Children with TBI have poorer sleep quality, more daytime sleepiness

June 8, 2015

American Academy of Sleep Medicine

Children with traumatic brain injuries have poorer sleep and more daytime sleepiness in comparison to healthy children, new research confirms. The children with TBI also had impaired emotional, physical and social functioning when compared to healthy children.

Results show that children with TBI were more likely to experience greater daytime sleepiness, sleep disturbances and a poorer overall sleep quality. The children with TBI also had impaired emotional, physical and social functioning when compared to healthy children.

"We were surprised that children with a TBI experienced persistent increases in daytime sleepiness and decreases in sleep quality compared to healthy children," said principal investigator Kimberly Allen, PhD, RN, assistant professor, Center for Narcolepsy, Sleep and Health Research, Department of Women Children and Family Health Science, at the University of Illinois-Chicago.

The research abstract was published recently in an online supplement of the journal Sleep and will be presented June 8, in Seattle, Washington, at SLEEP 2015, the 29th annual meeting of the Associated Professional Sleep Societies LLC.

The study group comprised 15 children with TBI and 15 healthy children, matched on age, race and maternal education level. Parents of children with TBI and parents of health children completed three surveys related to their child's sleep behaviors and sleep quality: Children's Sleep Habits Questionnaire (CSHQ), Child Sleep Wake Scale (CSWS), and th

http://www.sciencedaily.com/releases/2015/06/150608144143.htm

Poor sleep quality linked to reduced resilience among veterans

June 8, 2015

Science Daily/American Academy of Sleep Medicine

Poor sleep quality is associated with reduced resilience among veterans and returning military personnel, a new study suggests. Findings suggest that appraisal of sleep quality may contribute to resilience scores more than self-reported sleep efficiency.

Results show that 63 percent of participants endorsed poor sleep quality, which was negatively associated with resilience. Longer sleep onset, lower sleep efficiency, shorter sleep duration, worse sleep quality, and greater daytime disturbance were each associated with lower resilience. Findings suggest that appraisal of sleep quality may contribute to resilience scores more than self-reported sleep efficiency.

'To our knowledge, this study is the first to examine the relationship between resilience, defined here as positive stress-coping ability, and self-reported sleep quality among veterans and active duty service-members of the Iraq and Afghanistan conflicts,' said lead author Jaime M. Hughes, MPH, MSW, research affiliate at Durham VA Medical Center and doctoral student at the University of North Carolina-Chapel Hill.

The research abstract was published recently in an online supplement of the journal Sleep and will be presented June 8 in Seattle, Wash., at SLEEP 2015, the 29th annual meeting of the Associated Professional Sleep Societies LLC.

The study group comprised 2,597 Iraq and Afghanistan military veterans. Eighty percent were male with a mean age of 37 years. An in-person assessment captured resilience (Connor-Davidson Resilience Scale), Post-Traumatic Stress Disorder (Davidson Trauma Scale), sleep quality (Pittsburgh Sleep Quality Index), and combat exposure (Combat Exposure Scale).

'These results support the need for additional research to better understand resilience as it relates sleep behaviors and sleep quality. Such findings may contribute to a better understanding of how chronic sleep disturbance impacts an individual's adaptive and functional capacities upon reintegration, and can help to inform the development of novel sleep interventions,' said Hughes.

http://www.sciencedaily.com/releases/2015/06/150608213115.htm

High risk of sleep apnea in young veterans with PTSD

May 19, 2015

Science Daily/American Academy of Sleep Medicine

The probability of having a high risk of obstructive sleep apnea increased with increasing severity of post-traumatic stress disorder symptoms (PTSD), a new study of young US veterans shows. The study involved 195 Iraq and Afghanistan veterans who visited a Veterans' Affairs outpatient PTSD clinic for evaluation. Results show that 69.2 percent of participants had a high risk for sleep apnea, and this risk increased with PTSD symptom severity.

The study involved 195 Iraq and Afghanistan veterans who visited a VA outpatient PTSD clinic for evaluation. Results show that 69.2 percent of participants had a high risk for sleep apnea, and this risk increased with PTSD symptom severity. Every clinically significant increase in PTSD symptom severity was associated with a 40 percent increase in the probability of screening as high risk for sleep apnea.

"The implication is that veterans who come to PTSD treatment, even younger veterans, should be screened for obstructive sleep apnea so that they have the opportunity to be diagnosed and treated," said co-principal investigator Sonya Norman, PhD, researcher at the San Diego VA, director of the PTSD Consultation Program at the National Center for PTSD, and an associate professor of psychiatry at the University of California San Diego School of Medicine. "This is critical information because sleep apnea is a risk factor for a long list of health problems such as hypertension, cardiovascular disease and diabetes, and psychological problems including depression, worsening PTSD and anxiety."

The American Academy of Sleep Medicine reports that obstructive sleep apnea is a common sleep disease afflicting at least 25 million adults in the U.S. Sleep apnea warning signs include snoring and choking, gasping or silent breathing pauses during sleep. The AASM and other partners in the National Healthy Sleep Awareness Project, which is funded by the Centers for Disease Control and Prevention, urge anyone with symptoms of sleep apnea to visit http://www.stopsnoringpledge.org to pledge to "Stop the Snore" by talking to a doctor.

The study idea was initiated by Tonya Masino, MD, who was the first to recognize that a surprising number of younger veterans who were coming to the clinic for PTSD treatment also were presenting with sleep apnea symptoms. Study results are published in the May 15 issue of the Journal of Clinical Sleep Medicine.

Ninety-three percent of study participants were men, and their mean age was 33 years. Sleep apnea risk was evaluated using the Berlin Questionnaire, and PTSD was assessed using the PTSD Checklist Stressor Specific Version (PCL-S) questionnaire. Analyses controlled for potential confounders such as older age, smoking status, and use of central nervous system depressants.

