Young children especially vulnerable to effects of 9/11

— Two new longitudinal studies show that age played an important role in the effects of the September 11, 2001 (9/11) terrorist attacks on New York City. Both studies appear in a special section on children and disaster in the July/August 2010 issue of the journal Child Development.

In the first study, researchers found higher rates of clinically significant behavior problems among preschool children directly exposed to 9/11 in Lower Manhattan according to whether their mothers had post-traumatic stress disorder (PTSD) and depression. In the second study, New York City adolescents and their mothers had generally elevated rates of PTSD and depression one year after 9/11. Direct exposure to the events of 9/11 played a small but significant role in explaining the severity of mental health symptoms.

The first study, by researchers from Mount Sinai School of Medicine, the Jewish Board of Family and Children's Services, and the Bronx Department of Veterans Affairs Medical Center, looked at more than 100 moms and their preschool children who were directly exposed to the World Trade Center attacks. The families were recruited through extensive outreach in the Lower Manhattan area, primarily to preschools, between March 2003 and December 2005. The researchers asked: What's more important in determining terrorism-related problems in children — direct exposure to the attacks or indirect exposure to their mothers' attack-related psychological problems? As a follow-up, they asked whether young children exposed to the attacks whose mothers suffered from PTSD and depression were more likely to have serious behavior problems than similar children of moms with neither PTSD nor depression, or with only depression.

The study found that mothers' disaster-related psychological problems had a stronger impact on preschool children than children's direct exposure. Moreover, 9/11-exposed young children of moms with PTSD and depression, as documented by parent and teacher reports, were more likely to have clinically significant aggression, anxiety, depression, and sleep problems. The mothers' psychological well-being appeared to affect how well they helped their young children cope with exposure to disaster, although additional research is needed to shed light on this relationship.

The study was funded by the National Institute of Mental Health.

The second study was carried out by researchers from the University of Michigan, New York University, the Austin Independent School District, and Sesame Workshop; the sample of more than 400 12- to -20-year olds and their mothers was drawn from a larger school-based study. In this second study, adolescents and their mothers were found to have generally high levels of PTSD and depression. Directness of exposure played a small but statistically significant role in explaining the prevalence of PTSD and depression in adolescents and their mothers. It was only direct exposure (for example, seeing the planes hit the towers) that was associated with elevated rates of PTSD and depression.

The authors note, however, that school-based samples may have excluded those most seriously affected or those receiving intensive services. Generally high levels of PTSD and depression in both adolescents and mothers in the sample may indicate that the events of 9/11 had general effects on the population or that other stressors (such as community or family violence) were in the background.

The study was funded by the Centers for Disease Control and Prevention, the National Institute of Mental Health, and the National Institute on Drug Abuse.

Together, the two studies suggest that responding to children's post-trauma needs requires an understanding of how the children were exposed and of the impact of trauma-related changes in parent-child relationships.


Journal References:

  1. Claude M. Chemtob, Yoko Nomura, Khushmand Rajendran, Rachel Yehuda, Deena Schwartz, Robert Abramovitz. Impact of Maternal Posttraumatic Stress Disorder and Depression Following Exposure to the September 11 Attacks on Preschool Children’s Behavior. Child Development, 2010; 81 (4): 1129 DOI: 10.1111/j.1467-8624.2010.01458.x
  2. Elizabeth T. Gershoff, J. Lawrence Aber, Angelica Ware, Jennifer A. Kotler. Exposure to 9/11 Among Youth and Their Mothers in New York City: Enduring Associations With Mental Health and Sociopolitical Attitudes. Child Development, 2010; 81 (4): 1142 DOI: 10.1111/j.1467-8624.2010.01459.x

Hurricane Katrina's effects on children: Resilience and gender

— Rebuilding schools after Hurricane Katrina and providing supportive environments and relationships have helped many children reduce their levels of overall trauma from the hurricane that devastated the Gulf Coast in August 2005, according to a new study. A second study found that girls had distinct stress reactions from boys in the aftermath of the storm.

The studies appear in a special section on children and disaster in the July/August 2010 issue of the journal Child Development.

