Vision and balance issues are common in elementary school-age children with a concussion
June 4, 2020
Science Daily/Children's Hospital of Philadelphia
Head injuries that lead to concussions can happen at any age, and children impacted by concussions have different needs and recovery patterns. In a new study, researchers at Children's Hospital of Philadelphia (CHOP) have performed the most comprehensive characterization of elementary school-age concussions to date, revealing an opportunity to improve outcomes for this age group through more consistent visio-vestibular assessments at the initial health care visit. The findings were published today in the Journal of Pediatrics.
Many recent studies on pediatric concussions have focused on adolescent athletes, leading to changes in how clinicians diagnose and actively manage their concussions. But little is known about delivery of clinical care for young children with concussion who are different developmentally and in their goals for recovery than older youth.
"Since one-third of pediatric and adolescent concussion injuries occur in elementary school-age children, we set out to provide a comprehensive description of children ages 5-11 years who were diagnosed with concussion to pinpoint opportunities to improve the quality of diagnosis and care for this age group," said lead author Christina L. Master, MD, a sports medicine pediatrician at CHOP, a senior fellow at the Center for Injury Research and Prevention (CIRP), and Co-Director of the CHOP's Minds Matter Program.
The Minds Matter team collaborated with colleagues from with the U.S. Centers for Disease Control and Prevention (CDC), utilizing CHOP's single, linked electronic health records (EHR) system to analyse retrospective data on more than 1,500 patients ages 5-11 years and diagnosed with a concussion over a recent one-year period.
The study found that vision and balance issues were as common in this population as they are in adolescents. However, specific visio-vestibular assessments were not consistently performed at the time of diagnosis. In particular, these assessments occurred much less frequently outside of specialty care practices. Initial visits were evenly split between a primary care physician (49%) and an emergency department or urgent care (49%), with the remaining 2.1% seen in specialty care first, although it's important to note that 24.7% of all patients saw a specialist at some point in their care. Additionally, 21% of patients saw a school nurse, highlighting the important role nurses play in the identification and proper monitoring and management of these patients.
Approximately two-thirds of patients in this study (66.1%) self-reported visio-vestibular problems. Overall, 74.3% of patients had a visio-vestibular assessment at some point in their care and among these patients, 62.7% had identifiable deficits.
When it comes to providing concussion recovery planning to families, less than half (43.8%) of all concussed patients were provided with a letter recommending school accommodations, such as taking breaks for symptoms, extra time for assignments, or use of larger print or audio books. The vast majority (95%) of patients seen only in the emergency department were not provided with a letter for school accommodations.
In total, 56.2% of patients received documentation of clearance to return to play or recreational activities. While this may represent the proportion of children participating in organized sports, virtually all of these children are returning to physical activity of some type, like free play or gym class, and therefore all concussed children in this age group would benefit from guidance on how to return to physical activity.
"Children ages 5 to 11 years diagnosed with a concussion had similar rates of visio-vestibular deficits to adolescents and we know that adolescents who have visio-vestibular deficits also have a greater likelihood of persistent symptoms and poorer outcomes," Master said. "Our older youth really benefit from early intervention in the form of school accommodations, return to school and physical activity plans, and vestibular or vision therapy. We believe intervening early can also improve outcomes for younger children diagnosed with visio-vestibular deficits."
Master and her co-authors recommend that clinicians conduct visio-vestibular assessments at the initial health care visit and let the results guide the next steps for concussion management, such as providing a letter or discharge instructions specifying targeted school accommodations, return to physical activity plans and referrals to specialists for patients who have deficits and are therefore at risk of persistent symptoms and longer recovery times. Additionally, the researchers stressed the need to develop proper clinical support tools that aid clinicians in closing the gap to improve early identification and management of these deficits for younger children who have suffered concussions.
https://www.sciencedaily.com/releases/2020/06/200604095626.htm
Nitrous oxide may bring relief to veterans suffering from PTSD
July 7, 2020
Science Daily/University of Chicago Medical Center
A small pilot study provides an early glimpse of how some veterans struggling with PTSD may benefit from one simple, inexpensive treatment involving nitrous oxide, commonly known as laughing gas.
For military veterans suffering from post-traumatic stress disorder (PTSD), symptoms such as anxiety, anger and depression can have a devastating impact on their health, daily routine, relationships and overall quality of life.
A new pilot study by the University of Chicago Medicine and the Stanford University School of Medicine team from the VA Palo Alto Health Care System (principal investigators Carolyn Rodriguez, MD, and David Clark, MD, PhD) provides an early glimpse of how some of these veterans may benefit from one simple, inexpensive treatment involving nitrous oxide, commonly known as laughing gas.
"Effective treatments for PTSD are limited," said anesthesiologist Peter Nagele, MD, chair of the Department of Anesthesia & Critical Care at UChicago Medicine and co-author of the paper. "While small in scale, this study shows the early promise of using nitrous oxide to quickly relieve symptoms of PTSD."
The findings, based on a study of three military veterans suffering from PTSD and published June 30 in the Journal of Clinical Psychiatry, could lead to improved treatments for a psychiatric disorder that has affected thousands of current and former members of the U.S. military.
For this new study, three veterans with PTSD were asked to inhale a single one-hour dose of 50% nitrous oxide and 50% oxygen through a face mask. Within hours after breathing nitrous oxide, two of the patients reported a marked improvement in their PTSD symptoms. This improvement lasted one week for one of the patients, while the other patient's symptoms gradually returned over the week. The third patient reported an improvement two hours after his treatment but went back to experiencing symptoms the next day.
"Like many other treatments, nitrous oxide appears to be effective for some patients but not for others," explained Nagele, who is himself a veteran of the Austrian Army and grateful to have identified an opportunity to help other veterans. "Often drugs work only on a subset of patients, while others do not respond. It's our role to determine who may benefit from this treatment, and who won't."
Nagele is a pioneer in the field of using nitrous oxide to treat depression. Most commonly known for its use by dentists, nitrous oxide is a low-cost, easy-to-use medication. Although some patients may experience side effects like nausea or vomiting while receiving nitrous oxide, the reactions are temporary.
Exactly how and why nitrous oxide relieves symptoms of depression in some people has yet to be fully understood. Most traditional antidepressants work through a brain chemical called serotonin. Nitrous oxide, like ketamine, an anesthetic that recently received FDA-approval in a nasal spray form to treat major depression, works through a different mechanism, by blocking N-methyl-D-aspartate (NMDA) receptors.
A 2015 landmark study by Nagele found that two-thirds of patients with treatment-resistant depression experienced an improvement in symptoms after receiving nitrous oxide.