According to the authors, younger veterans with PTSD are rarely screened for sleep apnea and frequently remain undiagnosed. They noted that the mechanism underlying the relationship between sleep apnea and PTSD in military veterans is unclear. However, potential factors that may connect the two disorders include disturbed sleep in combat, prolonged sleep deprivation, sleep fragmentation and hyperarousal due to the physical and psychological stressors of combat, the chronic stress from PTSD, or the sleep disturbances caused by OSA. Longitudinal studies are needed to examine the temporal relationship between sleep apnea and PTSD.

The study was led by Norman and co-principal investigator Abigail Angkaw, PhD. The lead author of the study is Peter Colvonen, PhD.

According to the National Center for PTSD of the U.S. Department of Veterans Affairs, PTSD symptoms such as nightmares or flashbacks usually start soon after a traumatic event, but they may not appear until months or years later. Symptoms that last longer than four weeks, cause great distress or interfere with daily life may be a sign of PTSD. To get help for PTSD, veterans can call the Veterans Crisis Line at 1-800-273-8255 and press 1, text 838255, contact a local VA Medical Center, or use the online PTSD program locator on the VA website.

http://www.sciencedaily.com/releases/2015/05/150519182243.htm

Depression intensifies anger in veterans with PTSD

May 13, 2015

Science Daily/American Psychological Association (APA)

The tendency for veterans with post-traumatic stress disorder to lash out in anger can be significantly amplified if they are also depressed, according to new research.

"Our study findings should draw attention to anger as a major treatment need when military service members screen positive for PTSD or for depression, and especially when they screen positive for both," said lead author Raymond Novaco, PhD, professor of psychology and social behavior at the University of California, Irvine. The study appeared in the journal Psychological Trauma: Theory Research, Practice and Policy.

The researchers studied the behavioral health data of 2,077 U.S. soldiers (1,823 men and 254 women) who were deployed to Iraq and Afghanistan and subsequently sought behavioral health services at a large military installation. They screened the participants for PTSD and major depressive disorder, placing them in one of four groups: PTSD-only, MDD-only, PTSD and MDD combined or neither. They also measured the veterans' anger and whether they said they were considering harming others.

Anger and self-rated risk of harm were both significantly higher in the group with both PTSD and MDD compared to the other three groups. The researchers also found that PTSD was commonly paired with depression. Approximately 72 percent of those who screened positive for PTSD also screened positive for MDD.

One reason the authors chose to conduct this research is that anger has been given insufficient attention as a clinical problem among combat veterans and trauma populations in general, said Novaco. "PTSD and depression dominate the landscape, but these, of course, are formal psychiatric disorders," he said. "There is no diagnostic category for anger, nor do I think there should be, so anger slips from research attention."

Previous studies conducted with both military members and civilians who have experienced trauma have shown anger in the context of PTSD to be far more than a symptom; it can predict PTSD severity but also interfere with PTSD treatment. A 2010 study of more than 18,000 soldiers returning from Iraq found approximately 40 percent had physical bursts of anger, more than 30 percent threatened someone with physical violence and over 15 percent got into a physical fight.

"Anger is a driver of violent behavior but it is responsive to anger-focused psychological treatment," said Novaco, adding that this is one reason why soldiers presenting with PTSD, depression or, most important, both should receive treatment focusing on anger. He noted that numerous studies have been published on the effectiveness of cognitive behavior therapy for anger treatment, including anger treatment done with combat veterans.

http://www.sciencedaily.com/releases/2015/05/150513111859.htm

Self-harm, suicide ideation tightly linked in Iraq, Afghanistan veterans

May 8, 2015

Science Daily/Veterans Affairs Research Communications

Non-suicidal self-injury -- that is, purposefully hurting oneself without conscious suicidal intent -- is relatively common among Iraq and Afghanistan veterans, and it is a strong risk factor for suicidal behavior, according to research.

http://images.sciencedaily.com/2015/05/150508091602_1_540x360.jpg

Moreover, the study found that those who deliberately hurt themselves were more likely to engage in suicidal behavior. The researchers hope that NSSI could serve as a marker for identifying which veterans are most likely to attempt suicide.

For the study, Kimbrel and his colleagues recruited Iraq and Afghanistan veterans at the Central Texas VA Health Care System. The researchers excluded those with schizophrenia or bipolar disorder, but they included a higher-than-average proportion of veterans with PTSD. In the final study group, 35 percent had PTSD, 21 percent had depression, and 8 percent had alcohol use disorder. More than 90 percent of group was male and 67 percent were white.

After identifying suicidal ideation via a standardized screening questionnaire, the researchers further classified the participants as having either passive or active suicidal ideation.

Passive suicidal ideation could be described, says Kimbrel, as wishing you would go to sleep and not wake up. Active suicidal ideation is characterized by actually thinking about specific ways to end one's life.

Kimbrel found that NSSI was most strongly associated with active suicidal ideation. Specifically, Iraq and Afghanistan veterans who reported a history of NSSI were five times more likely to engage in active suicidal ideation, compared with veterans without a history of NSSI.

"These are people who are purposefully engaging in bodily harm, but the intent is not to commit suicide," says Kimbrel. "There are many reasons why they do this, but this behavior is associated with increased odds of eventually attempting suicide."

Kimbrel points to cutting oneself as the most commonly thought-of form of NSSI. "But there are a wide range of non-suicidal self-injurious behaviors that Veterans might be engaging in that clinicians should be aware of, such as burning or hitting oneself," notes Kimbrel.

Another recent study by Kimbrel's team that was published in the Journal of Traumatic Stress in 2014 found that more than half of 214 male Iraq and Afghanistan veterans seeking treatment for PTSD reported engaging in NSSI during their lifetime. Forty-five percent reported NSSI during the previous two weeks.

Those same veterans were nearly four times more likely to engage in suicidal ideation, compared with veterans seeking treatment for PTSD but without a history of NSSI.