In a longitudinal study of recovery patterns of children affected by Katrina, researchers at Louisiana State University Health Sciences Center and the St. Bernard Parish Public Schools looked at 400 mostly White elementary- and high-school-aged children (from ages 9 to 18) between 2005 and 2008. The children lived in a New Orleans school district that was heavily damaged by the hurricane.

When the researchers looked at the children two and three years after Katrina hit, they found that overall trauma symptoms (such as feeling depressed, sad, nervous, and having trouble concentrating and sleeping) had decreased. Furthermore, 45 percent of the children were found to be resistant to stress and lacked long-term psychological problems. The children's strengths, the researchers found, were largely the result of rebuilt schools (St. Bernard Parish reopened within 2-1/2 months of the hurricane) and supportive relationships (including the classmates students interacted with when they returned to school).

But this work in progress also found that more than a quarter of the children continued to have significant trauma symptoms of post-traumatic stress and depression three years later. Children who reported these symptoms were more likely to be younger, female, have seen a mental health professional, and also report family or school problems. They also reported being exposed to more traumas.

A second study on children affected by Katrina, conducted by researchers at the University of Missouri and The Pennsylvania State University, looked at the issue from the perspective of gender. Experiencing distress is a normal part of life, yet males and females have been found to show different patterns of stress reactions in laboratory studies.

In this study, researchers looked at more than 60 teens (ages 12 to 19) who had been displaced by Katrina and were living in a government relocation camp with their families two months after the hurricane. Most of the participants were African American teens from low-income families that had lived in New Orleans. The researchers measured psychological functioning (such as depression and aggression) and two hormone markers of stress regulation (salivary cortisol and alpha-amylase), then compared these with more than 50 adolescents who were demographically similar but lived in a part of the United States that wasn't affected by Katrina.

Male and female teens who experienced the hurricane showed distinct patterns of behavioral stress as well as gender differences in how they regulated physiological stress, the study found. Specifically, compared to the children who weren't exposed to Katrina, girls who survived the hurricane were more depressed and boys showed lower levels of aggression and higher levels of confidence. Heightened stress hormonal reactions were likewise associated with depression in girls and confidence in boys.

In suggesting that males and females develop specialized systems for processing and responding to stress, the study adds to our understanding of normative stress regulation following trauma.


Journal References:

  1. Mindy E. Kronenberg, Tonya Cross Hansel, Adrianne M. Brennan, Howard J. Osofsky, Joy D. Osofsky, and Beverly Lawrason. Children of Katrina: Lessons Learned About Postdisaster Symptoms and Recovery Patterns. Child Development, 2010; 81 (4): 1241 DOI: 10.1111/j.1467-8624.2010.01465.x
  2. Jacob M. Vigil, David C. Geary, Douglas A. Granger and Mark V. Flinn. Sex Differences in Salivary Cortisol, Alpha-Amylase, and Psychological Functioning Following Hurricane Katrina. Child Development, 2010; 81 (4): 1228 DOI: 10.1111/j.1467-8624.2010.01464.x

Post-traumatic stress disorder: Serotonin system influences vulnerability and treatment

 There is a great deal of interest in factors that contribute to the vulnerability to developing post-traumatic stress disorder, or PTSD. One factor that appears to contribute to the heritable vulnerability to PTSD is a variation in the gene that codes for the serotonin transporter, also known as the serotonin uptake site.

Having a shorter version of the serotonin transporter gene appears to increase one's risk for depression and PTSD after exposure to extremely stressful situations. This same gene variant increases the activation of an emotion control center in the brain, the amygdala. More recently, scientists began focusing on factors contributing to resilience to the impact of stress exposure. Could the same gene that contributes to the vulnerability to PTSD be implicated in the recovery from PTSD?

In their new study appearing in Biological Psychiatry, Dr. Richard Bryant and colleagues assessed whether serotonin transporter genotype predicted a change in patients' PTSD severity following treatment. Specifically, patients with PTSD were classified according to their genotype, and they received eight weeks of cognitive behavior therapy. Approximately one-third of patients do not respond to this treatment, and this study has now demonstrated that there may be a genetic basis for not responding to this therapy.