For his next study, Nagele is researching the ideal dose of nitrous oxide to treat intractable depression. Study participants with treatment-resistant depression received different doses of nitrous oxide so that Nagele and his team could compare each dose's effectiveness and side effects. The study is being funded by the Brain & Behavior Research Foundation.
"Does nitrous oxide help veterans with post traumatic stress disorder" was funded by the VA Office of Research and Development Clinical Science Research & Development Service.
https://www.sciencedaily.com/releases/2020/07/200702113647.htm
How experiencing traumatic stress leads to aggression
Strengthened amygdala pathways increase aggression, may be targets for PTSD treatment
May 18, 2020
Science Daily/Society for Neuroscience
Traumatic stress can cause aggression by strengthening two brain pathways involved in emotion, according to research recently published in JNeurosci. Targeting those pathways via deep brain stimulation may stymie aggression associated with post-traumatic stress disorder.
The consequences of traumatic stress linger long after the stress ends. People suffering from post-traumatic stress disorder often display heightened aggression, caused by unknown changes in the amygdala. An almond-shaped structure nestled deep inside the brain, the amygdala plays an essential role in emotion, social behaviors, and aggression.
Nordman et al. examined how different amygdala circuits changed in male mice after traumatic stress. Two connections strengthened, resulting in more attacks on other mice: the circuitry connecting the amygdala to the ventromedial hypothalamus and the bed nucleus of the stria terminalis. The former modulates the frequency of attacks, while the latter controls the length of attacks. The research team then used low frequencies of light to stop the pathways from strengthening, preventing an increase in aggressive behavior. Deep brain stimulation may elicit the same effect in humans.
https://www.sciencedaily.com/releases/2020/05/200518145022.htm
Marine training may take more mental than physical grit
June 26, 2020
Science Daily/University of Southern California - Health Sciences
The United States military has a constant need for service members who can serve in elite and specialized military units, such as the Marine Corps. However, because the training courses for these forces is so rigorous, the dropout rate is high.
To help determine predictors of success or failure in elite military training, Leslie Saxon, MD, executive director of the USC Center for Body Computing, and fellow Center for Body Computing researchers monitored the physical and psychological activity of three consecutive classes of Marines and sailors enrolled in a 25-day specialized training course.
The results were published in the Journal of Medical Internet Research mHealth and uHealth.
A total of 121 trainees participated. Only slightly more than half (64) successfully completed the course.
Researchers found there was no correlation between finishing and performance on physical training standards, such as hikes or aquatic training. Physical markers such as heart rate or sleep status also did not play a role.
Rather, the biggest determinant was mental. Trainees who identified themselves as extroverted and having a positive affect -- the ability to cultivate a joyful, confident attitude -- were most likely to complete the course.
"These findings are novel because they identify traits not typically associated with military performance, showing that psychological factors mattered more than physical performance outcomes," says Saxon, who is also a cardiologist with Keck Medicine of USC and a professor of medicine (clinical scholar) at the Keck School of Medicine of USC.
Researchers were also able to pinpoint psychological stressors that triggered dropping out of the course. Trainees typically quit before a stressful aquatic training exercise or after reporting an increase in emotional or physical pain and a decrease in confidence. This led researchers to be able to predict who would drop out of the course one to two days in advance.
While Saxon has been studying human performance in elite athletes for 15 years, this was her first study involving the military. She partnered with the USC Institute for Creative Technologies, which has established military research programs, to run the study with a training company in Camp Pendleton, Calif. that trains Marines in amphibious reconnaissance. Typically, only around half of the participants finish the training.
The study authors collected baseline personality assessments of the trainees before the recruits began the course, assessing personality type, emotional processing, outlook on life and mindfulness. Researchers next provided subjects with an iPhone and Apple Watch, and a specially designed mobile application to collect continuous daily measures of trainees' mental status, physical pain, heart rate, activity, sleep, hydration and nutrition during training.
The mobile application also prompted trainees to answer daily surveys on emotional and physical pain, well-being and confidence in course completion and instructor support.
"This study, the first to collect continuous data from individuals throughout a training, suggests that there may be interventions the military can take to reduce the number of dropouts," says Saxon. "This data could be helpful in designing future training courses for Marines and other military units to increase the number of elite service members, as well as provide insights on how to help athletes and other high performers handle challenges."
Saxon is already testing whether or not various psychological interventions or coaching might encourage more trainees to stay the course.
https://www.sciencedaily.com/releases/2020/06/200626092737.htm
Female Gulf War combat veterans have persistent symptoms more than 25 years later
May 26, 2020
Science Daily/Medical College of Georgia at Augusta University
More than a quarter century after the Gulf War, female veterans who saw combat have nearly a twofold risk of reporting more than 20 total medical symptoms, like cognition and respiratory troubles, than their fellow female veterans who were not deployed, investigators report.
A sizeable percentage of the female combat veterans still report neurological symptoms; about two-thirds report difficulty remembering new information and trouble concentrating, investigators report in the Journal of Women's Health.
An association with more headaches among the combat veterans also was reported and there were "strong associations" between deployment status and respiratory symptoms with 39% of combat veterans still reporting difficulty breathing or shortness of breath. More than half also report a low tolerance for heat and cold.
"It's been over 25 years since the war ended and these are very persistent health outcomes," says Dr. Steven S. Coughlin, interim chief of the Division of Epidemiology in the Medical College of Georgia Department of Population Health Sciences. "This tells us that the way the Gulf War illness manifests itself may be different in female than male veterans, so it's important to take gender into account," says Coughlin.
Twenty years ago, female Gulf War veterans were reporting similar problems, investigators say. The newly reported findings indicate the women are showing increased frequency of symptoms over time and above the rate that would be expected with normal aging, the investigators say. Their reported symptoms correspond with higher rates of diabetes, osteoporosis, thyroid problems, asthma and irritable bowel syndrome in this and similar groups.
Additional studies are needed to find biomarkers of Gulf War illness in these former soldiers and effective treatments, they write.
"We think this has a lot of importance for the health of these veterans and hopefully, when combined with information from other studies, it will lead to improved treatment," Coughlin says.
Three hundred-and-one female Gulf War veterans from all military branches participated in the study, including 203 who were deployed and 98 who were not sent directly into a war zone.
Other persistent problems war zone veterans report include about a third saying they frequently cough when they do not have a cold. Many of their reported symptoms fit the definition of Gulf War illness, which includes having at least three of six symptom categories that include fatigue, neurological/cognitive/mood problems, pain as well as respiratory, gastrointestinal and skin problems. Younger, non-white, female Army veterans were likely to report the most symptoms, they say.
Their significant symptom burden would likely impact the veterans' quality of life and require medical evaluation and treatment, Coughlin and his colleagues write.