"Among veterans, burning and hitting appear to be the specific forms of NSSI most strongly associated with suicidal ideation," says Kimbrel. Veterans who reported burning themselves were 17 times more likely to engage in suicidal ideation, compared with similar veterans who did not report NSSI. Veterans who reported hitting themselves were nearly eight times more likely to have suicidal ideation.

"Obviously, the rates of suicidal ideation that we identified among veterans engaging in these forms of NSSI were much higher than what we typically see among patients seeking treatment for PTSD," says Kimbrel.

According to Kimbrel, NSSI may increase a person's capacity to commit suicide. This ties in with a theory originally described by Florida State University's Dr. Thomas Joiner in his 2005 book Why People Die By Suicide. The theory is that suicide essentially requires two components to align, a desire and a capacity.

According to Kimbrel, NSSI, along with the kind of violence often encountered in combat, can increase people's capability for suicide by mitigating some of their natural, innate responses to injury.

Kimbrel's hope is that by expanding suicidal assessments of veterans to include NSSI information, providers can better identify those at high risk for suicide long before they ever make an attempt.

"If we can identify veterans engaging in NSSI early on, then hopefully we can begin to change their trajectory and put them onto a more positive course," says Kimbrel. "There are treatments that can help. The most important thing is to get veterans at increased risk for suicide into treatment as soon as possible."

http://www.sciencedaily.com/releases/2015/05/150508091602.htm

Post-traumatic stress disorder linked to accelerated aging

May 8, 2015

Science Daily/University of California, San Diego Health Sciences

People with PTSD may also be at risk for accelerated aging or premature senescence, research suggests. The researchers noted that there has not been another study that links PTSD, a psychological disorder with no established genetic basis, to a basic biological process such as aging.

Writing in the May 7 online issue of American Journal of Geriatric Psychiatry, researchers at University of California, San Diego School of Medicine and Veterans Affairs San Diego Healthcare System suggest that people with PTSD may also be at risk for accelerated aging or premature senescence.

"This is the first study of its type to link PTSD, a psychological disorder with no established genetic basis, which is caused by external, traumatic stress, with long-term, systemic effects on a basic biological process such as aging," said Dilip V. Jeste, MD, Distinguished Professor of Psychiatry and Neurosciences and director of the Center on Healthy Aging and Senior Care at UC San Diego, who is the senior author of this study.

Researchers had previously noted a potential association between psychiatric conditions, such as schizophrenia and bipolar disorder, and acceleration of the aging process. Jeste and colleagues determined to see if PTSD might show a similar association by conducting a comprehensive review of published empirical studies relevant to early aging in PTSD, covering multiple databases going back to 2000.

There is no standardized definition of what constitutes premature or accelerated senescence. For guidance, the researchers looked at early aging phenomena associated with non-psychiatric conditions, such as Hutchinson-Gilford progeria syndrome, HIV infection and Down's syndrome. The majority of evidence fell into three categories: biological indicators or biomarkers, such as leukocyte telomere length (LTL), earlier occurrence or higher prevalence of medical conditions associated with advanced age and premature mortality.

In their literature review, the UC San Diego team identified 64 relevant studies; 22 were suitable for calculating overall effect sizes for biomarkers, 10 for mortality.

All six studies looking specifically at LTL found reduced telomere length in persons with PTSD. Leukocytes are white blood cells. Telomeres are stretches of protective, repetitive nucleotide sequences at the ends of chromosomes. These sequences shorten with every cell replication and are considered a strong measure of the aging process in cells.

The scientists also found consistent evidence of increased pro-inflammatory markers, such as C-reactive protein and tumor necrosis factor alpha, associated with PTSD.

A majority of reviewed studies found increased medical comorbidity of PTSD with several targeted conditions associated with normal aging, including cardiovascular disease, type 2 diabetes, gastrointestinal ulcer disease and dementia.

Seven of 10 studies indicated a mild-to-moderate association of PTSD with earlier mortality, consistent with an early onset or acceleration of aging in PTSD.

"These findings do not speak to whether accelerated aging is specific to PTSD, but they do argue the need to re-conceptualize PTSD as something more than a mental illness," said first author James B. Lohr, MD, professor of psychiatry. "Early senescence, increased medical morbidity and premature mortality in PTSD have implications in health care beyond simply treating PTSD symptoms. Our findings warrant a deeper look at this phenomenon and a more integrated medical-psychiatric approach to their care."

Barton Palmer, PhD, professor of psychiatry and a coauthor of the study, cautioned that "prospective longitudinal studies are needed to directly demonstrate accelerated aging in PTSD and to establish underlying mechanisms."

http://www.sciencedaily.com/releases/2015/05/150508082346.htm

Sleep problems prevalent for military members

April 7, 2015

RAND Corporation

Improving the quality and quantity of US military members' sleep following deployment could help reduce other health problems, including depression and post-traumatic stress disorder, according to a new study.

However, a lack of consistent and transparent sleep-related policies may impede efforts to promote sleep health among service members, researchers say.

"The U.S. military has shifted from combat operations in Iraq and Afghanistan toward helping service members and veterans reintegrate into noncombat roles," said Wendy Troxel, co-leader of the study and a behavioral scientist at RAND, a nonprofit research organization. "One issue that is often overlooked once military men and women return home is that of persistent sleep problems, because in many ways such problems are viewed as endemic to military culture."

Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems. Sleep problems often follow a chronic course, persisting long after service members return home from combat, with consequences for their reintegration and the readiness and resiliency of the force, researchers say.

The RAND report is the first comprehensive review of sleep-related policies and programs across the U.S. Department of Defense, examining the frequency of sleep disorders and factors that contribute to the problem. A survey of nearly 2,000 service members from all branches of the U.S. military found sleep problems had negative effects on mental health, daytime functioning and perceived operational readiness.

"Military policies on prevention of sleep problems are lacking, and medical policies focus on treating mental disorders that are often linked with sleep problems, instead of sleep itself," said Regina Shih, project co-leader and a senior social scientist at RAND. "We know that sleep problems may precede the onset of mental disorders."