Dr. Bryant explained: "Patients with PTSD who carried the short allele of the serotonin transporter gene promoter responded more poorly to treatment than other PTSD patients. This study highlights that the serotonin system is implicated in responding to cognitive behavior therapy."

The recent focus on personalized medicine has emphasized the impact of variation in genes that influence the responses to medications. This study supports the reasoning that genetic variation would also influence the response to psychotherapeutic or rehabilitative treatments.

Dr. John Krystal, Editor of Biological Psychiatry, noted, "While this study identifies a potential predictor of poor treatment response, it also may help to identify groups of individuals who respond relatively favorably to treatment. It is interesting this 'good outcome' group is a group that is also more resilient, i.e., less likely to develop PTSD or depression, after stress."

Although further research is necessary, this initial finding indicates that PTSD treatments may need to be modified to accommodate patients' genetic profiles.


Journal Reference:

  1. Richard A. Bryant, Kim L. Felmingham, Erin M. Falconer, Laarnie Pe Benito, Carol Dobson-Stone, Kerrie D. Pierce, Peter R. Schofield. Preliminary Evidence of the Short Allele of the Serotonin Transporter Gene Predicting Poor Response to Cognitive Behavior Therapy in Posttraumatic Stress Disorder. Biological Psychiatry, 2010; 67 (12): 1217 DOI: 10.1016/j.biopsych.2010.03.016

Do creative work activities create stress?

The demands associated with creative work activities pose key challenges for workers, according to new research out of the University of Toronto that describes the stress associated with some aspects of work and its impact on the boundaries between work and family life.

Researchers measured the extent to which people engaged in creative work activities using data from a national survey of more than 1,200 American workers. Sociology professor Scott Schieman (UofT) and his coauthor and PhD student Marisa Young (UofT) asked participants questions like: "How often do you have the chance to learn new things?"; "How often do you have the chance to solve problems?"; "How often does your job allow you to develop your skills or abilities?" and "How often does your job require you to be creative?" They used responses to these questions to create an index that they label "creative work activities."

The authors describe three core sets of findings:

  • People who score higher on the creative work index are more likely to experience excessive job pressures, feel overwhelmed by their workloads, and more frequently receive work-related contact (emails, texts, calls) outside of normal work hours;
  • In turn, people who experience these job-related pressures engage in more frequent "work-family multitasking" — that is, they try to juggle job- and home-related tasks at the same time while they are at home.
  • Taken together, these job demands and work-family multitasking result in more conflict between work and family roles — a central cause of problems for functioning in the family/household domain.

According to Schieman, "these stressful elements of creative work detract from what most people generally see as the positive sides of creative job conditions. And, these processes reveal the unexpected ways that the work life can cause stress in our lives — stress that is typically associated with higher status job conditions and can sometimes blur the boundaries between work and non-work life."

This research also discovered that people who score higher on the creative work index are more likely to think about their work outside of normal work hours. However, when this occurred, many said that they didn't feel "stressed out" by these thoughts. Schieman adds: "There are aspects of creative work that many people enjoy thinking about because they add a sense of accomplishment and fulfillment to our lives. This is quite different from the stressful thoughts about work that keep some of us awake at night: the deadlines you can't control, someone else's incompetent work that you need to handle first thing in the morning, or routine work that lacks challenge or feels like a grind."


Journal Reference:

  1. Schieman et al. The Demands of Creative Work: Implications for Stress in the Work-Family Interface. Social Science Research, 2010; 39 (2): 246 DOI: 10.1016/j.ssresearch.2009.05.008

Sleep problems are common in US soldiers returning from wartime deployment

— There is an extremely high prevalence of sleep disturbances in U.S. soldiers returning from wartime deployment, according to a research abstract presented June 8, 2010, in San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the Associated Professional Sleep Societies LLC.

Results indicate that 86 percent of participants had sleep disturbances upon return from deployment and 45 days later even though the majority of them had no signs of post-traumatic stress disorder or depression. Soldiers were more likely to have sleep disturbances if they had a personal history of sleep problems, symptoms of physical illness or mild traumatic brain injury.