"We are trying to fill in this gap in the published literature about Gulf War illness among women veterans because they have been greatly understudied," Coughlin says, referencing the first conflict in which the United States included a sizeable female contingent directly in warfare.
The gender differences they are finding are consistent with earlier studies as well as other current ones coming out of Florida-based Nova Southeastern University, for example, where they are conducting a clinical trial to try to reverse some of the ill effects, he says.
The findings also are more evidence that the female veterans of the Gulf War may have more chronic health issues and conditions than other groups of women generally or female veterans specifically.
Coughlin theorizes that females may be more susceptible to some of the wartime hazards because on average their body size is smaller and because of other differences in physiology. "We can only speculate," he adds.
When troops started to come home from the Middle East following the conflict that lasted from August 1990 through February 1991, they reported a constellation of symptoms, including headaches, gastrointestinal complaints, skin ailments, forgetfulness, fatigue, particularly after exertion, and musculoskeletal pain, says Coughlin, who served as a senior epidemiologist with the Department of Veterans Affairs Central Office in Washington, D.C. The leading theory early on was that it was a psychogenic illness, somewhat similar to the PTSD experienced by many Vietnam War veterans. Now the consensus is that much of it results from the neurological impact of neurotoxins soldiers on the frontline were exposed to, Coughlin says.
"They were inundated with pesticides, there are a lot of biting flies and pests in that part of the world so they had uniforms infused with pesticides, a lot of them even wore a dog's flea collar for extra protection," he says. Soldiers also were asked to take pyridostigmine bromide, a drug given to patients with myasthenia gravis to improve muscle strength, prophylactically to help protect them from nerve agents in field, but the drug itself is mildly toxic to nerves and there is some evidence that, in combination with some of the insecticides used, it becomes more potent.
"Every time the alarms went off, they would have to take these little white pills," Coughlin says. There were other environmental toxins as well, like blown up munitions factories and low dose exposure to sarin nerve gas and others. "It's similar to what you see among agricultural workers exposed to pesticides," he notes. The veterans also were exposed to hazards such as smoke from oil well fires and burn pits used to incinerate waste, the investigators write.
The new study looked at the frequency and patterns of health symptoms in the female veterans as well as military service and lifestyle. The investigators theorized that symptoms associated with Gulf War illness would be more prominent in the women who saw conflict.
They found the deployed veterans were significantly more likely to report seven symptoms consistent with Gulf War illness, including low tolerance for heat or cold, difficulty breathing or shortness of breath, frequent coughing without having a cold, difficulty concentrating and remembering recent information, feeling down or depressed and anxious, the investigators write. Those deployed were more than twice as likely to report more total symptoms and nonwhites -- including American Indians, Alaska natives as well as Asian Americans and Pacific Islands Americans -- were four times more likely to report symptoms than whites. Older women were less likely than younger women to report symptoms and those enlisted in the Air Force and Navy were significantly less likely to report more symptoms than those in the Army.
Participants in the study were a mean age of early 50s and other demographics, like race, ethnicity and education, were similar, but those who saw combat were more likely to have served in the Army or Navy and less likely to have served in the Air Force.
They were taken from a national cohort of 1,318 Gulf War veterans created from the Veterans Affairs Cooperative Studies Program 585 Gulf War Era Cohort and Biorepository pilot study. Outcomes of female veterans in the group have not been reported separately. Women comprised 7% of the 700,000 military personnel to serve in the Gulf War, the largest number of women to serve in a war zone in U.S. military history at that time. The influx of the some 50,000 female Gulf War veterans resulted in the establishment of specialty clinics for them at VA hospitals. Evidence indicates about 19% of women veterans still have delayed or unmet health care needs, possibly because of expanded military roles for women, including increased exposure to combat, the investigators write.
Female veterans who have been involved in conflicts since the Vietnam War report higher rates of poor sleep quality, fatigue, insomnia, chronic pain, including headache and musculoskeletal complaints, respiratory problems and skin problems, as well as cognitive and mood related complaints, Coughlin and his colleagues write.
https://www.sciencedaily.com/releases/2020/05/200526091406.htm
How associative fear memory is formed in the brain
March 13, 2020
Science Daily/University of California - Riverside
How does the brain form "fear memory" that links a traumatic event to a particular situation? A pair of researchers at the University of California, Riverside, may have found an answer.
Using a mouse model, the researchers demonstrated the formation of fear memory involves the strengthening of neural pathways between two brain areas: the hippocampus, which responds to a particular context and encodes it, and the amygdala, which triggers defensive behavior, including fear responses.
Study results appear today in Nature Communications.
"It has been hypothesized that fear memory is formed by strengthening the connections between the hippocampus and amygdala," said Jun-Hyeong Cho, an assistant professor in the Department of Molecular, Cell and Systems Biology and the study's lead author. "Experimental evidence, however, has been weak. Our study now demonstrates for the first time that the formation of fear memory associated with a context indeed involves the strengthening of the connections between the hippocampus and amygdala."
According to Cho, weakening these connections could erase the fear memory.
"Our study, therefore, also provides insights into developing therapeutic strategies to suppress maladaptive fear memories in post-traumatic stress disorder patients," he said.
Post-traumatic stress disorder, or PTSD, affects 7% of the U.S. population. A psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event, such as war, assault, or disaster, PTSD can cause problems in daily life for months, and even years, in affected persons.
Cho explained the capability of our brains to form a fear memory associated with a situation that predicts danger is highly adaptive since it enables us to learn from our past traumatic experiences and avoid those dangerous situations in the future. This process is dysregulated, however, in PTSD, where overgeneralized and exaggerated fear responses cause symptoms including nightmares or unwanted memories of the trauma, avoidance of situations that trigger memories of the trauma, heightened reactions, anxiety, and depressed mood.
"The neural mechanism of learned fear has an enormous survival value for animals, who must predict danger from seemingly neutral contexts," Cho said. "Suppose we had a car accident in a particular place and got severely injured. We would then feel afraid of that -- or similar -- place even long after we recover from the physical injury. This is because our brains form a memory that associates the car accident with the situation where we experienced the trauma. This associative memory makes us feel afraid of that, or similar, situation and we avoid such threatening situations."
According to Cho, during the car accident, the brain processes a set of multisensory circumstances around the traumatic event, such as visual information about the place, auditory information such as a crash sound, and smells of burning materials from damaged cars. The brain then integrates these sensory signals as a highly abstract form -- the context -- and forms a memory that associates the traumatic event with the context.
