Health ranks as top concern for veterans immediately after military service

Findings based on survey of nearly 10,000 veterans

January 2, 2020

Veterans Affairs Research Communications

In a survey of nearly 10,000 veterans newly separated from military service, most were satisfied with their work and social well-being, but more than half reported chronic physical health problems, and a third reported chronic mental health conditions.

In the months after separating from military service, most veterans are less satisfied with their health than with their work or social relationships, found a study by Veterans Affairs researchers. While the veterans surveyed were mostly satisfied with their work and social well-being, a majority were dealing with chronic physical health conditions and a third reported chronic mental health conditions.

According to Dr. Dawne Vogt of the VA Boston Healthcare System and Boston University, lead author on the study, the results highlight the importance of addressing veterans' health concerns early.

"What remains to be seen is whether those veterans with health conditions -- which were more commonly experienced by deployed veterans -- continue to maintain high levels of well-being in other life domains over time," she says. "Given that it is well-established that health problems can erode functioning in other life domains, it may be that these individuals experience declines in their broader well-being over time."

The results appear Jan. 2, 2019, in the American Journal of Preventive Medicine.

More than 200,000 U.S. service members transition out of military service each year. Researchers have pointed to the early transition period as a critical time to address challenges veterans may face in readjusting to civilian life.

To investigate which of these challenges are most pressing to newly separated veterans, researchers from the VA National Center for PTSD and colleagues surveyed almost 10,000 veterans from a population-based roster of all separating service members.

All participants left the military in the fall of 2016. Veterans were surveyed about three months after their separation, and then six months after that.

The researchers found that the biggest concern was health. At both three and nine months after leaving the military, 53% of participants said they had chronic physical health conditions. About 33% reported chronic mental health conditions at both time points.

The most commonly reported health conditions were chronic pain, sleep problems, anxiety, and depression. Slightly more than half of participants said they had reduced satisfaction with their health between when they first left the military and a few months later. Health satisfaction did not change much between three and nine months after separation.

While physical and mental health was a concern for many veterans, most reported high vocational and social well-being. The majority of participants said they were satisfied with their work and social relationships and that they were functioning well in these areas. According to Vogt, the fact that most participants had high work and social satisfaction "highlights the resilience of the veteran population, and should provide some reassurance to those concerned about the well-being of newly separated veterans."

More than three-quarters of participants said they were in an intimate relationship in the months after they left the military. Almost two-thirds reported that they had regular contact with their friends and extended family and that they were involved in their broader communities.

Over half of participants had found work three months after military separation. While most participants reported high work satisfaction, the study group showed an overall decline in work functioning over the first year after military separation. Functioning declined even though overall employment rates increased. The researchers hypothesized that this decline in work functioning could be due to health concerns, which are known to erode broader well-being over time.

The study also found differences in well-being based on other factors. Enlisted veterans showed consistently poorer health, vocational, and social well-being than officers. Veterans who had deployed to a war zone had more health concerns than veterans who did not deploy.

There were also several differences between men and women. Male veterans were more likely to be employed than female veterans both three and nine months after leaving the military. Men were also more likely to report hearing conditions, high blood pressure, and high cholesterol. Women were more likely to endorse mental health conditions at nine months post-separation. They also reported more depression and anxiety at both timepoints.

The researchers have shared their findings with the VA Transition Assistance Program (TAP), which helps Veterans transition back to civilian life. The program is jointly managed by VA and the departments of Defense and Labor, in coordination with the departments of Education and Homeland Security, as well as the U.S. Office of Personnel Management and the U.S. Small Business Administration. According to Vogt, the results could help TAP and other programs that help veterans with readjustment decide how to allocate their resources. Vogt writes that the findings "suggest that maybe we don't need as much focus on promoting employment right now, and need more emphasis on treatment of mental/physical health conditions."

The researchers say their findings have implications not only for VA but for the wide spectrum of organizations nationwide -- more than 40,000 in all -- that provide programs, services, and support for veterans making their transition back to civilian life. Historically, much of the support for veterans leaving the military has primarily focused on providing employment and educational assistance and informing veterans of their benefits. But the findings suggest that veterans' health concerns should be prioritized, says Vogt. Interventions should also target at-risk subgroups of veterans. The researchers concluded that addressing newly separated veterans' health concerns could promote their broader well-being and longer-term readjustment.

Vogt points out the importance of addressing veterans' readjustment challenges before they worsen and have a chance to erode broader well-being. She says this may require re-evaluating support methods. "Given that most transition support is targeted to veterans with the most acute or chronic concerns," she says, "this recommendation may require rethinking how veteran programs prioritize their efforts. While it makes sense to target resources to those with greatest need, it is better to support individuals before their concerns become chronic when we can."

Work is underway to expand on this study using the same study group. The research team is analyzing how veterans' health and well-being changes in the second and third year after leaving service, as well as how veterans' initial health status impacts their subsequent well-being in other areas.

https://www.sciencedaily.com/releases/2020/01/200102143403.htm

Researchers discover neuroprotective treatment for chronic traumatic brain injury

Brief pharmacologic treatment one year after traumatic brain injury in mice reverses cognitive impairment

October 19, 2020

Science Daily/University Hospitals Cleveland Medical Center

TBI survivors are currently treated with extensive physical and cognitive rehabilitation, accompanied by medications that may mitigate symptoms yet do not halt or slow neurodegeneration. Now, researchers have found for the first time that this process can be pharmacologically reversed in an animal model of this chronic health condition, offering an important proof of principle in the field and a potential path to new therapy.

Traumatic brain injury (TBI) is a leading cause of cognitive impairment that affects millions of people worldwide. Despite growing awareness about the debilitating and lifelong progressive consequences of TBI, there are currently no treatments that slow the deteriorative process. TBI survivors are currently treated with extensive physical and cognitive rehabilitation, accompanied by medications that may mitigate symptoms yet do not halt or slow neurodegeneration.

Now, researchers have found for the first time that this process can be pharmacologically reversed in an animal model of this chronic health condition, offering an important proof of principle in the field and a potential path to new therapy. The findings from Harrington Discovery Institute at University Hospitals (UH), Case Western Reserve University (CWRU) School of Medicine, and Louis Stokes Cleveland VA Medical Center were recently published in the Proceedings of the National Academy of Sciences (PNAS) USA.

"TBI can lead to lifelong detrimental effects on multiple aspects of health," explains Andrew A. Pieper, MD, PhD, senior author on the study and Director of the Harrington Discovery Institute at UH Neurotherapeutics Center, Morley-Mather Chair in Neuropsychiatry, Professor of Psychiatry at CWRU, and Psychiatrist at the Louis Stokes Cleveland VA Medical Center Geriatrics Research Education and Clinical Center (GRECC). "Adverse long-term outcomes of TBI commonly include sensorimotor impairment, cognitive dysfunction, or emotional dysregulation, such as depression and anxiety, including worsened post-traumatic stress disorder. In addition, TBI significantly increases the risk of later developing aging-related forms of dementia, such as Alzheimer's and Parkinson's diseases."

Dr. Pieper and his team set out to test whether it was possible to reverse the lifelong chronic neurodegeneration and associated cognitive deficits after TBI, which had never been demonstrated before. They utilized a mouse model that mimicked concussive impact in middle-aged people suffering a TBI decades prior, and administered an energy-elevating neuroprotective compound, known as P7C3-A20, that they had previously shown to have therapeutic value in acute TBI. The research team waited for one year after injury and then administered the compound daily to mice for one month.

Strikingly, this brief treatment with P7C3-A20 restored normal cognitive function. They continued to observe the mice for an additional four months, during which time they did not administer any more compound. Remarkably, at the end of this period the mice still showed normal cognitive function. Thus, after just one month of treatment, cognitive function remained improved four months later.

"When we examined the brains under the microscope, we saw that chronic neurodegeneration after TBI had completely stopped in the mice that had been briefly-treated with P7C3-A20," said Edwin Vázquez-Rosa, PhD, co-first author on the study. "Then, under electron microscopy we discovered that P7C3-A20 had also facilitated repair of the endothelial cells lining the blood vessels of the brain."

"This is the first time we've seen that P7C3-A20 can protect endothelial cells at the interface of the cardiovascular system and the brain, known as the neurovascular unit (NVU)," explains Min-Kyoo Shin, PhD, co-first author on the study. Deterioration of the NVU occurs in almost all types of brain injury and disease, and is a well-known early and chronic feature of Alzheimer's disease. The team also showed that P7C3-A20 directly protects human brain microvascular endothelial cells cultured in the laboratory as well.