"This is the first study to describe the prevalence of sleep disturbances at two different time points in soldiers returning from deployment without any apparent physical trauma from blasts or amputation," said principal investigator Major Betty Garner, PhD, a nurse scientist in the Nursing Research Office at Landstuhl Regional Medical Center in Landstuhl, Germany. "The most surprising finding from this small preliminary sample was the extremely high percentage of sleep disturbances in soldiers even 45 days after they returned from wartime deployment back to the United States — the safe zone."

Major Garner conducted the study as a doctoral student at the University of Washington, where she screened 58 U.S. soldiers between the ages of 23 and 58 years. Participants were assessed immediately upon return from deployment and 45 days later using the Pittsburgh Sleep Quality Index, Post Deployment Health Assessment, Perceived Stress Scale and Combat Exposure Scale.

The U.S. has deployed more than one million soldiers in support of overseas operations in Iraq and Afghanistan since 2001. The researchers noted that the stress and uncertainty involved with deployment may have an impact on the sleep quality of soldiers.

According to Major Garner, previous research studies have shown disturbed sleep can be a symptom of existing medical conditions or a risk factor for the development of mental and physical health disorders. Therefore, the prompt treatment of sleep disturbances in soldiers returning from deployment might mitigate future physical and mental health problems.

"It is anticipated that this knowledge will facilitate the identification of those at risk for sleep disturbances and the provision of education for health care providers in the crucial role of sleep in our soldiers," said Major Garner.

The study was supported by the U.S. Military's TriService Nursing Research Program through the Uniformed Services University of the Health Sciences.

About one-tenth of soldiers returning from Iraq may be impaired by mental health problems, study finds

Between 8.5 percent and 14 percent of soldiers returning from Iraq report serious functional impairment due to either posttraumatic stress disorder or depression, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

"A growing body of literature has demonstrated the association of combat in Iraq and Afghanistan with post-deployment mental health problems, particularly posttraumatic stress disorder (PTSD) and depression," the authors write as background information in the article. "However, studies have shown varying prevalence rates of these disorders based on different case definitions and have not assessed functional impairment, alcohol misuse or aggressive behavior as comorbid factors occurring with PTSD and depression."

Between 2004 and 2007, Jeffrey L. Thomas, Ph.D., of the Walter Reed Army Institute of Research, Silver Spring, Md., and colleagues collected anonymous mental health surveys of 18,305 U.S. Army soldiers three and 12 months following deployment. The soldiers were members of four Active Component (non-reserve) and two National Guard (reserve) infantry brigade combat teams. They were screened for PTSD, depression, alcohol misuse and aggressive behaviors, and asked if these problems caused difficulties doing work, taking care of things at home or getting along with other people.

"Using the least stringent definition, we observed PTSD rates across Active Component and National Guard study groups, study time points ranging from 20.7 percent to 30.5 percent, and depression rates ranging from 11.5 percent to 16 percent," the authors write. "Using the strictest definitions with high symptom rates and serious functional impairment, PTSD prevalence ranged from 5.6 percent to 11.3 percent and depression prevalence from 5 percent to 8.5 percent."

Alcohol misuse or aggressive behavior — including slamming a door, punching a wall or threatening or perpetrating physical violence in anger — was present in about half of the cases of PTSD or depression.

Between the three- and 12-month time points, depression and/or PTSD rates remained the same among Active Component soldiers but increased among National Guard soldiers, despite similar rates of combat experiences and similar prevalence rates of mental health problems three months after deployment. "Therefore, the emergence of differences by 12 months likely does not have to do with differences in the health effects of combat but rather with other variables related to readjustment to civilian life or access to health care," the authors write.

The results suggest consequences not only for the care of returning soldiers and their families, but also peers in their units, they conclude. "The findings of the study show that at 12 months following combat, the prevalence of mental health problems among veterans does not abate, and in many cases, increases. It is a virtual certainty that soldiers who remain in service will deploy again; this study shows that a sizable proportion (9 percent to 14 percent) have depression or PTSD symptoms with serious functional impairment," they write. "If soldiers who are struggling with serious functional impairment as the result of a previous deployment are deployed again, there is potential that this could impair their performance in combat. This has implications for the safety of unit members and mission success."