While there may be stigma about seeking sleep treatment, it may be lower than the stigma associated with seeking help for mental health problems. Researchers say this suggests sleep could be a gateway to improving psychological health and readiness in service members.

Researchers say that historically, military cultural attitudes have tended to discount the importance of sleep. For example, service members noted that depriving oneself of sleep is often seen as a badge of honor and acknowledging the need for sleep can be seen as a sign of weakness.

The study recommends widespread education and awareness programs within the Defense Department as one means of shifting these cultural attitudes. In operational contexts, the military emphasizes mission first and the need for sleep may be sacrificed for operational demands. Policies are needed to educate service members and leaders about the importance of sleep, including awareness on the importance of sleep for resilience.

Leaders are not always sure how to develop and execute sleep plans that can balance circadian rhythms with the realities of operational environments, or how to allow for adequate recovery periods after extended sleep deprivation in order to optimize force readiness.

The RAND study presents 16 policy recommendations to help the military improve the prevention, identification and treatment of sleep problems in service members. Those policies fall under four broad categories: prevention of sleep problems; increasing identification and diagnosis of sleep problems; ways to clinically manage sleep disorders and promote sleep health; and ways to improve sleep in training and operational contexts.

http://www.sciencedaily.com/releases/2015/04/150407095639.htm

Can light therapy help the brain?

April 2, 2015

Veterans Affairs Research Communications

An innovative therapy that applies red and near-infrared light to the brain is now being tested for Gulf War Illness, traumatic brain injury, and PTSD.

Following up on promising results from pilot work, researchers at the VA Boston Healthcare System are testing the effects of light therapy on brain function in veterans with Gulf War Illness.

Veterans in the study wear a helmet lined with light-emitting diodes that apply red and near-infrared light to the scalp. They also have diodes placed in their nostrils, to deliver photons to the deeper parts of the brain.

The light is painless and generates no heat. A treatment takes about 30 minutes.

The therapy, though still considered "investigational" and not covered by most health insurance plans, is already used by some alternative medicine practitioners to treat wounds and pain. The light from the diodes has been shown to boost the output of nitric oxide near where the LEDs are placed, which improves blood flow in that location.

"We are applying a technology that's been around for a while," says lead investigator Dr. Margaret Naeser, "but it's always been used on the body, for wound healing and to treat muscle aches and pains, and joint problems. We're starting to use it on the brain."

Naeser is a research linguist and speech pathologist for the Boston VA, and a research professor of neurology at Boston University School of Medicine (BUSM). She is also a licensed acupuncturist and has conducted past research on laser acupuncture to treat paralysis in stroke, and pain in carpal tunnel syndrome.

The LED therapy increases blood flow in the brain, as shown on MRI scans. It also appears to have an effect on damaged brain cells, specifically on their mitochondria. These are bean-shaped subunits within the cell that put out energy in the form of a chemical known as ATP. The red and near-infrared light photons penetrate through the skull and into brain cells and spur the mitochondria to produce more ATP. That can mean clearer, sharper thinking, says Naeser.

Naeser says brain damage caused by explosions, or exposure to pesticides or other neurotoxins--such as in the Gulf War--could impair the mitochondria in cells. She believes light therapy can be a valuable adjunct to standard cognitive rehabilitation, which typically involves "exercising" the brain in various ways to take advantage of brain plasticity and forge new neural networks.

"The light-emitting diodes add something beyond what's currently available with cognitive rehabilitation therapy," says Naeser. "That's a very important therapy, but patients can go only so far with it. And in fact, most of the traumatic brain injury and PTSD cases that we've helped so far with LEDs on the head have been through cognitive rehabilitation therapy. These people still showed additional progress after the LED treatments. It's likely a combination of both methods would produce the best results."

The LED approach has its skeptics, but Naeser's group has already published some encouraging results in the peer-reviewed scientific literature.

Last June in the Journal of Neurotrauma, they reported the outcomes of LED therapy in 11 patients with chronic TBI, ranging in age from 26 to 62. Most of the injuries occurred in car accidents or on the athletic field. One was a battlefield injury, from an improvised explosive device (IED).

Neuropsychological testing before the therapy and at several points thereafter showed gains in areas such as executive function, verbal learning, and memory. The study volunteers also reported better sleep and fewer PTSD symptoms.

The study authors concluded that the pilot results warranted a randomized, placebo-controlled trial--the gold standard in medical research.

That's happening now, thanks to VA support. One trial, already underway, aims to enroll 160 Gulf War veterans. Half the veterans will get the real LED therapy for 15 sessions, while the others will get a mock version, using sham lights.

Then the groups will switch, so all the volunteers will end up getting the real therapy, although they won't know at which point they received it. After each veteran's last real or sham treatment, he or she will undergo tests of brain function.

Naeser points out that "because this is a blinded, controlled study, neither the participant nor the assistant applying the LED helmet and the intranasal diodes is aware whether the LEDs are real or sham. So they both wear goggles that block out the red LED light." The near-infrared light is invisible to begin with.

Besides the Gulf War study, other trials of the LED therapy are getting underway:

·      Later this year, a trial will launch for veterans age 18 to 55 who have both traumatic brain injury (TBI) and posttraumatic stress disorder--a common combination in recent war veterans. The VA-funded study will be led by Naeser's colleague Dr. Jeffrey Knight, a psychologist with VA's National Center for PTSD and an assistant professor of psychiatry at BUSM.

·      Dr. Yelena Bogdanova, a clinical psychologist with VA and assistant professor of psychiatry at BUSM, will lead a VA-funded trial looking at the impact of LED therapy on sleep and cognition in veterans with blast TBI.

·      Naeser is collaborating on an Army study testing LED therapy, delivered via the helmets and the nose diodes, for active-duty soldiers with blast TBI. The study, funded by the Army's Advanced Medical Technology Initiative, will also test the feasibility and effectiveness of using only the nasal LED devices--and not the helmets--as an at-home, self-administered treatment. The study leader is Dr. Carole Palumbo, an investigator with VA and the Army Research Institute of Environmental Medicine, and an associate professor of neurology at BUSM.