"Except for aging and genetics, TBI is the greatest risk factor for developing Alzheimer's disease," explains Matasha Dhar, PhD, co-first author on the study. "We speculate that preserving the blood-brain barrier at the NVU might be a way to protect TBI patients from this increased risk."

Robert A. Bonomo, MD, Associate Chief of Staff and Director of the Cleveland GRECC asserts, "These seminal findings have tremendous long-term impact on our veteran population that suffers from TBI."

There are currently no medicines available to patients that directly protect the blood brain barrier. A medicine with this property, such as one derived from the P7C3 series of compounds, would have broad applicability to numerous conditions of the brain, including TBI and Alzheimer's disease.

https://www.sciencedaily.com/releases/2020/10/201019155924.htm

Nurture trumps nature in determining severity of PTSD symptoms

October 1, 2020

Science Daily/Yale University

Researchers at Yale and elsewhere previously identified a host of genetic risk factors that help explain why some veterans are especially susceptible to the debilitating symptoms of post-traumatic stress disorder (PTSD).

A new Yale-led study published Oct. 1 in the journal Biological Psychiatry has now identified a social factor that can mitigate these genetic risks: the ability to form loving and trusting relationships with others.

The study is one of the first to explore the role of nurture as well as nature in its investigation of the biological basis of PTSD.

"We exist in a context. We are more than our genes," said Yale's Robert H. Pietrzak, associate professor of psychiatry and public health, and senior author of the study.

Pietrzak is also director of the Translational Psychiatric Epidemiology Laboratory of the Clinical Neurosciences Division of the U.S. Department of Veterans Affairs National Center for PTSD.

Like many genetic studies on mental disorders such as depression, anxiety, and schizophrenia, PTSD studies have revealed numerous genetic risk factors that contribute to the severity of the disorder. For instance, a previous study of more than 165,000 U.S. military veterans led by Yale's Joel Gelernter, the Foundations Fund Professor of Psychiatry and professor of genetics and of neuroscience, found variants in eight separate regions of the genome that help predict who is most likely to experience the repeated disturbing memories and flashbacks that are hallmark symptoms of PTSD.

In the new study, Pietrzak, Gelernter, and colleagues looked at psychological as well as genetic data collected from the National Health and Resilience in Veterans Study, which surveyed a national sample of U.S. military veterans, and is supported by the National Center for PTSD. The researchers specifically focused on a measure of attachment style -- the ability or inability to form meaningful relations with others -- as a potential moderator of genetic risk for PTSD symptoms.

Individuals with a secure attachment style perceive relationships as stable, feel that they are worthy of love and trust, and are able to solicit help from others. Those with an insecure attachment style report an aversion to or anxiety about intimacy with others, and have difficulty asking for help from others.

They found that the ability to form secure attachments essentially neutralized the collective effects of genetic risk for PTSD symptoms. The impact was particularly pronounced in a variant of the IGSF11 gene, which has been linked to synaptic plasticity or the ability of the brain to form new connections between brain cells.

Pietrzak noted that deficits in synaptic plasticity have also been linked to PTSD, depression, and anxiety, among other mental disorders. The findings illustrate the importance of integrating environmental and social as well as genetic factors in the study of PTSD and related disorders, the authors said.

"Social environmental factors are critical to informing risk for PTSD and should be considered as potential moderators of genetic effects," he said. "The ability to form secure attachments is one of the strongest protective factors for PTSD."

The findings, which will help predict who is at greater risk of experiencing severe symptoms of PTSD, also suggest that psychological treatments targeting interpersonal relationships may help mitigate PTSD symptoms in veterans with elevated genetic risk for this disorder, he said.

https://www.sciencedaily.com/releases/2020/10/201001113705.htm

People with less body response to stress task had more PTSD signs after COVID-19 began

Study findings surprised researchers, who had expected the reverse, researcher says

August 31, 2020

Science Daily/Baylor University

People who did not have a large heart rate response to a stress task surprised researchers later -- after the onset of the COVID-19 pandemic -- when they showed more symptoms of post-traumatic stress disorder related to the crisis than others who also did the stress task and COVID-19 stress ratings.

Researchers had anticipated that the reverse would be true -- that those with higher heart rate reactions to the stress task would experience more distress related to COVID-19. Previous work shows individuals with a PTSD have higher responses to stress. But very few studies have examined heart rate responses to acute stress before the onset of a traumatic event, researchers said.

"The study shows that diminished biological arousal -- how the body responds when it is exposed to something startling or stressful -- before a global pandemic may predict PTSD symptoms related to the event," said principal investigator Annie T. Ginty, Ph.D., assistant professor of psychology and neuroscience at Baylor University.

The biological reactions were measured by blood pressure and heart rate, said co-author Danielle Young, Psy.D., research coordinator in the Baylor Behavioral Medicine Lab.

The study, published in the journal Psychosomatic Medicine, grew out of an ongoing study of undergraduate students at Baylor University.

"The research also showed that some college students were experiencing distress related to the pandemic in its earliest stages, even when social distancing was just beginning," Ginty said.

In the study's first phase, with 120 participants, researchers measured their resting heart rate and blood pressure before and during a standard acute psychological stress test. They asked students to do mental math, rather than writing down figures or using a calculator, and give the scorers verbal responses. In a four-minute test, they were asked to add consecutive single-digit numbers while remembering the most recent and adding it to the next number presented. They did this while being videotaped with a scorer present and looking at themselves in a mirror.

"The standard acute psychological stress task is meant to increase levels of stress by including requirements of cognitive effort, social evaluation, self-evaluation and competition," Ginty said. "The task substantially increases heart rate and feelings of stress."

The study's first phase, which ended in February 2020, was done in Central Texas. After the pandemic's onset, researchers launched a second phase between March 26 and April 5, sending participants a follow-up questionnaire about COVID-19. The participants were in 22 states after early campus closure due to COVID-19. When asked, none had tested positive for COVID-19 and 87.5 percent were living in a city/state with a "shelter in place" order.

The questionnaire included standard items used to measure PTSD symptoms of intrusion (dreaming about the event and having trouble staying asleep), hyperarousal (irritability and having trouble concentrating) and avoidance (trying not to think or talk about the event) in the seven days before they responded to the questionnaire.

The findings are in line with a previous study of soldiers, which showed that a lower response of cortisol -- the primary stress hormone -- to an acute psychological stress task before deployment predicted greater PTSD symptoms post deployment.

The present study supports growing evidence that lower biological arousal in response to psychological stress may be bad for health outcomes, particularly mental health outcomes. The findings support Ginty's previous work, which demonstrated that lower arousal to acute stress is associated with higher levels of perceived stress -- meaning that people rate their environment as more stressful.

Previous work also has shown that higher levels of biological arousal may be associated with developing PTSD symptoms. But those studies used what are considered passive tasks -- such as hearing loud bursts of noise. Lower biological responses to stress tasks that require participants to actively engage in the task may be a unique biomarker for mental health outcomes.

Ginty said that future research should aim for more comprehensive measures of biological reactivity and include a lifetime history of traumatic event exposure. However, the current study did account for childhood trauma and diagnosis of a mental health condition before the pandemic's onset.

"Since findings suggest that individuals with diminished arousal to active stress may be at greater risk for negative mental health outcomes, it could be helpful to offer preventive treatment or resources to them at the early stages of stress or trauma exposure," Ginty said.

https://www.sciencedaily.com/releases/2020/08/200831165700.htm

Research shows how a diet change might help US veterans with Gulf War illness

August 31, 2020

Science Daily/American University

A new study from American University shows the results from a dietary intervention in U.S. veterans suffering from Gulf War Illness, a neurological disorder in veterans who served in the Persian Gulf War from 1990 to 1991.

The veterans' overall number of symptoms were reduced and they experienced less pain and fatigue after one month on a diet low in glutamate, which is a flavor enhancer commonly added to foods, and that also functions as an important neurotransmitter in the nervous system.

Because the symptoms of GWI are similar to those of fibromyalgia, the U.S. Department of Defense provides funding for previously tested treatments in fibromyalgia that could also help veterans suffering from GWI. The low glutamate diet was previously shown to reduce symptoms in fibromyalgia, and thus, was a candidate for this funding. There are no cures for either illness, and treatments are being sought for both to manage chronic pain. GWI is thought to be connected to nervous system dysfunction in veterans. In the Gulf War, soldiers were exposed to various neurotoxins such as chemical warfare agents, pyridostigmine bromide (PB) pills, pesticides, burning oil fields, and depleted uranium.

"Gulf War Illness is a debilitating disorder which includes widespread pain, fatigue, headaches, cognitive dysfunction, and gastrointestinal symptoms. Veterans with GWI have a reduced quality of life as compared to veterans who do not have the illness," said AU Associate Professor of Health Studies Kathleen Holton, who explores how food additives contribute to neurological symptoms and is a member of AU's Center for Behavioral Neuroscience. "In this study testing the low glutamate diet, the majority of veterans reported feeling better. We saw significant reductions in their overall number of symptoms and significant improvements in pain and fatigue."