Journal Reference:

  1. Jeffrey L. Thomas; Joshua E. Wilk; Lyndon A. Riviere; Dennis McGurk; Carl A. Castro; Charles W. Hoge. Prevalence of Mental Health Problems and Functional Impairment Among Active Component and National Guard Soldiers 3 and 12 Months Following Combat in Iraq. Arch Gen Psychiatry, 2010; 67 (6): 614-623

Post-traumatic stress disorder associated with dementia among older veterans

Older veterans with post-traumatic stress disorder (PTSD) appear more likely to develop dementia over a seven-year period than those without PTSD, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

PTSD is a common psychiatric symptom and often occurs in veterans returning from combat, according to background information in the article. As many as 17 percent of veterans returning from Iraq and Afghanistan are estimated to have PTSD, and 10 percent to 15 percent of Vietnam veterans had PTSD symptoms 15 years or longer after their return. Previous studies have associated PTSD with a wide variety of medical conditions in younger and middle-aged veterans, along with declines in cognitive (thinking, learning and memory) performance.

Kristine Yaffe, M.D., of the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, and colleagues studied 181,093 veterans 55 years and older (average age 68.8, 96.5 percent men) between 1997 and 2000. Of these, 53,155 had PTSD and 127,938 did not.

Over seven years of follow-up, from 2000 to 2007, 31,107 (17.2 percent) of the veterans developed dementia. Veterans with PTSD had a 10.6 percent risk of developing dementia, whereas the risk among those without dementia was 6.6 percent.

Those with PTSD were still more likely to develop dementia when the analyses were adjusted for important differences, including demographic variables and other medical and psychiatric illnesses.

"There are several reasons why patients with PTSD may have an increased risk of developing dementia," the authors write. PTSD may contribute to the cause of dementia, or chronic stress may link the two conditions. Stress may damage the hippocampus, a brain area critical for memory and learning, or cause alterations in neurotransmitter and hormone levels that could precipitate dementia.

"The finding that PTSD is associated with a near doubling of the risk of dementia has important public health, policy and biological implications," the authors conclude. "It is important that those with PTSD are treated, and further investigation is needed to see whether successful treatment of PTSD may reduce the risk of adverse health outcomes, including dementia. In addition, it is critical to follow up patients with PTSD, especially if they are of an advanced age, to screen for cognitive impairment. Finally, mechanisms linking PTSD and dementia must be identified in hope of finding ways to improve the care and outcomes of patients with PTSD."


Journal Reference:

  1. Kristine Yaffe; Eric Vittinghoff; Karla Lindquist; Deborah Barnes; Kenneth E. Covinsky; Thomas Neylan; Molly Kluse; Charles Marmar. Posttraumatic Stress Disorder and Risk of Dementia Among US Veterans. Arch Gen Psychiatry, 2010; 67 (6): 608-613

Bright light therapy improves sleep disturbances in soldiers with combat PTSD, research finds

Bright light therapy has significant effects on sleep disturbances associated with combat-related post-traumatic stress disorder, according to a research abstract presented June 7, 2010, in San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the Associated Professional Sleep Societies LLC.

Results indicate that bright light therapy produced a significantly greater improvement than placebo in sleep disturbances specific to PTSD. Bright light therapy also produced a moderate improvement in PTSD symptoms and depression.

"Results of this ongoing study show significant effects of bright light on disruptive nocturnal behaviors associated with combat PTSD, as well as positive effects of bright light therapy on PTSD symptom severity," said study coordinator Shannon Cornelius, PhD, graduate research assistant for Dr. Shawn D. Youngstedt in the department of exercise science at the University of South Carolina in Columbia, S.C. "Because bright light therapy is a relatively simple, self-administered, inexpensive treatment with few side effects, these results are an important step to further establish the efficacy of bright light therapy as an alternative or adjunct treatment for combat-related PTSD."

The study involved 16 soldiers who returned to the U.S. with combat-related PTSD after serving in Operation Enduring Freedom or Operation Iraqi Freedom. Following a one-week baseline, participants were randomized to one of two four-week treatments. Eight soldiers received 10,000 lux of bright light therapy for 30 minutes each day. The other eight participants were assigned to the placebo group and received sham treatment with an inactivated negative ion generator. The Clinician-Administered PTSD Scale (CAPS-2) was completed at baseline and immediately following completion of the study. At weekly intervals, depression was assessed with the Beck Depression Inventory (BDI-II), and sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) with addendum for PTSD (PSQI-PTSD).