The researchers also plan to develop strategies to suppress pathological fear memories in PTSD.
https://www.sciencedaily.com/releases/2020/03/200313112137.htm
Cyberbullying linked to post traumatic stress for victims and perpetrators
Children should be screened for symptoms, suggest researchers
June 23, 2020
Science Daily/BMJ
Cyberbullying -- bullying online rather than face to face -- is linked to various types of post traumatic stress disorder (PTSD) symptoms, both for victims and perpetrators, suggests the first study of its kind, published online in the Archives of Disease in Childhood.
Their findings prompt the researchers to suggest that asking about cyberbullying should become a routine part of any children's mental health or psychological assessment.
The prevalence of cyberbullying among teens is thought to be between 10% and 40% and to pose specific risks because it can be done day and night, in various contexts, is rapid, anonymous, and reaches a wide audience, say the researchers.
It has been suggested that there may be some overlap between traditional bullying and cyberbullying.
To explore this further, and find out what the mental health impact of cyberbullying might be, the researchers questioned 2218 pupils aged between 11 and 19 from four secondary schools in London about their experiences of bullying.
They used The Olweus Bully/Victim Questionnaire to find out what type of bullying the teens had been involved with, how often this had happened, and for how long it had lasted.
And they screened for PTSD symptoms using the Children Revised Impact of Events Scale (CRIES), which has two dimensions: intrusive thoughts and avoidance behaviours.
Just over half the teens were girls (55%). Around a third (34%) were of white ethnicity; two thirds were of black, Asian and other minority ethnic backgrounds. Most of the children (80%) had been born in the UK.
The survey responses showed that nearly half (46%) of all the pupils reported a history of any type of bullying: 17% as victims; 12% as perpetrators; and 4% as both.
But involvement in traditional bullying (1 in 3 of the teens) was more common than involvement in cyberbullying (1 in 4).
Some 13% of the teens had been cyberbullied; 8.5% had bullied others online; and 4% had been both victim and perpetrator. Some 16% of the teens had been bullied in person; 12% had bullied others in person; and 6.5% had been both victim and perpetrator.
There was some overlap between both types of bullying, although pure cyberbullies were less likely to also be traditional bullies.
Half of those involved in a specific role in cyberbullying were also involved in the same role in traditional bullying: 52% of cyber victims were also traditional victims; 45.5% of cyber victims were also traditional bully victims; and 48% of the cyberbullies were also traditional bullies.
Around 72% (1516) of the teens completed the CRIES assessment. More than a third of cyber victims (35%), more than one in four (29%) of the cyberbullies, and a similar proportion (28%) of those who were both, scored above the threshold for clinically significant PTSD symptoms.
Further analysis indicated that cyber victims displayed significantly more PTSD symptoms than did cyberbullies, and they experienced more intrusive thoughts and avoidance behaviours.
Cyberbullies also had significantly more PTSD symptoms than teens who weren't involved in any form of bullying.
This is an observational study, so can't establish cause and effect. It also relied on subjective reports, and it didn't include a full clinical assessment of suspected PTSD symptoms.
And while the sample was representative of UK urban teens, the findings may not be applicable to other regions or countries, caution the researchers.
Nevertheless, they suggest their findings have important implications. "Parents, teachers and health professionals need to be aware of possible PTSD symptoms in young people involved in cyberbullying," they write.
And they note: "Despite cyberbullying being less frequent than traditional bullying, it is noteworthy that more than a third of the cyberbullies were not involved in traditional bullying, whereas a huge majority of the cyberbully victims were involved in traditional bullying, mainly as traditional victims or [as both victim and perpetrator].
"This suggests that the anonymity provided to perpetrators online may constitute a new platform for bullying to occur, though this finding requires further study."
https://www.sciencedaily.com/releases/2020/06/200623185242.htm
Financial Assistance for Recovering Addicts
Article provided by LendEDU
Financial hardship is common among recovering addicts, but there are resources that provide financial aid for drug rehab. Individuals in recovery have access to grants, non-profit and private programs, personal funding, and insurance to manage the expense of rehab.
For people living with addiction, as well as those who care for them, all aspects of life can be affected. Addiction not only creates emotional and physical wounds but can cause other hardships as well.
One significant hurdle faced by those recovering from addiction is financial instability. Substance abuse and drug addiction are expensive on their own, but living with addiction or going through recovery adds further financial challenges.
From rehabilitative therapy to prescription medication and more, the costs of treatment add up quickly – according to U.S News and World Report, the “…annual economic impact from the misuse of prescription drugs, illicit drugs, or alcohol is $442 billion.”
Fortunately, financial aid for drug rehab comes in a variety of forms, from health insurance coverage to state and federal funding. This guide will outline some of the resources designed to provide financial assistance for recovering addicts.
In this guide:
Financial aid for drug rehab
On average, drug rehab costs range from a few to several hundred dollars for a 30-day detox, and between $5,000 and $80,000 for residential recovery treatment. Many individuals in or contemplating recovery may see this as a deterrent to getting the help they need. However, several resources exist that offer financial assistance for drug rehab and associated programs.
Health insurance and the ACA
With the passage of the Affordable Care Act, pre-existing health conditions were no longer an exclusionary tactic for insurance providers. This drastically changed how addiction recovery was viewed under many health insurance plans.
Treatment for addiction is generally considered a covered medical condition. Additionally, The Mental Health Parity and Addiction Equity Act mandates that large group health insurance plans cannot impose less favorable limitations on mental health or substance use disorder treatment benefits than on medical or surgical benefits. The ACA amended this federal law to include individual health insurance coverage, not just large group plans.
Any ACA-compliant health insurance policy may pay between 60% and 90% of the cost of rehabilitation. If you have been denied coverage or experienced benefit limits that are not in compliance with these laws, an appeals process may be necessary.
To appeal a denial of benefits under an ACA health insurance plan, request a fair and full review of the denial with the insurance provider directly or follow your state’s external review process. More information about the appeals process can be found here.
To understand what rehabilitation costs are covered with your specific insurance plan, get in contact with your health insurance provider or check policy limits online.
Government grants for recovering addicts
In addition to health insurance coverage through ACA programs, grants may also be available from state and federal governments. Government grants for addiction recovery vary depending on financial circumstances and location, but the resources below are worth evaluating to determine the level of assistance available.
Substance Abuse and Mental Health Services Administration (SAMHSA)
One resource for federal grants for recovering addicts is the Substance Abuse and Mental Health Service Administration (SAMHSA) program. Through SAMHSA, block grants are provided to state addiction treatment providers to benefit those in need. Typically, receiving a SAMHSA grant requires meeting specific income requirements or participating in a qualified treatment program through the courts.
To see eligibility information and complete the application process, visit the SAMHSA website.
State-funded and local treatment programs
According to a recent study conducted by Pew Charitable Trusts, a significant portion of spending on drug and alcohol addiction treatment is done by state and local governments. Public assistance in this form often falls under the purview of specific agencies, such as human services or public health departments.