The study, published in the journal Nutrients, details the experiments in a clinical trial of 40 veterans with GWI. The study participants were randomized to either immediately start the low glutamate diet for one month, or to a control group. After completion of the one-month diet, participants were challenged with monosodium glutamate and placebo to see if symptoms returned.

The challenge with MSG versus placebo resulted in significant variability in response among participants, with some subjects worsening, while others actually improved. This suggests that while a diet low in glutamate can effectively reduce overall symptoms, pain, and fatigue in GWI, more research is needed to understand how the diet may be altering how glutamate is handled in the body, and the specific role that nutrients may play in these improvements.

The role of glutamate 

Glutamate is most easily identified when it is in the form of the food additive MSG; however, it appears most commonly in American diets hidden under many other food additive names in processed foods. Americans also consume glutamate through some foods where it occurs naturally, such as soy sauce, fish sauce, aged cheeses like parmesan, seaweed, and mushrooms.

Glutamate is known to play a role in pain transmission, where it functions as an excitatory neurotransmitter in the nervous system. When there's too much of it, it can cause disrupted signaling or kill cells, in a process called excitotoxicity. Previous research has shown that glutamate is high in pain processing areas of the brain in individuals with fibromyalgia and migraine. High concentrations of glutamate have also been linked to epilepsy, multiple sclerosis, Parkinson's disease, ALS, cognitive dysfunction (including Alzheimer's), and psychiatric issues such as depression, anxiety and PTSD.

In her research, Holton limits people's exposure to glutamate, while also increasing intake of nutrients known to protect against excitotoxicity. She analyzes how diet affects cognitive function, brain wave activity, brain glutamate levels, and brain function using MRI. In the study of veterans, the low glutamate diet was made up of whole foods low in additives and high in nutrients. Holton theorizes that the increased consumption of nutrients that are protective against excitotoxicity may have led to improved handling of glutamate in the nervous system. The study and diet tested in the veterans were similar to her previous studies, where she observed improvements in those with fibromyalgia, as well as in Kenyan villagers living with chronic pain.

It will take more research to determine if reducing exposure to glutamate can be used as a treatment for chronic widespread pain and other neurological symptoms in U.S. veterans with GWI. Holton is currently pursuing funding for her next grant, which will recruit 120 veterans for a Phase 3 clinical trial to confirm the study's findings in a larger group, and further explore the mechanisms for these effects.

https://www.sciencedaily.com/releases/2020/08/200831112333.htm

Nurses burned out and want to quit

August 28, 2020

Science Daily/European Society of Cardiology

A survey of nurses caring for children with heart problems has revealed that more than half are emotionally exhausted. The analysis, presented today at ESC Congress 2020, also found that good working environments were linked with less burnout.

"Nurses' wellbeing is central to ensuring the best outcomes for patients," said study author Dr. Annamaria Bagnasco of the University of Genoa, Italy. "When wards have poor leadership and fragmented teams with no development prospects for nurses this should raise an alarm that there is a risk of burnout."

Previous research has shown that burnout rates are higher in paediatrics than in other specialties, and that burnout is connected to patient safety. Strategies to reduce burnout and its impact on patient safety are needed.

This study examined emotional exhaustion in nurses providing routine care on paediatric cardiology wards and whether it was related to the working environment.

Data were obtained from the RN4CAST@ITPed study. A web survey was distributed to 2,769 nurses working in children's hospitals throughout Italy between September 2017 and January 2018. A total of 2,205 (80%) nurses responded, of whom 85 worked in cardiology wards and intensive care units (ICUs). Additional data were collected from hospital administrations. Topics included workload, skill mix, work environment, and emotional exhaustion.

The following definitions were used: Workload referred to how many patients each nurse was caring for (nurse-patient ratio). Skill mix included both the education level of nurses working in one unit and the number of nursing assistants providing support during each shift.

Work environment was measured with the Practice Environment Scale of the Nursing Work Index (PES-NWI), which covers issues such as: having a nurse manager or immediate supervisor who is a good manager and leader; opportunities for advancement; opportunities to participate in policy decisions; and collaboration between nurses and doctors.

Emotional exhaustion was investigated using the Maslach Burnout Inventory, which measures feelings about work. For example, feeling emotionally drained, used up, fatigued in the morning, burned out, frustrated, working too hard, stressed, or "at the end of my rope."

This analysis focused on responses from the 85 nurses working in cardiology wards and ICUs at five hospitals. Interviews were also conducted with these nurses. More than half (58%) were emotionally exhausted. The main causes were related to working conditions, including being responsible for high numbers of patients and the complexity of caring for sick children.

"The most important consequence was that 30% of the nurses we interviewed wanted to either go and work in another hospital or even change their career," said Dr. Bagnasco.

The researchers then analysed the relationship between emotional exhaustion and the working environment. Improving the workplace environment was associated with an 81% fall in emotional exhaustion -- even with the same skill mix and nurse-patient ratio.

"Our study shows that nurses value good leadership, being involved in decision-making, having chances to develop their career, and team working," said Dr. Bagnasco. "The lack of these conditions is connected to burnout, which we know from prior research could compromise patient safety."

Dr. Bagnasco noted that paediatric cardiac nurses must collaborate with children and their families, who often feel concerned and afraid. She said: "Establishing a trusting relationship is essential but burned out nurses may find it 'too heavy' to bear emotionally. If the working environment is positive for the nurses who work in it, children and their families will receive better and safer care."

https://www.sciencedaily.com/releases/2020/08/200828081037.htm

Police officers face multifaceted, compounding stressors that can lead to adverse events

August 18, 2020

Science Daily/University of Texas Health Science Center at Houston

Repeated exposure to high-stress calls for service and ongoing exposure to stress without relief were two of the contributing factors that could lead law enforcement officers to become susceptible to adverse events while performing their duties, according to a new study published in BMC Public Health by researchers at The University of Texas Health Science Center at Houston (UTHealth).

The study team aims to use this research to develop intervention models that can address and help prevent these multifaceted stressors from affecting an officer's ability to respond to high-stress calls confidently.

"If we can develop innovative interventions for law enforcement officers that address their unique occupational demands, we can help mitigate compounding stress factors that affect their overall mental health," said Katelyn Jetelina, PhD, MPH, the study's lead author and an assistant professor at UTHealth School of Public Health in Dallas.

The research team collected data from three law enforcement agencies in the Dallas-Ft. Worth metroplex: a large urban department, a suburban department, and a rural department. The researchers met with officers in focus group settings to identify stressors and to gain insight on how to prevent future adverse effects such as use of force, officer or civilian injury, civilian complaints, or discharge of a weapon.

The study participants were 86% male and 14% female with an average tenure of 12 years. Five themes emerged that influenced an officer's perception of the stress level of a call -- officer characteristics such as former military experience or gender, civilian behavior, supervisor factors such as the tendency to micromanage, environmental factors, and situational factors.

The data revealed several factors that contributed to officer stress accumulation, including not "resetting" stress levels after a high-stress call, burnout from answering numerous back-to-back calls, and feeling pressure to move on to the next call quickly. Experience from a previous adverse event was also a contributing factor to cumulative stress. However, according to the focus group responses, behaviors such as taking a break between calls, practicing breathing exercises, and addressing one's mental health over time can help lower levels of chronic stress.

The researchers noted that the combination of the perceived stress level of a call and other cumulative stress factors increase the likelihood for adverse events between police and the public. If the cycle of chronic stress is addressed and limitations placed on the number of high-stress calls an officer responds to during a shift, adverse events may be limited as well. Previous studies have shown that for other occupations, reduced levels of stress increase productivity and job satisfaction.

Irving Police Chief Jeff Spivey, whose officers participated in the study, said the results will help them find additional ways to assist their officers with mental health needs.

"Providing multiple resources for our officers to support and focus on their mental health needs, like our internal peer support groups, is a cause I am very proud to champion," Spivey said. "Peer support services have proven to be effective in helping police officers appropriately manage their mental health; that's why we have teamed up with the Caruth Police Institute and other departments across the state to create a peer network for first responders throughout Texas."

