PTSD Diagnoses on the Rise

Posttraumatic stress disorder (PTSD) now affects one in 29 Americans, reports Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, in a June 6 statement. An anxiety disorder, PTSD affects not only combat veterans but also crime and abuse victims, disaster survivors, first responders, and others who have experienced trauma in their lives.

Symptoms of PTSD can include sleep problems, irritability, anger, recurrent dreams about the trauma, intense reactions to reminders of the trauma, disturbances in relationships, and isolation. The good news is that PTSD is treatable, and new research is helping to identify the kinds of treatment that are most effective.

“The Department of Health and Human Services, along with the Departments of Veterans Affairs and Defense, are supporting new research to reveal the underlying causes of PTSD and related conditions, develop better tools to identify those at highest risk of developing the disorder, and develop new and better treatments and preventive interventions,” says Sebelius.

The National Institute of Mental Health is also funding research—including both evaluation and intervention studies—on a wide range of PTSD topics. Current NIMH studies are focused on:

• Teens coping with parental military deployment
• The effectiveness of a Web-based intervention for guardians of children whose one parent has murdered the other
• The effects of stress in pregnancy
• Cognitive behavioral treatment for PTSD in people with additional serious mental illnesses
• Comparing behavioral therapies for treating adolescents with PTSD related to sexual abuse
• The development of magnetic resonance imaging techniques for studying mood and anxiety disorders
• Group intervention for interpersonal trauma
• Prazosin for treating noncombat-trauma PTSD
• Psychobiological mechanisms of resilience to trauma

To learn more about these studies, or for information and resources to share with your clients, visit the PTSD Web site at the NIMH.

Historic, Censored “Shell-Shock” Documentary Film Restored and Released for On-line Viewing

Director John Huston’s film Let There Be Light, a documentary about the psychological issues of soldiers returning from World War II, has recently been restored and released by the National Archives and Records Administration. Produced by the U.S. Army in 1945, this controversial film was censored for more than three decades. By the time it was finally given a public screening in 1980, the quality of the then-available print was so poor that it was very difficult to view and understand. In this new restoration, the technical problems have been resolved, and many of us will now see this important piece of history for the first time.

Let There Be Light deals with “shell-shock,” or in today’s terms, post-traumatic stress disorder (PTSD), among returning soldiers. Huston, who is best known as the director of such classics as The Maltese Falcon (1941), Key Largo (1948), and The African Queen (1951), was serving as a major in the U.S. Army Signal Corps when he was given the assignment to create the documentary in June 1945. Its working title was The Returning Psychoneurotics. Although by current standards, the psychiatric methods and therapeutic “cures” are dated and perhaps unrealistic, the film captures some historically significant aspects of military psychiatric practice during the 1940s.

Huston later described the project:

I visited a number of Army hospitals during the research phase, and finally settled on Mason General Hospital on Long Island as the best place to make the picture. It was the biggest in the East, and the officers and doctors there were the most sympathetic and willing…. The hospital admitted two groups of 75 patients each week, and the goal was to restore these men physically, mentally and emotionally within six to eight weeks, to the point where they could be returned to civilian life in as good condition—or almost as good—as when they came into the Army…. I decided that the best way to make the film was to follow one group through from the day of their arrival until their discharge. (Source: National Film Preservation Foundation, Film Notes)

Let There Be Light was ground-breaking not only in its use of unscripted interview techniques, but also because of the mix of racial groups represented in the film. Although the U.S. military would remain largely segregated until President Truman’s executive order of 1948, a few Army hospitals had begun integrating in 1943. Huston’s film shows African American and white soldiers being treated side-by-side, an unusually progressive choice at that time.

To view this documentary now, visit the National Film Preservation Foundation and click on the link for Let There Be Light. And let us know what you think—leave a comment here to join the conversation!

Psychiatric Community Considers Name Change for PTSD

What’s in a name? For young veterans and others coping with post-traumatic stress disorder, a name could mean the difference between seeking treatment and suffering alone. Psychiatrists and military officers are now considering the implications of a name change for PTSD in an effort to reduce the stigma associated with this diagnosis. The new name under consideration? Post-traumatic stress injury, or PTSI.