Financial aid for drug rehab may be offered through reduced-cost or no-cost treatment facilities funded by the state. Additionally, assistance in getting back on one’s feet after treatment may also be available. This assistance often comes in the form of low or no-cost sober living for recovering addicts.
Disability income can also be an option for those in recovery, although the definition of disability is quite strict. Other financial aid for recovering addicts on a state or local level include food stamps, health insurance through Medicaid, employment assistance, or training at little to no cost.
Recovering addicts can visit their state or local government’s website or local human services office to determine what programs and partnerships are available.
VA benefits
Another source of drug rehab assistance comes from the US Department of Veterans Affairs. Through the VA, several programs are made available to veterans of the military who are struggling with addiction. Treatment programs, including in-patient and out-patient services, medically-assisted treatment, and residential care, are offered at no cost to qualifying veterans. For help, veterans can speak with their VA healthcare provider, contact a local Vet Center, or call the VA hotline at 1-800-827-1000.
Financial aid directly from treatment centers
Financial assistance for recovering addicts may also be available directly from a treatment center. Because the cost of rehabilitation can be high in private facilities, many offer payment plans and financing to help ease the burden.
After discharge, an individual in recovery may have an option to establish a payment plan that requires installment payments over a period of several months or several years. Interest may or may not be charged, so it is necessary to fully understand the total cost of financing a treatment stay.
You may also be able to find a free treatment center for drug addiction. Typically, centers that do not charge for outpatient or in-patient services for drug rehab have requirements that patients must meet. For instance, the Salvation Army offers little to no-cost drug rehab so long as the patient agrees to work 40 hours per week to help offset the cost. Check with local organizations to see if financing or free treatment is available, but be sure to understand everything that it entails.
Faith-based rehab programs
Many faith-based organizations offer treatment services to recovering addicts. In some cases, sponsorship is available for individuals in the community trying to get out of the throes of addiction. Although the cost of faith-based treatment may not be lower than other treatment centers, this sponsorship can bring down the expense.
Check with local religious organizations or leaders, such as churches, pastors, or priests, to ask about faith-based treatment services available.
National Foundation for Credit Counseling
The National Foundation for Credit Counseling is a national non-profit that offers a variety of financial education and guidance to those struggling to manage their money. This organization does not provide financial assistance for drug rehab directly. However, people suffering from addiction can work with the counselors at the organization to gain a better understanding of what steps are necessary to improve their overall financial lives.
Crowdfunding
In addition to assistance from treatment centers, the government, or other community-based programs, financial help for drug rehabilitation may come from raising money on your own or with the help of a family member or friend.
Crowdfunding platforms, including GoFundMe and Indiegogo, allow individuals or organizations to raise funds for specific campaigns or initiatives. Crowdfunding campaigns may be used to help fund an individual need – such as covering the cost of drug rehabilitation – with help from friends, family, and local communities easily and quickly.
Drug rehab loan
Drug rehab loans offer another alternative to when recovering addicts need to secure financial aid. Although drug rehab loans are not free aid, they can be beneficial in getting the upfront funds needed to pay for treatment.
Loans for addiction treatment must be repaid with interest over the course of months or years, depending on terms, so it is essential to understand this difference from other forms of financial assistance when considering options.
This option should be a last resort and there should be a repayment plan in place before taking one out to ensure you don’t fall behind on payments.
Specialized lenders
A small number of specialized lenders offer loans to individuals entering or completing treatment programs. The most prominent is My Treatment Lender, which can finance co-pays, out-of-pocket expenses for rehabilitation, or an individual’s stay at an in-patient or residential treatment center.
Specialized lenders have various loan programs available with different costs, repayment terms, and qualification guidelines. Because of these variations, those interested in a specialized loan should evaluate the terms of all available loans before applying and receiving funds.
Personal loans
Finally, personal loans may also be a viable resource for drug rehab assistance. These loans are unsecured, meaning collateral such as a vehicle or home is not necessary to back them. They also offer fixed interest rates and predictable monthly payments that can help make repayment easier in recovery.
Personal loan rates may be higher for individuals with lower credit scores, but many lenders allow for a cosigner. Having a family member or friend with a higher credit score cosign a personal loan application can increase your chances for approval and potentially lower interest rates, which affect the total cost of borrowing.
As with any financing agreement, be sure to read the fine print when getting a personal loan for drug rehab assistance. Take time to understand your obligations as a borrower, as well as the fees you will pay to get the loan and repay it over time.
Author: Melissa Horton
Melissa Horton has an MBA in Finance and has worked as a financial professional for the past 13 years, helping clients understand the often complex vehicles available for both lending and investment needs. She is passionate about financial literacy and strives to educate clients and the general public to empower them in making smart financial decisions. Her work has been featured on Investopedia, iGrad, APRFinder, and more.
Can light therapy help improve mood in people with concussion?
March 2, 2020
Science Daily/American Academy of Neurology
People with mild traumatic brain injury who are exposed to early morning blue light therapy may experience a decrease in depression and other concussion symptoms, according to a preliminary study released today that will be presented at the American Academy of Neurology's 72nd Annual Meeting in Toronto, Canada, April 25 to May 1, 2020.
"Patients with mild traumatic brain injury, like concussion, often develop persistent problems associated with sleep, concentration and depression," said study author William D. Killgore, Ph.D., from the University of Arizona College of Medicine in Tucson. "Morning blue light exposure has been shown to lead to improved circadian rhythm of the body's sleep-wake cycle, which is linked to improved sleep, better mood and daytime alertness."
The double-blind, randomized study involved 35 people with an average age of 26 who had been diagnosed with concussion within the past 18 months. The participants used a tabletop device that shines bright light for 30 minutes each morning for six weeks. Seventeen people received blue light therapy and 18 people received a placebo amber light therapy.
At the beginning and the end of the study, both groups completed tests to measure symptoms of depression and other concussion symptoms, such as headache, fatigue and problems with sleep, memory and concentration.
The study found that the people who received the blue light therapy had lower scores on a test of depression, the Beck Depression Inventory, than the people who received the placebo light therapy. Raw depression scores showed a significant decline in only the blue group. The people in the blue light group improved by 22% on the test of depression, compared to a 4% worsening in mood for the people in the placebo group.
The improvement in depression scores among the people in the blue light group was also linked to improvements in other concussion symptoms such as sleep disturbance, fatigue, concentration, restlessness, and irritability, while there was no such relationship for the people in the placebo group.
"These results reinforce that blue light therapy may be an effective, non-drug treatment for concussion and that improvements in depression may result in improvement in both mental and physical concussion symptoms, and thus quality of life," said Killgore.