Jetelina and her team are currently testing the feasibility of using smart watches to break cumulative, real-time stress for officers. Additional research on the prevalence of undiagnosed mental health disorders among law enforcement officers is necessary to assess the effectiveness of current mental health resources and to ensure that new resources are developed.

https://www.sciencedaily.com/releases/2020/08/200818142143.htm

Concussions are a risk for young athletes in all sports -- not just football

Retrospective study reveals that younger brains take longer to heal

September 15, 2020

Science Daily/Henry Ford Health System

A recent study from the Henry Ford Sports Medicine Research team suggests that high school athletes competing, not only in football, but in soccer, hockey, basketball, swimming, cheerleading and other sports are not only at risk for concussions, but may need a longer recovery than first thought.

The study's results published by Orthopedics, a nationally recognized, peer-reviewed journal for orthopedic surgeons found that the most common sports for brain injuries were indeed football, hockey and soccer.

"We thought that concussion issues would be very short-lived," said Vasilios (Bill) Moutzouros, M.D., chief of Sports Medicine at Henry Ford and a study co-author, "That they wouldn't have as many attention issues, that they'd be able to recover for their sport much more quickly. Our study found just the opposite."

"The two sports, other than football, where concussions are common are soccer and hockey, although brain injuries can happen in any sport," said Meaghan Rourke, one of more than 30 Henry Ford athletic trainers who support sports programs at over 20 high schools, colleges and universities and professional teams in the tri-county area.

Michigan Gov. Gretchen Whitmer's latest executive order allows the high school football season to begin September 18. Football was reinstated by the Michigan High School Athletic Association (MHSAA) after initially being postponed until spring 2021. With football back in action with an adjusted six-game season, athletic trainers will once again be patrolling the sidelines and be on the lookout for signs of concussions. Other sports given the green light to compete this fall include soccer, volleyball, swimming and diving. These competitions will also present the potential for brain injuries from collisions, falls and impacts with the field of play.

"I went through a four-year period as an athletic trainer where I had at least one swimmer suffer a concussion. That's a sport you don't really think about in terms of concussions," said Rourke. She explained that in one instance a swimmer miscalculated her distance to the pool wall while doing the backstroke and bumped her head against the wall. As a result, the swimmer was out for more than a month with a concussion. Diving is another sport susceptible to brain injuries as the divers' heads impact the surface of the water at high speeds generated from their dives. In reality, all sports have the potential for concussions since athletics involve physical activity and competition.

"Competitive cheerleading is another sport where I've seen concussions happen. The kids get very high in the air, and if they slip and fall when they are coming down, they can suffer serious head injuries," said Rourke, "We usually have one or two athletes in that sport suffer concussions. Overall, I've probably had to deal with a concussion in every sport, including golf."

The retrospective study looked at Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores at baseline testing and following concussions performed by neuropsychologists. The study found that memory ImPACT scores increased as players suffered repeated concussions.

ImPACT is the brain injury testing protocol developed in the late 1990s at the University of Pittsburgh and released in the early 2000s. The testing protocol is the only FDA-approved tool for concussion assessment and is the national testing used by healthcare, educational and sports organizations to help assess and manage concussions. The protocol defines a concussion as "a disturbance in brain function that occurs following either a blow to the head or as a result of the violent shaking of the head." Symptoms of a concussion can include a combination of headaches, nausea, vomiting, balance problems, dizziness, fatigue, visual problems and a host of other brain-associated symptoms.

The study examined the records of 357 high school athletes who were treated for concussions at Henry Ford from 2013 to 2016. The athletes age averaged between 14-18 with nearly 62% being males. Football yielded the most concussions (27.7%), followed by hockey (21.8%), soccer (17%), basketball (9 %) and cheerleading (4.2%). From the study's participants, 72 played in "Other" sports and accounted for 20.3% of the total number of concussions. Overall, 14 % reported suffering from amnesia and 33 % reported a history of concussions.

Henry Ford athletic trainers use internationally approved guidelines to accurately diagnose concussions, appropriately manage the recovery process, and safely return athletes back to their game. They use sideline tools such as the Sports Concussion Assessment Tool 5 (SCAT5) to immediately evaluate cognitive function and, if needed, additional neuropsychological tests may be administered by a physician to track progression through the recovery process. SCAT5 is a standardized concussion assessment used by licensed healthcare providers when a concussion is suspected in athletes ages 12 and older.

Current MHSAA protocols call for a player showing concussion symptoms to be sidelined for at least 24 hours. Athletes at high schools staffed with a Henry Ford athletic trainer are sidelined for at least five days and follow a strict return to play protocol, "We're going to slowly bring them back," said Rourke. "We don't want to just throw them out there where they're going to get hit again, and then they're dealing with prolonged symptoms."

The Henry Ford research team found that athletes with only one concussion required at least 30 days of recovery prior to returning to their sport while others who reported a second or more concussions required more recovery time. They also learned that visual motor speed and reaction time scores decreased with recurrent concussions, and that male and female athletes with a previous history of concussion, and those with delayed diagnosis, required more time before returning to competition.

The study team hopes that the results help start the conversation on how to more safely return student athletes to their sport after a brain injury. "When you recognize that it can be up to 30 days to get a young student athlete back, you're going to change your mind-set on how you advance them, in terms of how you push them, in terms of how you test them," said Dr. Moutzouros.

Previously, it was believed that brain injuries were related to a player's age. The younger the player, the shorter the recovery time. "We need more studies on the younger athletes," said Dr. Moutzouros, "Many of us have children. We're all worried about them and we want them to be safe. So, we need to recognize that this is a problem for the youth athlete."

https://www.sciencedaily.com/releases/2020/09/200915110014.htm

Study pinpoints five most likely causes of post-traumatic stress in police officers

August 11, 2020

NYU Langone Health / NYU School of Medicine

A combination of genetic and emotional differences may lead to post-traumatic stress (PTS) in police officers, a new study finds.

Based on biological studies of officers in major cities, the study showed that the most significant PTS predictors are the tendency to startle at sudden sounds, early career displays of mental health symptoms (e.g., anxiety and depression), and certain genetic differences, including some known to influence a person's immune system.

"If we can identify major risk factors that cause PTS and treat them before they have the chance to develop into full-blown post-traumatic stress disorder, or PTSD, we can improve the quality of life for police officers and perhaps other emergency responders, and better help them deal with the stressors of their work," says senior study author Charles Marmar, MD, the Lucius N. Littauer Professor of Psychiatry at NYU Grossman School of Medicine.

Publishing online Aug. 10 in the journal Translational Psychiatry, the study authors employed a mathematical computer program developed by scientists at NYU Langone Health and the University of Minnesota. They used a combination of statistical analyses to test which of a large number of features linked by past studies to PTSD were the best at predicting its occurrence in police officers.

Some of this winnowing that determined the best predictors was accomplished using machine learning, mathematical models trained with data to find patterns. These algorithms enabled researchers to track how experiences, situations, and characteristics may have interacted over time to lead to PTS symptoms, and represent the first use of such techniques in PTS research in police officers, the authors say.

"Based on these techniques, our study identified specific causes of PTS, rather than possible links," says Marmar, also chair of the Department of Psychiatry at NYU Langone.

He adds that the need for better information is urgent. An estimated eight out of every 100 people experience PTS in their lifetimes, according to the National Institute of Mental Health. Police officers are particularly vulnerable, he says, facing an average of three traumatic experiences for every sixth months of service. Common symptoms include nightmares, aggression, and distressing flashbacks of the traumatic event, which can lead to poor sleep, anxiety, depression, and increased risk of suicide.

In the new study, the investigators analyzed data collected on 207 police officers from departments in New York City, San Francisco, Oakland, and San Jose who had PTS. All officers had experienced at least one life-threatening event during their first year on the job.

Using the computer program, the investigators searched for patterns in 148 different characteristics previously thought to be involved in PTS. They mapped out 83 different possible combinations of factors, or pathways, which could have influenced the officers as they developed the condition.

Then, they identified factors which appeared most frequently, and found that every pathway to PTS shared one of five causes. Besides the tendency to startle easily, severe distress following a traumatic experience, and a set of emotional health problems, such as anxiety and depression, played a key role in PTS. Genetic causes included mutations in the HDC gene, which is linked to problems in the immune system and mutations in the MR gene, which is involved in the body's immediate reaction to threats, known as the fight-or-flight response. If all five factors were eliminated, researchers say, the officers would not be expected to develop PTS.

"Because the factors we identified are causal, they should be actionable as well," says lead study investigator Glenn Saxe, MD, a professor in NYU Langone's Department of Child and Adolescent Psychiatry. "Several of the causal factors we identified -- the HDC gene, the MR gene, and the startle response -- point to well-mapped nerve circuits, which should allow us to find drugs and behavioral therapies that might help. Down the road, we see the possibility of using information collected from patients about causal factors to select the interventions that would provide the most benefit to them."