“No 19-year-old kid wants to be told he’s got a disorder,” said General Peter Chiarelli, in a May 5 interview with the Washington Post. Until his retirement in February of this year, Chiarelli was the nation’s second-highest ranking Army officer, and he led the effort to reduce the suicide rate among military personnel. He and other supporters of the name change believe that using the word “injury” instead of “disorder” will reduce the stigma that stops soldiers and others from seeking treatment. According to Chiarelli, “disorder” suggests a pre-existing condition that “makes the person seem weak.” “Injury,” on the other hand, is appropriate because the condition is caused by the experience of specific trauma, according to supporters of the change. Injuries, they point out, can often be healed with treatment.

This issue is coming to a head because the American Psychiatric Association is working on a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), expected in May 2013. Not everyone is in favor of the name change; one of the major concerns, according to psychologist Sherrie Bourg Carter, is that “altering a diagnostic label may have far-reaching financial implications for health insurers and disability claims. Specifically, some insurers and government agencies may not be willing to reimburse mental health providers for a condition that isn’t considered a disease or disorder” (Psychology Today blog, May 6).

American Psychiatric Association President Dr. John Oldham has suggested that he would be open to considering the name change. “If it turns out that that [the word ‘injury’] could be a less uncomfortable term and would facilitate people who need help getting it, and it didn’t have unintended consequences that we would have to be sure to try to think about, we would certainly be open to thinking about it,” Oldham told PBS NewsHour in a December interview.

What do you think? Would a name change help reduce the stigma associated with post-traumatic stress and encourage people to seek the help they need? PAR wants to hear from you, so leave a comment and join the conversation!

 

More than Six Years After Katrina, Trauma Remains

According to a new study conducted at Princeton University, many survivors of 2005’s Hurricane Katrina are still struggling with poor mental health even today, years after the storm.

Lead researcher Christina Paxson and her team began this project in 2003 as a study of low-income adults enrolled in community college. They used sites around the country for their research, three of those sites were located in New Orleans. Their original questionnaire asked participants for their opinions on topics related to education, income, families, and health.

After Hurricane Katrina hit in August 2005, the researchers decided to continue to track the New Orleans-based participants because the type of information they had was very rare in disaster studies, as they already knew much about the individual’s mental and physical health. In most disaster studies, researchers are never able to determine if the participants are suffering because of the disaster or because they already had underlying conditions that would have led to poor mental health even before the disaster hit.

With data collected one year before, 7-19 months after, and 43-54 months post-Katrina, they found that although symptoms of posttraumatic stress and psychological distress declined over time, these symptoms were still high 43-54 months after the storm. They also found that damage to the home was an especially important predictor of chronic posttraumatic stress symptoms, with and without symptoms of psychological distress. Those individuals with higher earnings and better social support reported better outcomes in the long run, but results indicate that mental health issues still remain a concern for hurricane survivors.

Even four years after the storm, researchers found that about a third of participants still reported high levels of posttraumatic stress and about 30 percent reported suffering from psychological distress.

According to Paxson, “I think the lesson for treatment of mental health conditions is don’t think it’s over after a year. It isn’t.”

To read more about the study, see January’s issue of Social Science & Medicine.

What do you find most beneficial in working with survivors of traumatic events?

Recent NDAA amendment paves way for cross-state PTSD counseling

The National Defense Authorization Act recently passed by Congress omitted a key requirement, possibly making it easier for active-duty military personnel and veterans to receive mental health care.

Previously, mental health practitioners were required to be licensed in the state in which care was being administered. The removal of this provision means that military personnel and vets located anywhere in the US may be able to receive counseling through video teleconference technology from a mental health professional  located elsewhere.

A previous exemption allowed cross-state counseling only if both practitioner and patient were located on federal property, but the new law permits care to be provided at any location, including from a civilian location or even inside a patient’s home.

Limitations still exist, however. The delivery of care via telehealth into service members’ homes is not currently authorized under Tricare policy.

Nearly 20% of service members returning from Iraq and Afghanistan report symptoms of PTSD or major depression, according to a Rand Corporation study. And telehealth is a hot topic within the military—last year, the Department of Defense National Center for Telehealth and Technology launched an online educational tool that enables combat veterans to learn more about PTSD within a “second life”-type environment.

How do you feel about using telehealth technology to deliver PTSD therapy? What other changes must be made to make this type of counseling more accessible? Weigh in—we’d love to hear what you think.