The main limitations of the study were a relatively small sample size and that not every participant had clinical depression, which is a more severe form of depression, so the study may not represent all people with mild traumatic brain injury.
Killgore said, "Limitations notwithstanding, the findings give a promising treatment approach to those suffering from mood disturbances following a concussion."
https://www.sciencedaily.com/releases/2020/03/200302162250.htm
Brain inflammation in veterans with Gulf War illness
February 13, 2020
Science Daily/Massachusetts General Hospital
In a new discovery, researchers at Massachusetts General Hospital (MGH) have detected widespread inflammation in the brains of veterans diagnosed with Gulf War Illness (GWI). These findings, published online in the journal Brain, Behavior, and Immunity on February 3, could serve as a guidepost for identifying and developing new therapies for people with GWI, as well as many other chronic conditions that have recently been linked to inflamed brain tissue, or neuroinflammation.
About 30 percent of soldiers who fought in the 1991 Gulf War suffer from GWI. Veterans with GWI display a range of symptoms, including fatigue, chronic pain and cognitive problems such as memory loss. The cause of GWI is unknown, but several potential culprits are suspected. They include exposure to nerve gas, as well as medicine given to protect against this neurotoxin; exposure to pesticides; and the stress of extreme temperature changes, sleep deprivation and physical exertion during deployment
Many of the symptoms of GWI overlap with those of another condition, fibromyalgia, notes the senior author of the study, Marco Loggia, PhD, whose laboratory at MGH's Athinoula A. Martinos Center for Biomedical Imaging focuses on understanding the brain mechanisms of pain and neuroinflammation in humans. Last year, Loggia and his colleagues showed in another study that fibromyalgia patients have extensive neuroinflammation. "So, we asked, Do veterans who have Gulf War Illness demonstrate evidence of neuroinflammation, too?"
To find out, Loggia and his team collaborated with the Gulf War Illness Consortium at Boston University, which helped them to recruit Gulf War veterans. The study included 23 veterans, of whom 15 had GWI, as well as 25 healthy civilian subjects. All study participants' brains were scanned using positron-emission tomography (PET) imaging, which measured levels of a molecule called translocator protein that rises in the presence of neuroinflammation. The scans detected little evidence of neuroinflammation in the healthy controls and veterans who were free of GWI. By contrast, the study found extensive inflammation in the brains of veterans with GWI, "particularly in the cortical regions, which are involved in 'higher-order' functions, such as memory, concentration and reasoning," says Zeynab Alshelh, PhD, one of two research fellows in Loggia's lab who co-led the study. "The neuroinflammation looked very similar to the widespread cortical inflammation we detected in fibromyalgia patients," says Alshelh.
What might cause neuroinflammation? The central nervous system has legions of immune cells that protect the brain by detecting bacteria, viruses, and other potentially harmful agents, then producing inflammatory molecules to destroy the invaders, explains Loggia. However, while this response can be beneficial in the short term, it may become exaggerated, says Loggia, "and when that happens, inflammation becomes pathological -- it becomes the problem."
Research by Loggia's lab and other investigators has also implicated neuroinflammation in a number of additional conditions, including chronic pain, depression, anxiety, autism, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Huntington's disease and migraine. The findings of the GWI study, says Loggia, "could help motivate a more aggressive evaluation of neuroinflammation as a potential therapeutic target."
https://www.sciencedaily.com/releases/2020/02/200213175919.htm
Concussion risk in youth football
January 21, 2020
Science Daily/Virginia Tech
For decades, there's been a widespread assumption among people with an interest in sports-related injury that youth football players are more vulnerable to concussion and other head injuries than their older, bigger counterparts.
The Virginia Tech Helmet Lab has published the first data validating that conventional wisdom, in a study released in the January issue of the Annals of Biomedical Engineering.
The research, funded by a five-year grant from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health, demonstrated that the head accelerations leading to concussion in youth football players are lower than those that typically cause injury in high school, collegiate, and professional athletes -- data that will be critical for designing and testing protective equipment.
"These are the first biomechanical data characterizing concussion risk in kids," said Steve Rowson, an associate professor of biomedical engineering and mechanics and the director of the Virginia Tech Helmet Lab. "Children aren't just scaled-down adults: Differences in anatomy and physiology, like head-neck proportions and brain development, contribute to differences in tolerance to head impact. These results can lead to data-driven interventions to reduce risk in youth sports."
Kids between the ages of 9 and 14 make up the largest group of football players in the country. But the research cataloging head impacts on U.S. football fields, and determining which ones are most likely to cause injury, has focused on high school, collegiate, and pro players, limiting the understanding of what conditions lead to concussion in youth football.
In younger players, the fatty myelin sheaths that help protect brain cells haven't fully developed. They also tend to have larger heads relative to their bodies than adult players do, with less neck musculature to help absorb the force of an impact. For all these reasons, researchers had presumed that youth players were more susceptible to concussion. But they needed data to prove it.
Virginia Tech has been studying head impacts in football since 2003, when Stefan Duma, the Harry Wyatt Professor of Engineering and founder of the Helmet Lab, instrumented the helmets worn by the university's varsity football team with sensors to measure head impacts.
Since then, Duma, Rowson, and their research team have expanded their studies to more sports and a broader range of demographic groups. They've been studying youth players since they won this critical grant from the NIH in 2015.
For the study, they partnered with researchers at Brown University and Wake Forest University to track six different youth football teams in Virginia, North Carolina, and Rhode Island. More than 100 players wore helmets lined with sensors that measured the linear and rotational acceleration of their heads during four seasons' worth of practices and games, recording thousands of impacts. All concussions were diagnosed by clinicians at each site; neuropsychological testing before and after each season measured the players' cognitive function.
The National Operating Committee on Standards for Athletic Equipment, an independent standards body that certifies equipment including football helmets, provided additional funding that helped accelerate the data collection.
That data allowed the researchers to develop a mathematical relationship between the magnitude of a head impact and the risk of concussion. What they found was that youth players are on average more susceptible to concussion at lower levels of acceleration than high school and collegiate players are.
In high school and college players, the average concussive impact is associated with a head acceleration around 102 g, with similar values for pro athletes. In youth players, the new study found, the average concussive impact was associated with a head acceleration of only 62 g. The rotational acceleration values associated with concussion were similarly reduced, from 4,412 rad/s2 in adults to 2,609 rad/s2 in youth players.
"These numbers prove for the first time that youth players are at a higher risk of injury at lower head accelerations," Duma said, "but it is important to note that the overall head acceleration exposure in youth football is much lower than in adult football."
Despite that heightened susceptibility, concussions in youth football are relatively rare: Younger, lighter players collide with less force than adult athletes, so they're less likely to jostle their brains enough to cause serious injury.