Saxe says other future interventions might target factors that may not cause PTS on their own, but frequently contribute to its development. For example, the study found that difficulty adjusting to work contributed to PTS development in 60 percent of the causal pathways. Therefore, a straightforward solution, like giving more support to new police officers who are having difficulty adjusting to police work, may reduce their risk of getting PTS, according to Saxe.

Moving forward, the researchers plan to apply the same algorithm technique in a much larger group of traumatized adults and children, focusing on a more extensive set of characteristics and experience

https://www.sciencedaily.com/releases/2020/08/200810213211.htm

Further evidence World Trade Center responders are at risk for dementia

July 28, 2020

Science Daily/Stony Brook University

Two studies led by Stony Brook University researchers to be presented virtually at the Alzheimer's Association International Conference on July 28, 2020, indicate that World Trade Center (WTC) first responders are at risk for developing dementia. The studies included individuals with signs of cognitive impairment (CI) who show neuroradiological abnormalities and changes in their blood similar to that seen in Alzheimer's disease patients and those with related dementias.

One study in Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring (DADM) shows that many responders with CI have reduced gray matter thickness in the brain consistent with neurodegenerative conditions and evidence their brain "age" is about 10 years older on average than the normal population. This research is in collaboration with scientists at the Icahn School of Medicine at Mount Sinai.

The other study, to be published in Translational Psychiatry, reveals some responders with post-traumatic stress disorder (PTSD) and mild CI possess protein changes in their blood consistent with Alzheimer's.

"The environmental exposures and psychological pressures experienced by responders during 911 and its aftermath has had an insidious effect on their health and well-being," says Benjamin Luft, MD, Director of the Stony Brook WTC Health and Wellness Program. "Now nearly 20 years post-911, clinicians who care for these individuals are seeing more patients who are showing signs of cognitive disorders and possible dementia. Findings from our new studies provide data for the first time that support the idea that this population of patients who have cognitive impairment not only have psychological problems such as PTSD but may be at high-risk for neurodegenerative disorders, a possibility that needs immediate and continued investigation."

One study is the first to use MRI imaging to assess the brain matter of WTC responder patients with and without symptoms of CI. The goal of this study is to determine if WTC responders in their midlife have developed CI due to changes in their brain possibly caused by neurotoxins they were exposed to at Ground Zero. The age range of patients was 45 to 65 years, an age range where cortical atrophy is rare in the normal population.

Researchers measured the brain cortex, the area responsible for cognition. Cortical thickness is a consistent measure of brain atrophy commonly used in studies of patients with Alzheimer's and related dementias. Imaging revealed areas of the cortex are atrophied in many WTC patients with cognitive impairment, compared to control subjects.

"While there are many reasons for cognitive decline because of brain changes, the loss of gray matter in the brain is one of the most concerning and can be measured by cortical thickness," explains Sean Clouston, PhD, lead author and Associate Professor of Family, Population and Preventive Medicine and in the Program in Public Health. "We found a direct correlation between those suffering from cognitive impairment and cortical thickness, indicating a reduction in gray matter of the brain at levels consistent with neurodegenerative disease."

The overall amount of cortical atrophy in responders with CI was significantly more than responders who did not have CI symptoms, as well as to the general population based on normative data.

According to the authors, the MRI imaging revealed that cortical thickness was significantly reduced in 23 out of 34 cortical regions among those with CI. These included the frontal, temporal and occipital lobes. When compared to published data, both responders with CI and those without CI showed significant reductions in cortical thickness in seven regions in or near the temporal lobe potentially indicative of a population-level effect.

Dr. Clouston said that the level of reduction in the cortical thickness in many responders is similar to that in patients with dementia and is "a possible indicator of early stage dementia with possible early onset dementia likely to occur for a portion of these individuals at midlife."

However, he explains that these patients need to be studied longitudinally to determine whether these changes progress over time. Additional imaging and other related brain research is also necessary to determine the cause or causes of brain atrophy in WTC responders.

The second study describes an analysis of 276 proteins in the blood in 181 WTC male responders in midlife -- their average age 55 years.

Each of the identified proteins are instrumental to a range of processes indicative of neurological diseases, cellular regulation, immunology, cardiovascular, inflammatory, developmental and metabolism functions.

Given that PTSD and mild CI are common to 911 responders -- which affect their cognitive and memory processes -- individuals with these conditions were studied.

By using a sophisticated process that identifies dysregulation of proteins among the 276 identified for the study, the researchers found that WTC responders with mild CI also had proteinopathy, or problematic changes in the proteome, consistent with Alzheimer's and related diseases as well as other neuropsychiatric conditions.

"We believe that neuro-inflammation is a possible mechanism in which responders with PTSD appear to be at a higher risk of developing mild cognitive impairment," said Dr. Luft, senior author. "We hope our unique analysis of proteins associated with cognitive impairment-related diseases in this population is an additional way to identify their risk based on changes in their body likely due from their exposures."

https://www.sciencedaily.com/releases/2020/07/200728113554.htm

The most important task for a PTSD service dog for veterans is disrupting anxiety

July 22, 2020

Science Daily/Purdue University

Science has shown that service dogs can benefit some veterans with PTSD. But the exact role service dogs play in the day-to-day lives of veterans -- and the helpfulness of the tasks they perform -- is less known.

A recent study led by Purdue University's College of Veterinary Medicine shows what trained tasks service dogs perform the most often and which ones are the most helpful to veterans with post-traumatic stress disorder. The study found that the task of disrupting episodes of anxiety ranked among the most important and most often used.

"There has been some debate on what kind of training PTSD service dogs need to be effective and how their assistance may be different than what a pet dog can provide," said Kerri Rodriguez, a human-animal interaction graduate student and a lead author on the study. "This study suggests that veterans are, in fact, using and benefiting from the specific trained tasks, which sets these dogs apart from pet dogs or emotional support dogs."

Rodriguez led the work with Maggie O'Haire, associate professor of human-animal interaction. Their research was published in Frontiers in Psychology. The study was done in conjunction with K9s For Warriors, with support and funding from Merrick Pet Care, and is in preparation for an ongoing large-scale clinical trial that is studying veterans with and without service dogs over an extended period of time.

The study found that, on average, the dog's training to both alert the veteran to any increasing anxiety and providing physical contact during anxiety episodes were reported to be the most important and the most often used in a typical day. Veterans with a service dog also rated all of the service dog's trained tasks as being "moderately" to "quite a bit" important for their PTSD.

Some trained tasks include picking up on cues veterans display when experiencing distress or anxiety and consequently nudging, pawing or licking them to encourage the veteran to focus on the dog. The service dogs also are trained to notice when veterans are experiencing anxiety at night and will actively wake up the person from nightmares.

The dogs also are trained to perform tasks in public -- such as looking the opposite way in a crowded room or store to provide a sense of security for the veteran.

The study also found that trained service dog tasks were used on average 3.16 times per day, with individual tasks ranging from an average of 1.36 to 5.05 times per day.

Previous research led by Rodriguez showed that the bond between a service dog and the veteran was a significant factor in the importance of untrained behaviors. Although all trained tasks were reported to be important for veterans' PTSD, those with a service dog actually rated the importance of untrained behaviors higher than the importance of trained tasks. This suggests that there are some therapeutic aspects of the service dog's companionship that are helping just as much, if not more, than the dog's trained tasks, Rodriguez said. "These service dogs offer valuable companionship, provide joy and happiness, and add structure and routine to veterans' lives that are likely very important for veterans' PTSD."

The study surveyed 216 veterans from K9s For Warriors, including 134 with a service dog and 82 on the waitlist. The study complements a previous publication published last year that focused specifically on the service dogs' training, behavior and the human-animal bond.

While service dogs were reported to help a number of specific PTSD symptoms such as having nightmares, experiencing flashbacks, or being hyperaware in public, there were some symptoms that service dogs did not help, such as amnesia and risk-taking.

"Both this research, as well as other related studies on PTSD service dogs, suggest that service dogs are not a standalone cure for PTSD," O'Haire said. "Rather, there appear to be specific areas of veterans' lives that a PTSD service dog can help as a complementary intervention to other evidence-based treatments for PTSD."

Veterans on the waitlist to receive a service dog expected the service dog's trained tasks to be more important for their PTSD and used more frequently on a daily basis than what was reported by veterans who already had a service dog.

"Veterans on the waitlist may have higher expectations for a future PTSD service dog because of feelings of hope and excitement, which may not necessarily be a bad thing," Rodriguez said. "However, it is important for mental health professionals to encourage realistic expectations to veterans who are considering getting a PTSD service dog of their own."

https://www.sciencedaily.com/releases/2020/07/200722142116.htm

Front-line physicians stressed and anxious at work and home

New study reports moderate to severe stress levels in ER doctors during the frenetic early phase of COVID-19 pandemic

July 21, 2020

Science Daily/University of California - San Francisco

Amid the COVID-19 chaos in many hospitals, emergency medicine physicians in seven cities around the country experienced rising levels of anxiety and emotional exhaustion, regardless of the intensity of the local surge, according to a new analysis led by UC San Francisco.

