A four-fold approach

For her workshops, Prof. Slone identified four of the most important resilience factors: mobilizing appropriate support; attributing meaning to the traumatic experience; developing self-efficacy and problem-solving skills; and improving self-esteem. Next, she developed a school-based intervention program to help students develop and utilize the desired qualities. She and her fellow researchers created a workbook for each factor, she explains, and held training sessions with teachers. Through a four-to-six week workshop process, the children were led through a variety of activities designed to improve each quality.

Analyzing pre- and post-workshop questionnaires, interviews, and evaluations, Prof. Slone and her fellow researchers determined that in addition to developing the individual resilience factor each workshop focused on, the students displayed less anxiety and aggressive behavior, a better sense of well-being and improved social interaction and academic performance.

Teachers as well as students benefited from the workshops, says Prof. Slone. Prior to implementing this program, teachers had no method for talking to their students about the traumatic symptoms they observed. Teachers reported that the workshops enhanced their ability to help their students with difficult issues, and even improved class and school morale.

Helping children around the world

Although the program would need to be modified to account for cultural differences, says Prof. Slone, similar programs can be introduced in schools internationally. She believes that her workshops give teachers the tools they need to communicate with their students about difficult issues, and allow children to better psychologically handle the traumas to which they may have been exposed. This could help children deal with the effects of events such as 9/11 or the London Underground bombings.

The first step, explains Prof. Slone, is to determine what resilience factors benefit the children in a given society or culture. Once these factors are identified, the workshops can be adapted to help foster these particular factors. "This type of secondary intervention has the potential to be effective for a wide variety of trauma exposure," she says. "And it is possible to enhance resilience factors in large populations of children. They're lessons that can last a lifetime."

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Journal Reference:

1. M. Slone, A. Shoshani. Efficacy of a school-based primary prevention program for coping with exposure to political violence. International Journal of Behavioral Development, 2008; 32 (4): 348 DOI: 10.1177/0165025408090976

 After the campus shootings at Virginia Tech in 2007 and Northern Illinois University in 2008, hundreds of affected students turned to social media websites to share their grief and search for solace. A new study of these students found that their online activities neither helped nor harmed their long-term psychological health.

The study, which appears in Personality and Social Psychology Bulletin, gives a first-of-its-kind portrait of student reactions to shootings on their campuses. It also documents the (online and off-line) activities they engaged in to memorialize and recover from these events.

"After the shooting at Virginia Teach I noticed immediately on my Facebook account that my friends were changing their pictures to memorial ribbons or they were joining groups to support the students at Virginia Tech," said Amanda Vicary, a doctoral student who conducted the study with University of Illinois psychology professor R. Chris Fraley. "I started looking (for studies on this topic) and realized that no research had been done looking at how people use the Internet specifically to grieve or investigating how students responded psychologically to these shootings."

Two weeks after the shootings at Virginia Tech, Vicary sent an e-mail to 900 Virginia Tech students with Facebook accounts inviting them to participate in an online survey.

One hundred twenty-four of those students chose to do so. The survey assessed the students for symptoms of depression and post-traumatic stress disorder (PTSD), and asked them about their participation in online and off-line activities related to the shootings.

Vicary conducted a second survey of many of the same students six weeks later (two months after the shootings).

After a gunman killed five and injured 18 people at Northern Illinois (10 months after the shootings at Virginia Tech), Vicary conducted a similar survey there, with 160 NIU students responding.

The combined results from both campuses revealed that 71 percent of the respondents suffered from significant symptoms of depression and 64 percent had significant symptoms of PTSD two weeks after the shootings on their campuses.

Many respondents reported that they had participated in online memorials, texted, sent e-mails or instant messages or posted comments about the tragedies on social networking sites such as Facebook. Nearly 90 percent had joined at least one Facebook group concerning the shooting. More than 70 percent had replaced their profile pictures with a Virginia Tech or NIU memorial ribbon, and 28 percent had posted a message on a memorial website.