But as with any sport, there's still a risk of injury. So effective protective equipment is critical -- and that's the practical value of this study, Duma explained. Knowing the levels of acceleration that put youth players at risk for concussion provides a benchmark to use for helmet testing.
Earlier this year, the Helmet Lab released the industry's first youth-specific football helmet ratings, evaluating the helmets with laboratory tests based on their on-field data.
"No one had ever come up with a rating system tailored to youth helmets, partly because the data didn't exist," said Duma, who also directs the university's Institute for Critical Technology and Applied Science. "Now we can evaluate helmets based on the actual risks youth players experience, and companies can use that information to design models specifically for this large group of players."
https://www.sciencedaily.com/releases/2020/01/200121133259.htm
Blue light can help heal mild traumatic brain injury
January 15, 2020
Science Daily/University of Arizona
Daily exposure to blue wavelength light each morning helps to re-entrain the circadian rhythm so that people get better, more regular sleep which was translated into improvements in cognitive function, reduced daytime sleepiness and actual brain repair.
Early morning blue light exposure therapy can aid the healing process of people impact by mild traumatic brain injury, according to new research from the University of Arizona.
"Daily exposure to blue wavelength light each morning helps to re-entrain the circadian rhythm so that people get better, more regular sleep. This is likely true for everybody, but we recently demonstrated it in people recovering from mild traumatic brain injury, or mTBI. That improvement in sleep was translated into improvements in cognitive function, reduced daytime sleepiness and actual brain repair," said William D. "Scott" Killgore, psychiatry professor in the College of Medicine -- Tucson and lead author on a new study published in the journal Neurobiology of Disease.
Mild traumatic brain injuries, or concussions, are often the result of falls, fights, car accidents and sports participation. Among other threats, military personnel can also experience mTBI from exposure to explosive blasts: Shockwaves strike the soft tissue of the gut and push a burst of pressure into the brain, causing microscopic damage to blood vessels and brain tissue, Killgore said.
"Your brain is about the consistency of thick Jell-O," he said. "Imagine a bowl of Jell-O getting hit from a punch or slamming against the steering wheel in a car accident. What's it doing? It's absorbing that shock and bouncing around. During that impact, microscopic brain cells thinner than a strand of hair can easily stretch and tear and rip from the force."
Those with a concussion or mTBI might can momentarily seen stars, become disoriented, or even briefly lost consciousness following the injury; however, loss of consciousness doesn't always happen and many people who sustain a concussion are able to walk it off without realizing they have a mild brain injury, according to Killgore. Headaches, attention problems and mental fogginess are commonly reported after head injuries and can persist for weeks or months for some people.
Few, if any, effective treatments for mTBI exist. The U.S. Army Medical Research and Development Command funded the research to find alternatives to medicinal methods of mTBI recovery.
"About 50% of people with mTBI also complain that they have sleep problems after an injury," Killgore said.
Recent research has shown that the brain repairs itself during sleep, so Killgore and his co-authors -- John Vanuk, Bradley Shane, Mareen Weber and Sahil Bajaj, all from the Department of Psychiatry -- sought to determine if improved sleep led to a faster recovery.
In a randomized clinical trial, adults with mTBI used a cube-like device that shines bright blue light (with a peak wavelength of 469 nm) at participants from their desk or tables for 30 minutes early each morning for six weeks. Control groups were exposed to bright amber light.
"Blue light suppresses brain production of a chemical called melatonin," Killgore said. "You don't want melatonin in the morning because it makes you drowsy and prepares the brain to sleep. When you are exposed to blue light in the morning, it shifts your brain's biological clock so that in the evening, your melatonin will kick in earlier and help you to fall asleep and stay asleep."
People get the most restorative sleep when it aligns with their natural circadian rhythm of melatonin -- the body's sleep-wake cycle associated with night and day.
"The circadian rhythm is one of the most powerful influences on human behavior," Killgore said. "Humans evolved on a planet for millions of years with a 24-hour light/dark cycle, and that's deeply engrained in all our cells. If we can get you sleeping regularly, at the same time each day, that's much better because the body and the brain can more effectively coordinate all these repair processes."
As a result of the blue light treatment, participants fell asleep and woke an average of one hour earlier than before the trial and were less sleepy during the daytime. Participants improved their speed and efficiency in brain processing and showed an increase in volume in the pulvinar nucleus, an area of the brain responsible for visual attention. Neural connections and communication flow between the pulvinar nucleus and other parts of the brain that drive alertness and cognition were also strengthened.
"We think we're facilitating brain healing by promoting better sleep and circadian alignment, and as these systems heal, these brain areas are communicating with each other more effectively. That could be what's translating into improvements in cognition and less daytime sleepiness," Killgore said.
Blue light from computers, smartphones and TV screens often gives blue light a bad rap. But according to Killgore, "when it comes to light, timing is critical. Light is not necessarily good or bad in-and-of-itself. Like caffeine, it all comes down to when you use it. It can be terrible for your sleep if you're consuming coffee at 10 o'clock at night, but it may be great for your alertness if you have it in the morning."
He and his team plan to continue their research to see if blue light improves sleep quality and how light therapy might affect emotional and psychiatric disorders. Killgore believes that most people, whether injured or healthy, could benefit from correctly timed morning blue light exposure, a theory he hopes to prove for certain in future studies.
https://www.sciencedaily.com/releases/2020/01/200115164017.htm
Potential new treatment for preventing post traumatic stress disorder
Discovery of biomarker unique to people with PTSD a world first
January 13, 2020
Science Daily/Centre for Addiction and Mental Health
Scientists have discovered the first biomarker unique to PTSD patients and they have created a peptide shown in a preclinical trial to treat and even prevent PTSD.
Research led by the Centre for Addiction and Mental Health (CAMH) published in the Journal of Clinical Investigation points to a groundbreaking discovery about a new potential treatment and prevention for post-traumatic stress disorder (PTSD).
The research team, led by Dr. Fang Liu, Senior Scientist and Head of Molecular Neuroscience in CAMH's Campbell Family Mental Health Research Institute, and Professor and Co-director of Division of Neuroscience and Clinical Translation, Department of Psychiatry at the University of Toronto, recently identified a protein complex that is elevated in PTSD patients. The researchers also developed a peptide to target and disrupt the protein complex. They found that the peptide prevented recall or encoding of fear memories in early tests. This suggests that the peptide could treat PTSD symptoms or prevent them entirely.
"The discovery of the Glucocorticoid Receptor-FKBP51 protein complex provides a new understanding of molecular mechanisms underlying PTSD," said Dr. Liu. "We believe this protein complex normally increases after severe stress, but in most cases, levels soon go back to baseline levels. However, in those who develop PTSD, the protein complex remains persistently elevated, and so this could be a blood-based biomarker for PTSD as well as being a target for pharmacological treatment. In addition, the peptide we developed could be given after a traumatic event, and could possibly prevent the patient from developing PTSD. This is a completely new approach to PTSD and for psychiatric disorders in general."