In the first known study to assess stress levels of U.S. physicians during the coronavirus pandemic, doctors reported moderate to severe levels of anxiety at both work and home, including worry about exposing relatives and friends to the virus. Among the 426 emergency physicians surveyed, most reported changes in behavior toward family and friends, especially decreased signs of affection.

"Occupational exposure has changed the vast majority of physicians' behavior at both work and home," said lead author Robert M. Rodriguez, MD, a professor of Emergency Medicine at UCSF. "At home, doctors are worried about exposing family members or roommates, possibly needing to self-quarantine, and the effects of excess social isolation because of their work on the front line."

The results, which appear July 21, 2020, in Academic Emergency Medicine, found slight differences between men and women, with women reporting higher stress. Among male physicians, the median reported effect of the pandemic on both work and home stress levels was 5 on a scale of 1 to 7 (1=not at all, 4=somewhat, and 7=extremely). For women, the median was 6 in both areas. Both men and women also reported that levels of emotional exhaustion or burnout increased from a pre-pandemic median of 3 to a median of 4 after the pandemic started.

Lack of PPE was associated with the highest level of concern and was also the measure most often cited that would provide greatest relief. The doctors also voiced anxiety about inadequate rapid diagnostic testing, the risk of community spread by discharged patients, and the well-being of coworkers diagnosed with COVID-19.

But the survey also showed clear-cut ways of mitigating anxiety:

• Improve access to PPE;

• Increase availability of rapid turnaround testing;

• Clearly communicate COVID-19 protocol changes;

• Assure access to self-testing and personal leave for front line providers.

The responses came from faculty (55 percent), fellows (4.5 percent), and residents (about 39 percent), with a median age of 35. Most physicians lived with a partner (72 percent), while some lived alone (nearly 15 percent) or with roommates (11 percent). Nearly 39 percent had a child under age 18.

The study involved healthcare providers at seven academic emergency departments and affiliated institutions in California, Louisiana and New Jersey. Researchers noted that the majority of study sites were in California, which at the time of the survey had not yet experienced the large surges of patients seen in other areas of the country. But the study found that median levels of anxiety in the California sites were similar to those in the New Orleans and Camden sites, which were experiencing surges at the time.

"This suggests that the impact of COVID-19 on anxiety levels is pervasive and that measures to mitigate stress should be enacted universally," Rodriguez said. "Some of our findings may be intuitive, but this research provides a critical early template for the design and implementation of interventions that will address the mental health needs of emergency physicians in the COVID-19 pandemic era."

The study is longitudinal, with this first phase focused on the early "acceleration" phase of the pandemic. Subsequent studies will address stressors that have arisen throughout the course of the pandemic, including childcare and homeschooling demands, the economic impact of fewer patients overall in the ER, and possible development of long-term post-traumatic stress.

https://www.sciencedaily.com/releases/2020/07/200721084205.htm

High school athletes require longer recovery following concussions

Epidemiologic findings from a high school population

July 21, 2020

Science Daily/Henry Ford Health System

High school athletes sustaining a concussion require careful attention when determining return-to-sport (RTS) readiness. The purpose of this study was to determine epidemiological and RTS data of a large cohort of high school athletes who sustained one or more concussions. Young athletes are typically sidelined for at least one month after suffering a concussion, according to a Henry Ford Hospital study that provides new perspective on concussions and brain injuries.

The study's results were published ahead of the Michigan High School Athletic Association's recent announcement that the fall high school sports season will begin as traditionally scheduled, with football practices starting on Aug. 10.

The findings published by Orthopedics, a nationally recognized, peer-reviewed journal for orthopedic surgeons, are from a study conducted between September 2013 and December 2016. The study focused on 357 high school adolescents who sustained one or more concussions by analyzing historical data and then comparing it to more recent findings tied to an increase in reported concussions among young athletes.

The average age of the study's patients was 15-and-a-half years with nearly 62% being males, the most common sport participated in by these athletes was football, followed by hockey and then soccer. From the study's participants, 14 % reported suffering from amnesia and 33 % reported a history of concussions. Results of the study include:

• Athletes with only one concussion required just over 30 days of recovery prior to returning to sport (RTS) while others who reported a second or more concussions required more time.

• The most common sport of injury was football (27.7%). There was a high incidence of previous concussion (33.1%), and 32 athletes sustained a recurrent concussion.

• Visual motor speed and reaction time scores decreased with recurrent concussions.

• Male and female athletes with a previous history of concussion, and those with delayed diagnosis, required increased time to RTS.

The research team also found that athletes who have suffered concussions have a higher incidence of non-contact lower extremity injuries due to balance issues after concussions which may have implications on the performance, safety and well-being of athletes. These findings will be the focus of the next study also led by Toufic Jildeh, M.D., administrative chief resident in Orthopaedic Surgery at Henry Ford Hospital.

One of the earliest studies on concussion data came from the NFL's mild traumatic brain injury committee and was published in the journal Neurosurgery in January 2004. Based on data collected between 1996 and 2001, researchers found that NFL players were sidelined for six or fewer days after a concussion.

A related 2019 study also led by Dr. Jildeh and published in American Journal of Sports Medicine showed a similar trend with NFL players being sidelined much longer.

"Historically, the literature reported a concussion prevalence of 4-5%, however recent studies have found that nearly 20% of adolescents have suffered at least one concussion, there's a huge disparity in terms of reporting over time," says Dr. Jildeh. Previously, it was thought that young age was a protective factor against concussion and that the neuroplasticity offered fast recovery. However, this thinking has been disproven with more recent studies.

"Concussions have been a pressing issue. We want to limit the number of concussions and head injuries in a young athlete," says Vasilios (Bill) Moutzouros, M.D., chief of Sports Medicine at Henry Ford and a study co-author, adding that younger athletes who suffer a concussion early in life are much more likely to experience longer term effects if they get repeatedly concussed.

Kelechi Okoroha, M.D., a Henry Ford sports medicine surgeon and study co-author, points to the findings as a baseline for young athletes with a history of concussions, "Depending on the number of concussions, the 30-day mark gives us a baseline for how much time adolescent athletes required before returning to sport," he says.

The study offers a lot of information to reflect on and build on according to Jeffrey Kutcher, M.D., medical director and sports neurologist at the Henry Ford Concussion and Sports Neurology Clinic, and global director of the Kutcher Clinic.

"Concussion diagnosis and management requires an individualized and comprehensive neurological approach to ensure we are accurately diagnosing and managing return to play effectively," says Dr. Kutcher who also serves as advisor to the players' associations for the National Football League and National Hockey League.

The study concludes that team physicians must be particularly mindful when evaluating an adolescent athlete due to the short and long-term neurocognitive implications, particularly as it pertains to RTS, and that high school athletes sustaining a concussion require careful attention when determining RTS readiness.

https://www.sciencedaily.com/releases/2020/07/200721094433.htm

Traditional PTSD therapy doesn't trigger drug relapse

People with addiction aren't getting effective treatment for PTSD due to incorrect presumptions

July 20, 2020

Science Daily/Johns Hopkins Medicine

Researchers have now demonstrated that behavior therapy that exposes people to memories of their trauma doesn't cause relapses of opioid or other drug use, and that PTSD severity and emotional problems have decreased after the first therapy session.

About a quarter of people with drug or alcohol use disorders also suffer from post-traumatic stress disorder (PTSD), which is typically caused by a traumatic or stressful life event such as rape or combat, and which leaves the person with intense anxiety. However, patients and health care providers have been reluctant to pursue the gold-standard treatment for PTSD -- cognitive behavioral therapy -- because they anticipate that thinking and talking about traumatic events during therapy will cause relapse.

Johns Hopkins researchers have now demonstrated that behavior therapy that exposes people to memories of their trauma doesn't cause relapses of opioid or other drug use, and that PTSD severity and emotional problems have decreased after the first therapy session.

These findings were published June 29 in the Journal of Traumatic Stress.

This work originated from a larger project in which Jessica Peirce, Ph.D., associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, and her colleagues tested how to get often reluctant patients in addiction treatment to participate in PTSD therapy. In a 2017 article in the Journal of Consulting and Clinical Psychology, her team showed that patients with opioid dependence attended on average nine exposure therapy sessions for treating PTSD when given money as an incentive, compared with only one session without the incentive.