"It was fascinating from my point of view to see how grief and mourning plays out on the Internet and to learn that it works in a way that's very similar to the way it would if we were doing this outside of a digital framework," Fraley said. "People were sharing their thoughts and feelings with their friends on Facebook. They were attending virtual vigils, joining groups, doing many of the same kinds of things they would do in the non-digital world."

"Two months later, a fair amount of students were still suffering from significant symptoms, but many had recovered pretty considerably," Vicary said. Depressive symptoms still affected 30 percent of respondents (down from 71 percent), and PTSD was still an issue for 22 percent of them (down from 64 percent).

Most of the students reported that their online activities related to the shootings made them feel better, Vicary said. But the analysis revealed that the degree to which students engaged in online activities or communications about these tragedies had no discernable effect on their ultimate recovery from depressive or PTSD symptoms.

It may be that the students' online activities did help them feel a little better, Vicary said, but that immediate effect apparently did not translate into a long-term change.

The findings are instructive, however, because they show that the students' online activities were not harmful to their psychological health, Vicary said.

"Whenever a tragedy like this occurs, there is a debate in the news concerning students and their reliance on the Internet," she said. "Is it harming them? Is this doing something detrimental to their well-being? And in terms of what we found with grieving behaviors after these tragedies, the answer is no."

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Journal Reference:

1. A. M. Vicary, R. C. Fraley. Student Reactions to the Shootings at Virginia Tech and Northern Illinois University: Does Sharing Grief and Support Over the Internet Affect Recovery?Personality and Social Psychology Bulletin, 2010; DOI: 10.1177/0146167210384880

Individuals with co-occurring psychiatric illnesses, especially anxiety and depression, appear to have an increased risk of death within 30 days of surgery, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals.

Psychiatric illnesses occur along with physical complaints in an estimated 5 percent to 40 percent of hospitalized patients, according to background information in the article. Having a psychiatric condition is independently associated with an increased risk of illness and death. Previous studies of these conditions have largely been limited to patients admitted to the hospital for medical conditions, not surgical procedures.

Thad E. Abrams, M.D., M.S., of the Iowa City Veterans Affairs Medical Center and University of Iowa Carver College of Medicine, Iowa City, and colleagues studied 35,539 surgical patients admitted to intensive care units from Oct. 1, 2003, through Sept. 30, 2006. An existing psychiatric condition was identified in 8,922 (25.1 percent) of the patients, including 5,500 (15.5 percent) with depression, 2,913 (8.2 percent) with post-traumatic stress disorder, 2,473 (7 percent) with anxiety, 793 (2.2 percent) with bipolar disorder and 621 (1.8 percent) with psychosis.

Before adjustment, 30-day death rates were similar among patients with and without psychiatric illnesses (3.8 percent vs. 4 percent). However, after the researchers considered other factors in their analyses, 30-day death rates were higher for patients with psychiatric conditions.

In individual analyses, the risk of dying within 30 days was associated with depression and anxiety, but not with any other psychiatric condition. In addition, 30-day death rates among those with psychiatric conditions were higher for those undergoing respiratory or digestive system procedures but not procedures involving the circulatory, nervous or musculoskeletal system.

"Several potential mechanisms exist to explain these findings," the authors write. "First, studies indicate that patients with depression frequently do not adhere to medical recommendations for underlying medical conditions. It is therefore plausible that such undertreated conditions may affect postoperative care and outcomes. Second, patients with existing psychiatric comorbidity may be more likely to undergo surgery by a lower-quality surgeon or hospital. Third, pre-existing psychiatric comorbidity may serve as an indicator for greater severity of surgical risk."

The results suggest greater care should be taken among patients with a psychiatric illness who are undergoing surgery, the authors note. "Until further research is completed, we recommend that surgeons caring for patients with a history of anxiety or depression seek early involvement of multidisciplinary teams to help identify problematic areas in perioperative care processes, particularly regarding issues of surgeon-patient communication and adherence to post-surgical recommendations."

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Journal Reference:

1. Thad E. Abrams; Mary Vaughan-Sarrazin; Gary E. Rosenthal. Influence of Psychiatric Comorbidity on Surgical Mortality. Arch Surg, 2010; 145 (10): 947-953 DOI: 10.1001/archsurg.2010.190