PTSD occurs in some people after experiencing or witnessing traumatic events, such as sexual assault or military combat. Patients can suffer from debilitating flashbacks, nightmares and anxiety which can severely impact quality of life. There are currently no laboratory diagnostic tests for PTSD, and existing treatments have limited efficacy. According to a recent study published in the British Journal of Psychiatry, Canada has the highest prevalence of PTSD among 24 examined countries, and 9.2 per cent of Canadians will develop PTSD in their lifetimes.
"We are thrilled this CAMH-led discovery can potentially help millions of people put trauma behind them," added Dr. Liu.
The study has been supported by CIHR and the CAMH Discovery Fund. CAMH has filed a patent for the peptide and diagnostic aspect of Dr. Liu's invention. Dr. Liu and her team will conduct further testing and refining of the peptide before conducting human clinical trials.
https://www.sciencedaily.com/releases/2020/01/200113165057.htm
Losing a night of sleep may increase blood levels of Alzheimer's biomarker
January 8, 2020
Science Daily/Uppsala University
A preliminary study by researchers at Uppsala University has found that when young, healthy men were deprived of just one night of sleep, they had higher levels of tau -- a biomarker for Alzheimer's disease -- in their blood than when they had a full, uninterrupted night of rest. The study is published in the medical journal Neurology.
Tau is a protein found in neurons and the protein can form into tangles. These accumulate in the brains of people with Alzheimer's disease. This accumulation can start decades before symptoms of the disease appear. Previous studies of older adults have suggested that sleep deprivation can increase the level of tau in the cerebral spinal fluid. Trauma to the head can also increase circulating concentrations of tau in blood.
"Many of us experience sleep deprivation at some point in our lives due to jet lag, pulling an all-nighter to complete a project, or because of shift work, working overnights or inconsistent hours," said study author Jonathan Cedernaes, MD, PhD, from Uppsala University in Sweden. "Our exploratory study shows that even in young, healthy individuals, missing one night of sleep results in a slight increase in the level of tau in blood. This suggests that over time, similar types of sleep disruption could potentially have detrimental effects."
The study involved 15 healthy, normal-weight men with an average age of 22. They all reported regularly getting seven to nine hours of quality sleep per night.
There were two phases to the study. For each phase, the men were observed under a strict meal and activity schedule in a sleep clinic for two days and nights. Blood samples were taken in the evening and again in the morning. For one phase, participants were allowed to get a good night of sleep both nights. For the other phase, participants were allowed to get a good night of sleep the first night followed by a second night of sleep deprivation. During sleep deprivation, lights were kept on while participants sat up in bed playing games, watching movies or talking.
Researchers found that the men had an average 17-percent increase in tau levels in their blood after a night of sleep deprivation compared to an average 2-percent increase in tau levels after a good night of sleep.
Researchers also looked at four other biomarkers associated with Alzheimer's but there were no changes in levels between a good night of sleep and one night of no sleep.
"It's important to note that while accumulation of tau in the brain is not good, in the context of sleep loss, we do not know what higher levels of tau in blood represent" said Cedernaes. "When neurons are active, release of tau in the brain is increased. Higher levels in the blood may reflect that these tau proteins are being cleared from the brain or they may reflect an overall elevation of the concentration of tau levels in the brain. Future studies are needed to investigate this further, as well as to determine how long these changes in tau last, and to determine whether changes in tau in blood reflects a mechanism by which recurrent exposure to restricted, disrupted or irregular sleep may increase the risk of dementia. Such studies could provide key insight into whether interventions targeting sleep should begin at an early age to reduce a person's risk of developing dementia or Alzheimer's disease."
The main limitation of the study was its small size. In addition, it looked only at healthy young men, so the results may not be the same for women or older people.
https://www.sciencedaily.com/releases/2020/01/200108160342.htm
Study of veterans details genetic basis for anxiety, links anxiety and depression
January 7, 2020
Science Daily/Yale University
A massive genomewide analysis of approximately 200,000 military veterans has identified six genetic variants linked to anxiety, researchers from Yale and colleagues at other institutions report Jan. 7 in the American Journal of Psychiatry.
Some of the variants associated with anxiety had previously been implicated as risk factors for bipolar disorder, posttraumatic stress disorder, and schizophrenia.
The new study further contributes the first convincing molecular explanation for why anxiety and depression often coexist.
"This is the richest set of results for the genetic basis of anxiety to date," said co-lead author Joel Gelernter, the Foundations Fund Professor of Psychiatry, professor of genetics and of neuroscience at Yale. "There has been no explanation for the comorbidity of anxiety and depression and other mental health disorders, but here we have found specific, shared genetic risks."
Finding the genetic underpinnings of mental health disorders is the primary goal of the Million Veteran Program, a compilation of health and genetic data on U.S. military veterans run by the U.S. Veterans Administration. The research team analyzed the program's data and zeroed in on six variants linked to anxiety. Five were found in European Americans and one found only in African Americans.
"While there have been many studies on the genetic basis of depression, far fewer have looked for variants linked to anxiety, disorders of which afflict as many as 1 in 10 Americans," said senior author Murray Stein, San Diego VA staff psychiatrist and Distinguished Professor of Psychiatry and of family medicine and public health at UCSD.
Some variants were linked to genes that help govern gene activity or, intriguingly, to a gene involved in the functioning of receptors for the sex hormone estrogen. While this finding might help explain why women are more than twice as likely as men to suffer from anxiety disorders, researchers stressed that the variant affecting estrogen receptors was identified in a veteran cohort made up mostly of men, and said further investigation is necessary.
Another of the newly discovered anxiety gene variants, MAD1L1, whose function is not fully understood, was also highly notable. Variants of this gene have already been linked to bipolar disorder, posttraumatic stress disorder, and schizophrenia.
"One of the goals of this research is to find important risk genes that are associated with risk for many psychiatric and behavioral traits for which we don't have a good explanation," said Yale's Daniel Levey, a postdoctoral associate and co-lead author of the study.
To do the study, Yale's researchers teamed up with colleagues at the Veteran Affairs Connecticut Healthcare System, VA San Diego Healthcare System, and the University of California San Diego.
Said Gelernter, "This is a rich vein we have just begun to tap."
https://www.sciencedaily.com/releases/2020/01/200107081248.htm
Health ranks as top concern for veterans immediately after military service
Findings based on survey of nearly 10,000 veterans
January 2, 2020
Science Daily/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