Building on this earlier work, for the new study, her team examined week-to-week comparisons of cravings for opioids or other drugs before and after therapy sessions, self-reported days of drug use, and other distress. The researchers found there was no increase in use of opioids or other drugs, or in reported instances of stress after therapy sessions to treat PTSD. By the ninth therapy session, PTSD severity scores decreased, on average, by 54% compared to the first session.

"Now that we have evidence that treating PTSD won't impact recovery, patients can request therapy, and mental health providers have a duty to make it available to their patients," says Peirce. "There is a lot more resilience within this population than many health care providers give them credit for, and not offering the proper treatment is doing patients a disservice."

https://www.sciencedaily.com/releases/2020/07/200720092838.htm

Traumatic experiences can leave their mark on a person's eyes

July 17, 2020

Science Daily/Swansea University

New research by Welsh academics shows that a patient's pupils can reveal if they have suffered a traumatic experience in the past.

Post-traumatic stress disorder can occur when a person has experienced a traumatic event such as a car crash, combat stress, or abuse. They can be left with a greater sensitivity, or hyperarousal, to everyday events and an inability to switch off and relax.

The research, led by Dr Aimee McKinnon at Cardiff University and published in the journal Biological Psychology, looked for traces of these traumatic events in the eyes of patients who were suffering from PTSD by measuring the pupil of the eye while participants were shown threatening images such as vicious animals or weapons, as well as other images that showed neutral events, or even pleasant images.

The response of people with PTSD was different to other people, including people who had been traumatised but did not have PTSD.

At first the pupil failed to show the normal sharp constriction that is caused by changes in light level -- but then their pupils grew even larger to the emotional stimuli than for the other participants.

Another unexpected result was that pupils of the patients with PTSD not only showed the exaggerated response to threatening stimuli, but also to stimuli that depicted "positive" images, such as exciting sports scenes.

Swansea University's Professor Nicola Gray, who co-authored the paper along with Professor Robert Snowden of Cardiff University, believes this is an important finding.

She said: "This shows that the hyper-response of the pupil is in response to any arousing stimulus, and not just threatening ones. This may allow us to use these positive pictures in therapy, rather than relying upon negative images, that can be quite upsetting to the patient, and therefore make therapy more acceptable and bearable. This idea now needs testing empirically before it is put into clinical practice."

Dr McKinnon, who is now at Oxford University, added: "These findings allow us to understand that people with PTSD are automatically primed for threat and fear responses in any uncertain emotional context, and to consider what a burden this must be to them in everyday life.

"It also suggests that it is important for us to recognise that, in therapy, it is not just the fear-based stimuli that need deliberately re-appraising.

"If someone with PTSD is faced with any high-level of emotional stimulation, even if this is positive emotion, it can immediately trigger the threat system. Clinicians need to understand this impact of positive stimuli in order to support their service-users overcome the significant challenges they face."

https://www.sciencedaily.com/releases/2020/07/200717120138.htm

Experiencing childhood trauma makes body and brain age faster

Findings could help explain why children who suffer trauma often face poor health later in life

August 3, 2020

Science Daily/American Psychological Association

Children who suffer trauma from abuse or violence early in life show biological signs of aging faster than children who have never experienced adversity, according to research published by the American Psychological Association. The study examined three different signs of biological aging -- early puberty, cellular aging and changes in brain structure -- and found that trauma exposure was associated with all three.

"Exposure to adversity in childhood is a powerful predictor of health outcomes later in life -- not only mental health outcomes like depression and anxiety, but also physical health outcomes like cardiovascular disease, diabetes and cancer," said Katie McLaughlin, PhD, an associate professor of psychology at Harvard University and senior author of the study published in the journal Psychological Bulletin. "Our study suggests that experiencing violence can make the body age more quickly at a biological level, which may help to explain that connection."

Previous research found mixed evidence on whether childhood adversity is always linked to accelerated aging. However, those studies looked at many different types of adversity -- abuse, neglect, poverty and more -- and at several different measures of biological aging. To disentangle the results, McLaughlin and her colleagues decided to look separately at two categories of adversity: threat-related adversity, such as abuse and violence, and deprivation-related adversity, such as physical or emotional neglect or poverty.

The researchers performed a meta-analysis of almost 80 studies, with more than 116,000 total participants. They found that children who suffered threat-related trauma such as violence or abuse were more likely to enter puberty early and also showed signs of accelerated aging on a cellular level-including shortened telomeres, the protective caps at the ends of our strands of DNA that wear down as we age. However, children who experienced poverty or neglect did not show either of those signs of early aging.

In a second analysis, McLaughlin and her colleagues systematically reviewed 25 studies with more than 3,253 participants that examined how early-life adversity affects brain development. They found that adversity was associated with reduced cortical thickness -- a sign of aging because the cortex thins as people age. However, different types of adversity were associated with cortical thinning in different parts of the brain. Trauma and violence were associated with thinning in the ventromedial prefrontal cortex, which is involved in social and emotional processing, while deprivation was more often associated with thinning in the frontoparietal, default mode and visual networks, which are involved in sensory and cognitive processing.

These types of accelerated aging might originally have descended from useful evolutionary adaptations, according to McLaughlin. In a violent and threat-filled environment, for example, reaching puberty earlier could make people more likely to be able to reproduce before they die. And faster development of brain regions that play a role in emotion processing could help children identify and respond to threats, keeping them safer in dangerous environments. But these once-useful adaptations may have grave health and mental health consequences in adulthood.

The new research underscores the need for early interventions to help avoid those consequences. All of the studies looked at accelerated aging in children and adolescents under age 18. "The fact that we see such consistent evidence for faster aging at such a young age suggests that the biological mechanisms that contribute to health disparities are set in motion very early in life. This means that efforts to prevent these health disparities must also begin during childhood," McLaughlin said.

There are numerous evidence-based treatments that can improve mental health in children who have experienced trauma, McLaughlin said. "A critical next step is determining whether these psychosocial interventions might also be able to slow down this pattern of accelerated biological aging. If this is possible, we may be able to prevent many of the long-term health consequences of early-life adversity," she says.

https://www.sciencedaily.com/releases/2020/08/200803092120.htm

Concussions associated with cognitive, behavioral, and emotional consequences for students

July 22, 2020

Science Daily/University of Texas Health Science Center at Houston

Concussions can have a compounding effect on children, leading to long-term cognitive, behavioral, and emotional health consequences, according to researchers at The University of Texas Health Science Center at Houston (UTHealth), who published their findings in the American Journal of Sports Medicine.

In 2017, approximately 2.5 million high school students in the United States reported suffering at least one concussion related to sports or physical activity in the last 12 months, according to information from the U.S. Centers for Disease Control and Prevention (CDC).

The UTHealth researchers analyzed survey data from more than 13,000 high school students in the United States. According to the authors, it is the first study to report on the association between sports-related concussions and negative health implications based on a representative sample of U.S. high school students.

"We have previously speculated that children who suffer a concussion have more behavioral problems, so this study was able to provide a more comprehensive analysis on the various cognitive and behavioral health issues that this population faces in connection with this type of brain injury," said Gregory Knell, PhD, the study's first and corresponding author. Knell is an assistant professor at UTHealth School of Public Health in Dallas and is research faculty at Children's Health Andrews Institute for Orthopaedics and Sports Medicine.

A concussion is the most common form of traumatic brain injury, caused by a mild blow to the head. Common symptoms include a headache, ringing in the ears, nausea, vomiting, fatigue, drowsiness, and blurry vision.

Participants were asked how many times they had suffered a concussion from playing a sport or during physical activity in the last 12 months. Students were also surveyed on relevant cognitive, emotional, and behavioral factors and related health outcomes, including questions on topics such as academics, suicidal ideation, and substance abuse.

The study revealed that 14.5% of female high school athletes and 18.1% of male high school athletes reported experiencing at least one concussion the previous year. These students also reported at least one factor associated to their behavioral, cognitive, and emotional health. The questions covered topics such as difficulty concentrating, poor grades, drinking and driving, carrying a weapon, getting into a physical altercation, using tobacco or marijuana, binge drinking, feeling depressed, and having suicidal thoughts or actions.

Of the male participants who suffered at least one concussion, 33.8% reported they drank and drove in the last 30 days. For the female athletes who reported suffering more than one concussion, 19% stated they had used marijuana at least once in the last 30 days. Both male and female participants who answered that they had been in at least one physical fight in the last year were significantly more likely to have reported having at least one concussion in that same timeframe.

Other associated factors that were significantly more likely in male students who reported a prior concussion included difficulty concentrating, tobacco/e-cigarette use, and binge drinking. Female students who reported prior concussions were more likely to ride in a car with a driver who had been drinking, and have suicidal thoughts or actions.