Naeser hopes the work will validate LED therapy as a viable treatment for veterans and others with brain difficulties. She foresees potential not only for war injuries but for conditions such as depression, stroke, dementia, and even autism.

"There are going to be many applications, I think. We're just in the beginning stages right now."

http://www.sciencedaily.com/releases/2015/04/150402161648.htm

Antioxidant therapy may have promising potential in concussion treatment

April 1, 2015

Federation of American Societies for Experimental Biology (FASEB)

Antioxidants may play a key role in reducing the long-term effects of concussions and could potentially offer a unique new approach for treatment, a new study suggests. Common among athletes and soldiers, it is estimated that 3.4 million concussions occur each year in the United States. The development of a readily available oral supplement would have the potential to improve brain function in a percentage of concussion sufferers.

Common among athletes and soldiers, it is estimated that 3.4 million concussions occur each year in the United States. The development of a readily available oral supplement would have the potential to improve brain function in a percentage of concussion sufferers.

The study adds to recent findings that concussions can lead to chronic traumatic encephalopathy. Head injuries often lead to chronic traumatic encephalopathy, a disease associated with long-term brain damage and behavioral symptoms including memory loss, impulsive behavior, depression and aggression. The number of retired athletes and veterans diagnosed with chronic traumatic encephalopathy has climbed in recent years.

"Concussions can contribute to long-term changes within the brain and these changes are the result of cell death, which may be caused by oxidative stress," said Brandon Lucke-Wold, a M.D./Ph.D. student at West Virginia University's Medical School who conducted the research. "This study shows that antioxidants such as lipoic acid can reduce the long-term deficits when given after a concussion."

In Lucke-Wold's research, rats were divided into three groups: a non-concussed control group, a group that experienced concussive injury and another concussed group that received lipoic acid supplementation. Seven days after the concussion, the rats were tested for seemingly impulsive behavior through an elevated maze. The rats exposed to concussion without lipoic acid had increased impulsive behavior, and spent more time exploring open spaces indicative of risk taking behavior.

"This increase in impulsive behavior was an indication of underlying brain damage," said Lucke-Wold, who will present the research at the American Society for Pharmacology and Experimental Therapeutics (ASPET) Annual Meeting during Experimental Biology 2015.

Analysis of brains of the group receiving supplementation showed markedly decreased impulsive behavior. "These findings make sense because lipoic acid works to help reduce toxic free radicals that can damage cells," said Lucke-Wold.

"By understanding the mechanisms behind brain injury following concussion, we can more effectively target treatment interventions to reduce these damaging effects," he added.

http://www.sciencedaily.com/releases/2015/04/150401132752.htm

Study adds evidence on link between PTSD, heart disease

March 26, 2015

Veterans Affairs Research Communications

In a study of more than 8,000 veterans in Hawaii and the Pacific Islands, those with posttraumatic stress disorder had a nearly 50 percent greater risk of developing heart failure. The study adds to a growing body of evidence linking PTSD and heart disease. The research to date--including these latest findings--doesn't show a clear cause-and-effect relationship. But most experts believe PTSD, like other forms of chronic stress or anxiety, can damage the heart over time.

The study adds to a growing body of evidence linking PTSD and heart disease. The research to date--including these latest findings--doesn't show a clear cause-and-effect relationship. But most experts believe PTSD, like other forms of chronic stress or anxiety, can damage the heart over time.

"There are many theories as to how exactly PTSD contributes to heart disease," says Dr. Alyssa Mansfield, one of the study authors. "Overall, the evidence to date seems to point in the direction of a causal relationship."

Mansfield was senior author on the study while with the Pacific Islands Division of the National Center for PTSD of the Department of Veterans Affairs (VA). She is now with the VA Pacific Islands Health Care System and also an assistant adjunct professor of epidemiology at the University of Hawaii.

The study tracked 8,248 veterans who had been outpatients in the VA Pacific Islands system. The researchers followed them an average of just over seven years. Those with a PTSD diagnosis were 47 percent more likely to develop heart failure during the follow-up period. The researchers controlled for differences between the groups in health and demographic factors.

Out of the total study group, about 21 percent were diagnosed with PTSD. Of the total 371 cases of heart failure during the study, 287 occurred among those with PTSD, whereas only 84 cases occurred among the group without PTSD.

Combat service, whether or not it led to a full-blown PTSD diagnosis, was itself a strong predictor of heart failure. Those Veterans with combat experience were about five times more likely to develop heart failure during the study period, compared with those who had not seen combat. Other predictors of heart failure were advanced age, diabetes, high blood pressure, and overweight or obesity.

The authors of the study say they didn't have access to a full range of data that would have provided further clues as to the PTSD-heart disease link. For example, they were not able to distinguish in the data between those who had served in the Gulf during 1990 and 1991, and those who served more recently in Iraq or Afghanistan. Nor were they able to analyze whether racial or ethnic identity plays a role one way or the other, as that information was not complete for most veterans in study.

Nonetheless, the authors point out that the work is the "first large-scale longitudinal study to report an association between PTSD and incident heart failure in an outpatient sample of U.S. veterans."

Heart failure, in which the heart grows weaker and can't pump enough blood to adequately supply the body's needs, affects about 5 million Americans in all, with some 500,000 new cases each year. People with the condition feel tired with physical activity, as the muscles aren't getting enough blood.

The new results, says Mansfield, provide further potent evidence of the nexus between mental and physical health. The practical upshot of the findings, she says, is that veterans with PTSD should realize that by treating their PTSD, they may also be helping to prevent heart disease down the road.