Cornelius noted that sleep disturbance is a commonly reported problem that can play both a precipitating and perpetuating role in PTSD, making it an important target for therapy.

"Disturbed sleep is known to interact with depression and anxiety in a vicious cycle," said Cornelius. "By reducing the severity and occurrence of sleep disturbances, it may be possible to reduce the severity of symptoms such as anxiety and depression in combat-related PTSD."

The study was supported by a U.S. Department of Veterans Affairs Merit Award.

The American Academy of Sleep Medicine reports that 70 to 90 percent of people with PTSD describe subjective sleep disturbance. Recurrent nightmares of the traumatic event represent one of the most problematic and enduring symptoms of PTSD. These nightmares may take the form of a realistic reliving of the traumatic event or depict only some of its elements.

Bright light therapy exposes your eyes to intense but safe amounts of light for a specific and regular length of time. Typically it involves exposure to up to 10,000 lux of light for scheduled periods of 20 minutes or more using a small light box.

In a 2007 study published in the journal BMC Psychiatry, Youngstedt reported that bright light exposure may have an anxiolytic effect. Three hours of exposure to 3,000 lux of bright light for three consecutive days reduced anxiety in a group of low-anxiety adults.

Trauma-induced changes to genes may lead to post-traumatic stress disorder

A study by researchers at Columbia University's Mailman School of Public Health suggests that traumatic experiences "biologically embed" themselves in select genes, altering their functions and leading to the development of post-traumatic stress disorder (PTSD).

"Our findings suggest a new biological model of PTSD in which alteration of genes, induced by a traumatic event, changes a person's stress response and leads to the disorder," said Sandro Galea, MD, professor and chair of the Department of Epidemiology at the Mailman School of Public Health, and principal investigator.

"Identification of the biologic underpinnings of PTSD will be crucial for developing appropriate psychological and/or pharmacological interventions, particularly in the wake of an increasing number of military veterans returning home following recent wars worldwide."

The findings are published online in Proceedings of the National Academy of Sciences (PNAS).

Previous studies have found that lifetime experiences may alter the activity of specific genes by changing their methylation patterns. Methylated genes are generally inactive, while unmethylated genes are generally active.

The new study is the first large scale investigation to search for trauma-induced changes in the genes of people with PTSD. DNA samples were obtained from participants in the Detroit Neighborhood Health Study (DNHS), a longitudinal epidemiologic study investigating PTSD and other mental disorders in the city of Detroit. The researchers analyzed the methylation patterns of over 14,000 genes from blood samples taken from 100 Detroit residents, 23 of whom suffer from PTSD.

The analysis found that participants with PTSD had six to seven times more unmethylated genes than unaffected participants, and most of the unmethylated genes were involved in the immune system.

The observed methylation changes in the immune system genes were reflected in the PTSD participants' immune systems: levels of antibodies to a herpes virus were high in PTSD patients, indicative of a compromised immune system.

While people who experience severe trauma will exhibit a normal stress response, in PTSD, the stress response system becomes deregulated and chronically overactive causing compromised immune functioning. PTSD has long been linked to increased risk of numerous physical health problems — including diabetes and cardiovascular disease. This paper suggests why PTSD is so strongly associated with physical health problems — trauma exposure causes epigenetic changes in immune system genes and thus, compromised immune functioning putting individuals at risk for a host of disorders.

"Our findings show that PTSD may be associated with epigenetic changes in immune-system genes. If this is the case, these clusters could provide clues to our understanding of how a traumatic event changes gene expression, thus altering immune function and resulting in other possible physiologic alterations," says Dr. Galea.

The study was funded by grants from the NIH, with additional support provided by the Robert Wood Johnson Health and Society Scholars Program.


