Examination Reveals Adolescent Reaction to Iraq War

University of Cincinnati researchers are reporting what they call a significant pattern among Iraqi adolescents and their reaction to the war in Iraq – the higher the perceived threat of the war, the higher the teens reported their self-esteem. The findings – from a 2004 survey of 1,000 Iraqi adolescents in 10 neighborhoods in Baghdad – are reported in the current issue of the Journal of Adolescence.

Steve Carlton-Ford, a University of Cincinnati associate professor and co-author of the study, says the findings give a rare look at the impact of war on adolescents, explaining that, in general, sociologists and psychologists are examining how war affects small children. Carlton-Ford adds that in the cases of young children, conflict-related events typically lower a child’s psychological well-being. The survey of Iraqi teens was conducted in 2004 by co-author Morton Ender of the U.S. Military Academy at West Point, who supervised field surveys with the U.S. Army in the neighborhoods surrounding Baghdad. The study is also authored by UC doctoral student Ahoo Tabatabai.

The authors found that despite obvious threat to the adolescents’ sense of security, the youth were coping fairly well in 2004, with self-esteem levels comparable to that of Palestinian youth. “In the presence of conflict-related trauma one generally observes lower levels of psychological well-being (e.g., PTSD, grief reactions), and sometimes lower self-esteem,” write the authors. “Our results, however, are consistent with a body of theory and research that predicts self-esteem striving and higher self-esteem among the individuals who face indirect threats to central components of their social identities (rather than directly facing traumatic war-related events). In other words, in a situation where we observe a broad social context involving the presence of foreign forces (a clear violation of Muslim principles) combined with general violence throughout Baghdad and Iraq, we also observe a heightened sense of self, at least to the extent that one’s self is tied to one’s nation.”

The study suggests future surveys of adolescents under conditions of armed conflict to track their self-concept as they become young adults.

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Some Brain Injuries May Reduce Likelihood of Post-Traumatic Stress

A new study of combat-exposed Vietnam War veterans shows that those with injuries to certain parts of the brain were less likely to develop post-traumatic stress disorder (PTSD). The findings, from the National Institutes of Health (NIH) and the National Naval Medical Center, suggest that drugs or pacemaker-like devices aimed at dampening activity in these brain regions might be effective treatments for PTSD.

PTSD involves the persistent reliving of a traumatic experience through nightmares and flashbacks that may seem real. Twenty percent to 30 percent of Vietnam vets (more than 1 million) have been diagnosed with PTSD, and a similar rate has been reported among Hurricane Katrina survivors in New Orleans. Public health officials are currently tracking the disorder among soldiers returning from Iraq. Yet, while war and natural disasters tend to call the greatest attention to PTSD, it's estimated that millions of Americans suffer from it as a result of assault, rape, child abuse, car accidents, and other traumatic events.

Previous studies have shown that PTSD is associated with changes in brain activity, but those studies couldn't determine whether the changes were contributing to the disorder or merely occurring because of it.

Jordan Grafman, a senior investigator at the National Institute of Neurological Disorders and Stroke (NINDS), part of NIH, turned to the Vietnam Head Injury Study (VHIS) to make that distinction. The VHIS is a registry of Vietnam veterans who sustained penetrating brain injuries (which are less common in Iraq compared to concussion brain injuries). It has received support from the Department of Defense, the Department of Veterans of Affairs and NIH, and is currently supported by NINDS.

"If we could show that lesions in a specific brain region eliminated PTSD, we knew we could say that the region is critical to developing the disorder," says Grafman. The results of his study appear online in Nature Neuroscience.

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St. Jude Psychologist Says Most Children With Cancer Are Well-Adjusted

Children under treatment for cancer are generally emotionally well-adjusted and no more depressed or anxious than other children their age, according to researchers at St. Jude Children’s Research Hospital. In studies of depression, anxiety, posttraumatic stress and quality of life, children with cancer do as well as, and often better than their healthy peers.

“We see them as a flourishing population that has adapted to the stress of having cancer and undergoing treatment,” says Sean Phipps, a member of the St. Jude Division of Behavioral Medicine. “They become quite resilient to the long-and short-term emotional and physical effects of their disease and the treatments.”

The unexpected finding that children with cancer are emotionally resilient is important because of the dramatic improvement in survival rates of pediatric cancers. “There has been a shift in research toward the concerns of long-term survivors of pediatric cancers,” Phipps says. “The ability of these children to cope with the after-effects of cancer is the major issue now. What we are learning from this population might help us learn how to improve the quality of life of children who are not doing so well.”

Phipps is the author of an article on adaptive styles in children with cancer that appears in the advanced online issue of Journal of Pediatric Psychology. The article, based on research done by his group and other research teams around the country, was presented at the conference “Psychosocial and Neurocognitive Consequences of Childhood Cancer: A Symposium in Tribute to Raymond K. Mulhern,” held at St. Jude in September 2006, in honor of the late Raymond Mulhern, a pioneer in psychological research in pediatric oncology at the hospital. The symposium’s presentations will also appear in a special December issue of the journal.

The low level of depression among children with cancer does not reflect a state of “illusory mental health,” Phipps says. That is, these children are not simply clinging to an illusion of mental health by denying distress. Rather, many of them simply have a reduced awareness of emotional distress, and they think of themselves as being well-adjusted and content, a response called a “repressive adaptive style.”

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Is Television Traumatic?

Dream journals being kept by students in a college psychology class have provided researchers with a unique look at how people experienced the events of 9/11, including the influence that television coverage of the World Trade Center attacks had on people's levels of stress.

Reported in the April 2007 issue of the journal Psychological Science, the study data finds that for every hour of television viewed on Sept. 11 – with some students reporting in excess of 13 hours watched – levels of stress, as indicated by dream content, increased significantly. In addition, the study found that time spent talking with family and friends helped individuals to better process the day's horrific events.