By the same token, the authors point out that VA and other health care systems may need to step up efforts to prevent and treat heart failure among those with PTSD.

http://www.sciencedaily.com/releases/2015/03/150326130958.htm

Head injury patients show signs of faster aging in the brain

March 25, 2015

Imperial College London

People who have suffered serious head injuries show changes in brain structure resembling those seen in older people, according to a new study. The brain injury patients in this study were estimated to be around five years older on average than their real age.

Researchers at Imperial College London analysed brain scans from over 1,500 healthy people to develop a computer program that could predict a person's age from their brain scan. Then they used the program to estimate the "brain age" of 113 more healthy people and 99 patients who had suffered traumatic brain injuries.

The brain injury patients were estimated to be around five years older on average than their real age.

Head injuries are already known to increase the risk of age-related neurological conditions such as dementia later in life. The age prediction model may be useful as a screening tool to identify patients who are likely to develop problems and to target strategies that prevent or slow their decline.

"Your chronological age is not necessarily the best indicator of your health or how much longer you will live," said Dr James Cole, who led the study, from the Department of Medicine at Imperial College London. "There is a lot of interest in finding biomarkers of aging that can be used to measure a certain aspect of your health and predict future problems."

The study, published in the April issue of Annals of Neurology, used magnetic resonance imaging (MRI) to study changes in brain structure. The researchers used a machine learning algorithm to develop a computer program that could recognise age-related differences in the volume of white matter and grey matter in different parts of the brain.

The model was then used to estimate subjects' ages based on their brain scans. The study included 99 patients with traumatic brain injuries (TBI) caused by road accidents, falls or assaults, who had persistent neurological problems. The scans were taken between one month and 46 years after their injuries.

In healthy controls, the average difference between predicted age and real age was zero. In TBI patients, the difference was significantly higher, with a bigger discrepancy in patients with more severe injuries. Bigger differences in predicted age were associated with cognitive impairments such as poor memory and slow reaction times.

There was also a correlation between time since injury and predicted age difference, suggesting that these changes in brain structure do not occur during the injury itself, but result from ongoing biological processes, potentially similar to those seen in normal aging, that progress more quickly after an injury.

"Traumatic brain injury is not a static event," said Dr Cole. "It can set off secondary processes, possibly related to inflammation, that can cause more damage in the brain for years afterwards, and may contribute to the development of Alzheimer's or other forms of dementia."

The researchers believe the age prediction model could be applied not just to TBI patients, but might also be useful to screen outwardly healthy people.

"We want to do a study where we use the program to estimate brain age in healthy people, then see if the ones with 'old brains' are more likely to get neurodegenerative diseases. If it works, we could use it to identify people at high risk, enrol them in trials and potentially prescribe treatments that might stave off disease," said Dr Cole.

http://www.sciencedaily.com/releases/2015/03/150325082347.htm

Call for more research on brain damage in American football

March 24, 2015

Science Daily/BMJ

More research is needed to identify how athletes sustain brain injury from American football, and also to develop strategies to protect them, write experts. Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative syndrome that can affect athletes. It is thought to result from concussion and brain injury following repeated blows to the head.

But the topic of brain damage in football is controversial. The National Football League, for example, does not acknowledge any association between football and brain injury.

CTE symptoms include memory problems, depression, poor impulse and motor control, anger and apathy. But diagnosis can be confirmed only with an autopsy.

Over the course of the last 60 years, just 63 cases of CTE have been identified. When compared to the millions of football players, this number is very low, explain the authors, and this makes research "challenging" as definitive conclusions are difficult to make based on small samples.

Consequently, it will take time and further research to make American football safer, but it must remain a top priority, they argue.

All cases of confirmed CTE following autopsy suggest that the condition is linked to repetitive blows to the head.

But not all of these persons had a history of concussion and this suggests that undiagnosed subconcussive blows may also contribute to CTE, they explain, and call for more research into how the condition develops and to determine other risk factors.

Previous research has shown that retired NFL players demonstrated more cognitive impairment if they had started playing football at a younger age, and this suggests the role of long term injuries to the head.

The development of new technologies that can measure subconcussive blows would benefit research, add the authors. For example, helmet mounted accelerometers can measure these blows and has shown that high school players can sustain over 1,000 head impacts per season. But the NFL recently stopped its use because of difficulties and questions over the reliability of such data.

Risk reduction of head injuries has included legislation requiring injured athletes to be medically assessed before returning to play and changing rules to avoid or reduce head trauma. But long term studies still need to assess whether these strategies are effective, they add.

Protective equipment, such as helmets, have been implemented, but have mixed results and more mechanisms to reduce trauma and to treat injuries should be developed and evaluated, they argue.

"We are still lacking a clear clinical picture because there have been no long term prospective studies of the disease spectrum from diagnosis to death," write the authors. "It is unclear whether any treatment could slow progression of the disease if it was recognised early."

http://www.sciencedaily.com/releases/2015/03/150324210049.htm

Cannot sleep due to stress? Here is the cure

September 5, 2017

Science Daily/University of Tsukuba

Everyone empirically knows that stressful events certainly affect sound sleep. Scientists have found that the active component rich in sugarcane and other natural products may ameliorate stress and help having sound sleep.

In today's world ever-changing environment, demanding job works and socio-economic factors enforces sleep deprivation in human population. Sleep deprivation induces tremendous amount of stress, and stress itself is one of the major factors responsible for sleep loss or difficulty in falling into sleep. Currently available sleeping pills does not address stress component and often have severe side effects. Sleep loss is also associated with certain other diseases including obesity, cardiovascular diseases, depression, anxiety, mania deficits etc.

The research group led by Mahesh K. Kaushik and Yoshihiro Urade of the International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, found that octacosanol reduces stress and restores stress-affected sleep back to normal.

Octacosanol is abundantly present in various everyday foods such as sugarcane (thin whitish layer on surface), rice bran, wheat germ oil, bee wax etc. The crude extract is policosanol, where octacosanol is the major constituent. Policosanol and octacosanol have already been used in humans for various other medical conditions.