Journal Reference:

  1. M. Uddin, A. E. Aiello, D. E. Wildman, K. C. Koenen, G. Pawelec, R. de los Santos, E. Goldmann, S. Galea. Epigenetic and immune function profiles associated with posttraumatic stress disorder. Proceedings of the National Academy of Sciences, 2010; DOI: 10.1073/pnas.0910794107

Survivors of childhood cancers four times more likely to develop post-traumatic stress disorder

— Young adult survivors of childhood cancers are four times more likely to develop Post-Traumatic Stress Disorder (PTSD) than their control group siblings, a Childhood Cancer Survivors Study has found.

The study focused on 6,542 childhood cancer survivors over 18 who were diagnosed with cancer between 1970 and 1986 and 368 of their siblings as a control group. The study found that 589 survivors, or 9 percent, reported significant functional impairment and clinical distress as well as symptoms consistent with a full diagnosis of PTSD. In comparison, eight siblings, or 2 percent, reported impairment, distress and PTSD symptoms.

The study is published in the May issue of the journal Pediatrics.

"Childhood cancer survivors, like others with PTSD, have been exposed to an event that made them feel very frightened or helpless or horrified," said Dr. Margaret Stuber, a professor of psychiatry and biobehavioral sciences, a Jonsson Cancer Center researcher and first author of the study. "This study demonstrates that some of these survivors are suffering many years after successful treatment. Development of PTSD can be quite disabling for cancer survivors. This is treatable and not something they have to just live with."

Affected survivors reported symptoms such as increased arousal, phobias, startling easily, being hyper vigilant, avoidance of reminders of their cancer diagnosis and treatment, being on edge and suffering extreme anxiety. They also reported that the symptoms kept them from functioning normally.

Other studies have looked for PTSD in childhood cancer survivors while they're still children or adolescents, but the percentage reporting symptoms is far less, about 3 percent, Stuber said.

There could be several reasons for the discrepancy. Today's treatment regimens employ less toxic treatments and rely far less on whole head radiation for brain tumors, causing far less trauma to the young patients. Additionally, the improved supportive care available today may result in fewer physical and cognitive late effects from treatment.

The survivors in Stuber's study often underwent far harsher treatment regimens commonly used in the 1970s and early 1980s, and within the group studied, those that underwent the more toxic and damaging therapies reported more cases of PTSD.

Another possible reason that more of the young adults reported PTSD symptoms is because they're facing the stressful situations typical for people at that age — finding a job, getting married, starting a family. That stress may exacerbate the PTSD, Stuber said.

"It may be that symptoms, clinical distress and functional impairment only emerge among the more vulnerable childhood cancer survivors as they contend with the developmental tasks of young adulthood and the added challenges of the late effects of treatment," the study states. "The relative protection of the parental home is diminished as young adult survivors face the challenges of completing their education, finding a job, getting health insurance, establishing long-lasting intimate relationships and starting a family."

And because many of the patients in the study underwent harsh therapies, they often suffer from significant late effects — infertility, cognitive impairment, stunted growth. This add to stress levels as well. Those that suffer from cognitive impairment may find it impossible to go to college or to land a good job that earns them an adequate income.

"These survivors may find that can't get health insurance. They may be reluctant to put themselves on the marriage market because they're sterile. Those that can have children may be afraid of passing their 'bad genes' onto their children. Some treatments affect growth, so some survivors may be shorter and heavier than their peers," Stuber said. "They may feel like they're damaged goods."

Treatment options such as therapy and medication are available to help the survivors manage their symptoms. But addressing the issue will not be simple, Stuber said.

"People who had more intense treatment are more likely to have these symptoms because their treatment was more traumatic," Stuber said. "And because more damage was done to their bodies, it makes it more difficult to have a good life later. It's all interdigitating."

The study, funded by The National Cancer Institute, looked at children with all types of cancers, Stuber said. Participants filled out a comprehensive demographic and health survey.


Journal Reference:

  1. M. L. Stuber, K. A. Meeske, K. R. Krull, W. Leisenring, K. Stratton, A. E. Kazak, M. Huber, B. Zebrack, S. H. Uijtdehaage, A. C. Mertens, L. L. Robison, L. K. Zeltzer. Prevalence and Predictors of Posttraumatic Stress Disorder in Adult Survivors of Childhood Cancer. Pediatrics, 2010; 125 (5): e1124 DOI: 10.1542/peds.2009-2308