"Parents need to understand that a concussion is a very serious brain injury, one which requires treatment every time a concussion is sustained. This study has revealed this type of traumatic brain injury can have a compounding effect on children that could lead to more aggressive behavior, academic problems, and social issues," said study co-author Scott Burkhart, PsyD, a neuropsychologist at Children's Health Andrews Institute for Orthopaedics and Sports Medicine.

The research team encourages future studies to continue the surveillance on the prevalence of concussions among student athletes, as well as the severity of these injuries.

https://www.sciencedaily.com/releases/2020/07/200722163225.htm

Meditation linked to lower cardiovascular risk

Survey data from more than 61,000 people points to heart benefits

July 15, 2020

Science Daily/Veterans Affairs Research Communications

Meditation was linked to lower cardiovascular risk in a data analysis by Veterans Affairs researchers and colleagues.

The results appeared online June 30 in the American Journal of Cardiology.

Previous studies have suggested that meditation may have beneficial effects on a number of conditions. A 2017 American Heart Association scientific statement suggests that meditation may be of benefit for cardiovascular risk reduction. Data show that it may help with blood pressure, cholesterol level, quitting smoking, and overall cardiovascular health. However, this connection is far from definitive. By using a large national database with many participants, the authors of the new study sought further evidence on how meditation impacts cardiovascular risk.

Lead researcher Dr. Chayakrit Krittanawong -- of the Michael E. DeBakey VA Medical Center, Baylor College of Medicine, and the Icahn School of Medicine at Mount Sinai -- and his colleagues studied data from the National Health Interview Survey, conducted annually by the National Center for Health Statistics. It collects information on a wide range of health topics from a nationally representative sample.

The researchers looked at data on more than 61,000 survey participants. Of those, almost 6,000 (nearly 10%) said they participated in some form of meditation.

The researchers found that people who meditated had lower rates of high cholesterol, high blood pressure, diabetes, stroke, and coronary artery disease, compared with those who did not meditate.

The greatest difference was in coronary artery disease. Those who meditated were 51% as likely as those who didn't to have the disease. The prevalence of other cardiovascular risks in the meditation group compared with the non-meditation group was 65% for high cholesterol, 70% for diabetes, 76% for stroke, and 86% for high blood pressure.

The researchers controlled for other factors connected to cardiovascular risk, such as age, sex, cigarette smoking, and body mass index. After adjusting for these factors, the effect of meditation was still significant.

Many types of meditation exist. Most focus on attention and awareness. Meditation has been shown to increase physical and mental relaxation. "I believe in meditation, as it can give us a sense of calm, peace, and stress reduction, leading to improvement of our emotional well-being," explained Krittanawong.

Practicing meditation has been linked to decreased stress, greater mindfulness, and improved psychological health. It may even lead to long-term functional and anatomical changes in the brain. Meditation is also simple, cost-effective, and low-risk.

Krittanawong and colleagues did note several limitations to the study. First, the survey did not capture what type of meditation people were using. Some types of meditation may offer more cardiovascular benefit than others, say the researchers. The survey also did not ask about the duration or intensity of that meditation. It is possible that those who practice longer and more frequently will get more benefit, but the study cannot measure these effects.

Also, the researchers cannot definitively say that meditation directly decreases cardiovascular risk. It could be that people who are in better cardiovascular health to begin with are more likely to practice meditation, rather than the other way around.

Other life activities might also obscure the link between meditation and cardiovascular health. The researchers found factoring in alcohol consumption and physical activity lowered the significance of the relationship between meditation and cardiovascular risk.

Considering all these factors, the researchers concluded that meditation is "probably" associated with lower prevalence of cardiovascular risk. Krittanawong notes that, while the results suggest that meditation can improve cardiovascular health, "we would need a powerful study such as a clinical trial to determine whether meditation could benefit cardiovascular health in veterans."

Meanwhile, the study adds to a growing body of research on the potential benefits of meditation, they say.

https://www.sciencedaily.com/releases/2020/07/200715135734.htm

Long-studied protein could be a measure of traumatic brain injury

Cathepsin B in brain and cerebral spinal fluid is a biomarker for traumatic brain injury

July 13, 2020

Science Daily/Walter Reed Army Institute of Research

Scientists at the Walter Reed Army Institute for Research (WRAIR) have recently demonstrated that cathepsin B, a well-studied protein important to brain development and function, can be used as biomarker, or indicator of severity, for traumatic brain injury.

Traumatic brain injury (TBI) or brain trauma results from blows to the head, leading to life-changing disruption of the brain and a cascade of long-term health conditions. A leading cause of disability and death worldwide, TBI may occur due to an open-skull injury, like a gunshot wound, a fall, or an automobile accident. Athletes, the elderly, children, and military service members are particularly vulnerable.

Biomarkers are a source of great interest to researchers due to their potential to dramatically improve both the diagnosis and categorization of severity of TBI. Furthermore, they have the potential to validate treatment strategies by indicating whether drugs have reached their proposed targets and achieved therapeutic benefits.

In their publication in the Journal of Neurotrauma, the researchers showed that levels of cathepsin B were increased in areas of the injured brain relevant to controlling the senses, language, memory and other critical executive functions. In healthy cells, cathepsin B has a range of roles, including helping to eliminate damaged cells, maintaining metabolic homeostasis, and degrading improperly produced proteins. When the level of cathepsin B is not tightly controlled, it is linked to inflammation and tissue death. This publication reports the first results demonstrating the ability to use cathepsin B as a blood-based biomarker to capable of identifying TBI severity within different brain regions as well as cerebral spinal fluid.

"Biomarker tests that accurately reflect the extent and severity of injury can dramatically improve the standard of care, minimizing the need for resource-intensive diagnostics like CT or MRI scans in favor of more portable tests," said Dr. Angela Boutte, lead author and section chief of molecular biology and proteomics within the Brain Trauma Neuroprotection Branch at WRAIR. "This would allow for early, accurate detection of TBI, whether at the side of the road after an accident or, most importantly, on the battlefield to help guide medical decisions."

https://www.sciencedaily.com/releases/2020/07/200713154950.htm

Cannabis temporarily relieves PTSD symptoms

June 9, 2020

Science Daily/Washington State University

People suffering from post-traumatic distress disorder report that cannabis reduces the severity of their symptoms by more than half, at least in the short term, according to a recent study led by Carrie Cuttler, a Washington State University assistant professor of psychology.

Cuttler and her colleagues analyzed data of more than 400 people who tracked changes in their PTSD symptoms before and after cannabis use with Strainprint, an app developed to help users learn what types of medical cannabis work best for their symptoms. The group collectively used the app more than 11,000 times over a 31-month period.

The study, recently published in Journal of Affective Disorders, shows cannabis reduced the severity of intrusions, returning thoughts of a traumatic event, by about 62%; flashbacks by 51%, irritability by 67%, and anxiety by 57%. The symptom reductions were not permanent, however.

"The study suggests that cannabis does reduce symptoms of PTSD acutely, but it might not have longer term beneficial effects on the underlying condition," said Cuttler. "Working with this model, it seems that cannabis will temporarily mask symptoms, acting as a bit of a band aid, but once the period of intoxication wears off, the symptoms can return."

PTSD is a disorder affecting people recovering from traumatic events and impacts women at about twice the rate as men with a 9.7% to 3.6% lifetime prevalence, respectively. While therapy is recommended as the primary treatment, Cuttler said there is growing evidence that many people with PTSD are self-medicating with cannabis.

"A lot of people with PTSD do seem to turn to cannabis, but the literature on its efficacy for managing symptoms is a little sparse," Cuttler said.

This study provides some insight into the effectiveness of cannabis on PTSD symptoms, but as the authors note, it is limited by reliance on a self-selected sample of people who self-identify as having PTSD. Also, it is not possible to compare the symptom reductions experienced by cannabis users to a control group using a placebo.

While some placebo-controlled clinical trials have been done with nabilone, a synthetic form of THC, few have examined the effects of the whole cannabis plant on PTSD.

In this study, Cuttler and her colleagues looked at a variety of variables but found no difference in the effect of cannabis with differing levels of tetrahydrocannabinol (THC) and cannabidiol (CBD), two of the most studied constituents of cannabis. The results imply that it is some combination of THC, CBD and perhaps some of the many other parts of the cannabis plant that create the therapeutic effect. Cannabis has many molecules that can create a biological effect, including up to 120 cannabinoids, 250 terpenes and around 50 flavonoids.

"We need more studies that look at whole plant cannabis because this is what people are using much more than the synthetic cannabinoids," said Cuttler. "It is difficult to do good placebo-controlled trials with whole plant cannabis, but they're still really needed."

https://www.sciencedaily.com/releases/2020/06/200609144458.htm