In the current study, authors made an advancement and investigated the effect of octacosanol on sleep regulation in mildly stressed mice by oral administration. Octacosanol reduced corticosterone level in blood plasma, which is a stress marker. The octacosanol-administered mice also showed normal sleep, which was previously disturbed due to stress. They therefore claim that the octacosanol mitigates stress in mice and restores stress-affected sleep to normal in mice. The sleep induced by octacosanol was similar to natural sleep and physiological in nature. However, authors also claimed that octacosanol does not affect sleep in normal animals. These results clearly demonstrated that octacosanol is an active compound that has potential to reduce stress and to increase sleep, and it could potentially be useful for the therapy of insomnia caused by stress. Octacosanol can be considered safe for human use as a therapy, because it is a food-based compound and believed to show no side effects.

Octacosanol/policosanol supplements are used by humans for functions such as lipid metabolism, cholesterol lowering or to provide strength. However, well-planned clinical studies need to be carried out to confirm its effect on humans for its stress-mitigation and sleep-inducing potentials. "Future studies include the identification of target brain area of octacosanol, its BBB permeability, and the mechanism via which octacosanol lowers stress," Kaushik says.

https://www.sciencedaily.com/releases/2017/09/170905111357.htm

Generous people live happier lives

July 11, 2017

University of Zurich

Generosity makes people happier, even if they are only a little generous. People who act solely out of self-interest are less happy. Merely promising to be more generous is enough to trigger a change in our brains that makes us happier, neuroeconomists found in a recent study.

What some have been aware of for a long time, others find hard to believe: Those who are concerned about the well-being of their fellow human beings are happier than those who focus only on their own advancement. Doing something nice for another person gives many people a pleasant feeling that behavioral economists call a warm glow. In collaboration with international researchers, Philippe Tobler and Ernst Fehr from the Department of Economics at the University of Zurich investigated how brain areas communicate to produce this feeling. The results provide insight into the interplay between altruism and happiness.

Even a little generosity makes people happier

In their experiments, the researchers found that people who behaved generously were happier afterwards than those who behaved more selfishly. However, the amount of generosity did not influence the increase in contentment. "You don't need to become a self-sacrificing martyr to feel happier. Just being a little more generous will suffice," says Philippe Tobler.

Before the experiment started, some of the study participants had verbally committed to behaving generously towards other people. This group was willing to accept higher costs in order to do something nice for someone else. They also considered themselves happier after their generous behavior (but not beforehand) than the control group, who had committed to behaving generously toward themselves.

Intent alone suffices to cause neural changes

While the study participants were making their decision to behave or not to behave generously, the researchers examined activity in three areas of the participants' brains: in the temporoparietal junction (where prosocial behavior and generosity are processed), in the ventral striatum (which is associated with happiness), and in the orbitofrontal cortex (where we weigh the pros and cons during decision-making processes). These three brain areas interacted differently, depending on whether the study participants had committed to generosity or selfishness.

Simply promising to behave generously activated the altruistic area of the brain and intensified the interaction between this area and the area associated with happiness. "It is remarkable that intent alone generates a neural change before the action is actually implemented," says Tobler.

Benefit from the promise to behave generously

"Promising to behave generously could be used as a strategy to reinforce the desired behavior, on the one hand, and to feel happier, on the other," says Tobler. His co-author Soyoung Park adds: "There are still some open questions, such as: Can communication between these brain regions be trained and strengthened? If so, how? And, does the effect last when it is used deliberately, that is, if a person only behaves generously in order to feel happier?"

About the experiment

At the beginning of the experiment, the 50 participants were promised a sum of money that they would receive in the next few weeks and were supposed to spend. Half of the study participants committed to spending the money on someone they knew (experimental group, promise of generosity), while the other half committed to spending the money on themselves (control group).

Subsequently, all of the study participants made a series of decisions concerning generous behavior, namely, whether to giving somebody who is close to them a gift of money. The size of the gift and the cost thereof varied: One could, for example, give the other person five francs at a cost of two francs. Or give twenty francs at a cost of fifteen. While the study participants were making these decisions, the researchers measured activity in three brain areas: in the temporoparietal junction, where prosocial behavior and generosity are processed; in the ventral striatum, which is associated with happiness; and in the orbitofrontal cortex, where we weigh the pros and cons during decision-making processes. The participants were asked about their happiness before and after the experiment.

https://www.sciencedaily.com/releases/2017/07/170711112441.htm

History of depression puts women at risk for diabetes during pregnancy

March 31, 2015

Science Daily/Loyola University Health System

A history of depression may put women at risk for developing diabetes during pregnancy, according to research. This study also pointed to how common depression is during pregnancy and the need for screening and education.

"Women with a history of depression should be aware of their risk for gestational diabetes during pregnancy and raise the issue with their doctor," said Mary Byrn, PhD, RN, study co-author and assistant professor, MNSON. "Health-care providers also should know and understand the prevalence and symptoms of prenatal depression and gestational diabetes and screen and manage these women appropriately."

Loyola researchers used the Edinburgh Postnatal Depression Screen to measure symptoms of depression in 135 pregnant women attending routine prenatal care visits. Sixty-five study participants had gestational diabetes. These women were 3.79 times more likely to have a history of depression than women without gestational diabetes. In addition, 20 percent of women with gestational diabetes and 13 percent of women without gestational diabetes had significant symptoms of depression. Anxiety and perceived stress were significant predictive factors of depression for both groups.

Each year, more than 200,000 pregnancies are complicated by gestational diabetes. Pregnant women who have gestational diabetes and the added issue of depression are at an even greater risk for possible negative outcomes. Pregnant women who are depressed are more likely to practice unhealthy behaviors such as smoking, alcohol use and missing prenatal doctor visits.

The relationship between diabetes and depression is complex. Clinicians initially believed that depression in people with diabetes was due to the demands of living with a chronic illness. More contemporary thinking suggests that having depression may precipitate the onset of type 2 diabetes. Therefore, if depression is present prior to pregnancy, it may be important to monitor for the development of gestational diabetes.