"We had not set out to conduct a scientific study of TV viewing and trauma," says lead author Ruth Propper, an associate professor of psychology at Merrimack College in North Andover, Mass. "But it so happened that students enrolled in one of my courses during the fall 2001 semester were already in the process of keeping dream journals on a nightly basis. As the events of 9/11 were unfolding, I realized there was a valuable opportunity to find out what impact both media coverage and social interactions were having on individuals throughout the course of this tragedy."

So, on Sept. 12, Propper distributed a questionnaire to her students asking them to report on their activities of the day before, including the amount of TV they had watched, the amount of radio they had listened to, and the amount of time they had spent talking about the experience with family and friends.

"What distinguishes these findings is that they occurred in 'real-time,'" adds coauthor Robert Stickgold, a sleep researcher in the Division of Psychiatry at Beth Israel Deaconess Medical Center and associate professor of medicine at Harvard Medical School. "Because we have the students' pre-9/11 dreams with which to compare, we can draw more reliable conclusions about our post-9/11 findings."

Dreams are a reflection of the way the mind is processing and sorting the day's events, and depending on a person's state of mind, will contain different images. For the purposes of this study, the authors separated dream content into four categories: dreams containing specific references to 9/11 (smoke, explosions, police, box cutters, etc.); dreams with generalized threatening content (which made people fearful even though they didn't contain specific references to 9/11); dreams containing broadly related themes related to 9/11 (for example, disasters in general, rather than the 9/11 disaster specifically); and, dreams with strong negative emotional content (which elicited general feelings of anger, fear, or sadness).

"People's dreams can function as a measure of how much distress they are feeling and how well or poorly they are coping," says Stickgold. "If, in your dreams, you are still seeing specific traumatic images – buildings collapsing, fire burning, people jumping – then it means that these stressful events are not being adequately processed. But, if you're seeing tangential events in your dreams – for example, a hurricane rather than the specific 9/11 images – it indicates that your brain is trying to make sense of the trauma and that you are coping successfully."

Not surprisingly, the researchers found that in the days and weeks following the attacks the students' dreams were twice as likely to contain at least one of the four "content features" as they had prior to 9/11. But, says Propper, "Our next question was, 'Is there an explanation for why some individuals' dreams contained specific images of 9/11 and others didn't?'"
So, the authors turned to the questionnaires.

The questionnaire responses showed that throughout the day of Sept. 11, students spent between 0 and 2.5 hours listening to the radio. They spent between one and 12 hours – an average of 5.9 hours – talking about the events with family and friends. And they spent between 1.5 and 13 hours watching television news coverage of the attacks, an average of 6.5 hours.

"When we compared these responses with the dream journal entries, we discovered that for each hour of TV viewing a subject reported, there was a statistically significant six percent increase in the proportion of the dreams containing a specific reference to the attacks," says Propper. Among the individuals who watched less than three hours of television there were no specific references at all.

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U.S. Troops, Vets Not Getting Care They Need, Playboy Says

American troops fighting in Iraq and Iraq war veterans are not receiving the mental health care they deserve, specifically when it comes to the diagnosis and treatment of post traumatic stress disorder (PTSD), according to an investigative report for Playboy magazine.

Journalist Mark Boal spoke with numerous mental health experts, government sources and former military personnel who paint adisturbing picture about the government's handling of PTSD, according to Playboy.

Boal found that the Department of Defense (DOD) diagnoses about 2,000 cases of PTSD a year. Yet according to a landmark study conducted by Army researchers and published in The New England Journal of Medicine, PTSD rates for soldiers in Iraq and Afghanistan are running between 10 and 15 percent. That means one would expect to see the military diagnosing 13,000 to 20,000 cases of PTSD, Playboy says.

Former government officials agree there is a problem, according to Playboy.

"PTSD is being underdiagnosed on a fairly wholesale level," Playboy quotes Dr. Robert Roswell, a former undersecretary at the U.S. Department of Veterans Affairs, as saying.

Sources in the Pentagon and former officials of the VA, doctors working for the VA and DOD are being pressured to limit diagnoses of PTSD in order to save the military money and manpower, reports Boal.

Budget pressures may be the motivation to discourage diagnoses of PTSD, according to the Playboy article, which reports that when the DOD submitted a war budget to Congress, the line item for mental health casualties was simply left blank.

"DOD never prepared for a long war; it never prepared for anoccupation," says one senior congressional staffer, according to Playboy. "Now we're seeing the third thing it didn't anticipate: what to do with the soldiers when they come home. Now they really don't have the money."

Boal discovered politics may also be a factor, Playboy says.

"The soldier has tremendous symbolic power in American politics. Healthy, happy soldiers bespeak a just war. Like the amputees and flag-draped coffins the administration hides from public view, such soldiers are antithetical to the hawkish goal of mitigating the costs of the conflict," writes Boal."The critical difference is that mental illness isn't always obvious and is therefore easier to sweep under the rug."

As one congressional staffer puts in the Playboy story, "It's much easier to deny the reality of mental illness than it is to deny the spinal cord injury of some guy sitting in a wheelchair."

When questioned for the piece, Pentagon and VA officials vigorously denied there is a policy to underdiagnose PTSD, Playboy says.

"That would be immoral and unethical," Playboy quotes Dr. Michael Kilpatrick, the assistant secretary of defense for troop readiness as saying.

Officials attribute the low rates of diagnosis to a reluctance on the part of military doctors to "stigmatize the person or bring harm to their careers" by labeling them with PTSD according to Lieutenant Colonel Dr. Charles Engel, the director of the deployment health clinic center at Walter Reed Medical Center. "It's out of respect for the patient that they don't make the diagnosis."

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