"Depression may also contribute to the poor self-management of gestational diabetes and potentially increase the chance for complications during pregnancy," said Sue Penckofer, PhD, RN, study co-author and professor, MNSON. "We must further explore the relationship between diabetes and depression to help understand and improve prenatal care and outcomes for women and infants."

http://www.sciencedaily.com/releases/2015/03/150331121245.htm

Stress management techniques improve long-term mood and quality of life for women with breast cancer

March 23, 2015

Science Daily/Wiley

A new study shows that providing women with skills to manage stress early in their breast cancer treatment can improve their mood and quality of life many years later.

At the turn of the century, 240 women with a recent breast cancer diagnosis participated in a randomized trial that tested the effects of a stress management intervention developed by Michael Antoni, PhD, of the University of Miami. Dr. Antoni and his team found that, compared with patients who received a one-day seminar of education about breast cancer, patients who learned relaxation techniques and new coping skills in a supportive group over 10 weeks experienced improved quality of life and less depressive symptoms during the first year of treatment.

In their latest report, the researchers found that the women who received the stress management intervention had persistently less depressive symptoms and better quality of life up to 15 years later. "Women with breast cancer who participated in the study initially used stress management techniques to cope with the challenges of primary treatment to lower distress. Because these stress management techniques also give women tools to cope with fears of recurrence and disease progression, the present results indicate that these skills can be used to reduce distress and depressed mood and optimize quality of life across the survivorship period as women get on with their lives," said lead author Jamie Stagl, who is currently at Massachusetts General Hospital, in Boston.

Stagl noted that breast cancer survivors in the stress management group reported levels of depression and quality of life at the 15-year follow-up that were similar to what is reported by women without breast cancer. Also, the intervention was helpful for women of various races and ethnic backgrounds. "This is key given the fact that ethnic minority women experience poorer quality of life and outcomes after breast cancer treatment," said Stagl.

As survival rates increase for breast cancer, the question of how to maintain psychosocial health becomes increasingly salient. The current findings highlight the possibility that psychologists and social workers may be able to "inoculate" women with stress management skills early in treatment to help them maintain long-term psychosocial health.

"Because depressive symptoms have been associated with neuroendocrine and inflammatory processes that may influence cancer progression, our ongoing work is examining the effects of stress management on depression and inflammatory biomarkers on the one hand, and disease recurrence and survival on the other," said Dr. Antoni.

http://www.sciencedaily.com/releases/2015/03/150323075936.htm

Low vitamin D levels, depression linked in young women

March 18, 2015

Science Daily/Oregon State University

There is a relationship between low levels of vitamin D and depression in otherwise healthy young women, a new study shows.

OSU researchers found that young women with lower levels of vitamin D were more likely to have clinically significant depressive symptoms over the course of a five-week study, lead author David Kerr said. The results were consistent even when researchers took into account other possible explanations, such as time of year, exercise and time spent outside.

"Depression has multiple, powerful causes and if vitamin D is part of the picture, it is just a small part," said Kerr, an associate professor in the School of Psychological Science at OSU. "But given how many people are affected by depression, any little inroad we can find could have an important impact on public health."

The findings were published recently in the journal Psychiatry Research. Co-authors are Sarina Saturn of the School of Psychological Science; Balz Frei and Adrian Gombart of OSU's Linus Pauling Institute; David Zava of ZRT Laboratory and Walter Piper, a former OSU student now at New York University.

Vitamin D is an essential nutrient for bone health and muscle function. Deficiency has been associated with impaired immune function, some forms of cancer and cardiovascular disease, said Gombart, an associate professor of biochemistry and biophysics, principal investigator with the Linus Pauling Institute and international expert on vitamin D and the immune response.

People create their own vitamin D when their skin is exposed to sunlight. When sun is scarce in the winter, people can take a supplement, but vitamin D also is found in some foods, including milk that is fortified with it, Gombart said. The recommended daily allowance of vitamin D is 600 IU per day. There is no established level of vitamin D sufficiency for mental health.

The new study was prompted in part because there is a widely held belief that vitamin D and depression are connected, but there is not actually much scientific research out there to support the belief, Kerr said.

"I think people hear that vitamin D and depression can change with the seasons, so it is natural for them to assume the two are connected," he said.

According to Kerr and his colleagues, a lot of past research has actually found no association between the two, but much of that research has been based on much older adults or special medical populations.

Kerr's study focused on young women in the Pacific Northwest because they are at risk of both depression and vitamin D insufficiency. Past research found that 25 percent of American women experience clinical depression at some point in their lives, compared to 16 percent of men, for example.

OSU researchers recruited 185 college students, all women ages 18-25, to participate in the study at different times during the school year. Vitamin D levels were measured from blood samples and participants completed a depression symptom survey each week for five weeks.

Many women in the study had vitamin D levels considered insufficient for good health, and the rates were much higher among women of color, with 61 percent of women of color recording insufficient levels, compared to 35 percent of other women. In addition, more than a third of the participants reported clinically significant depressive symptoms each week over the course of the study.

"It may surprise people that so many apparently healthy young women are experiencing these health risks," Kerr said.

As expected, the women's vitamin D levels depended on the time of year, with levels dropping during the fall, at their lowest in winter, and rising in the spring. Depression did not show as a clear pattern, prompting Kerr to conclude that links between vitamin D deficiency and seasonal depression should be studied in larger groups of at-risk individuals.

Researchers say the study does not conclusively show that low vitamin D levels cause depression. A clinical trial examining whether vitamin D supplements might help prevent or relieve depression is the logical next step to understanding the link between the two, Kerr said.

OSU researchers already have begun a follow-up study on vitamin D deficiency in women of color. In the meantime, researchers encourage those at risk of vitamin D deficiency to speak with their doctor about taking a supplement.

"Vitamin D supplements are inexpensive and readily available." Kerr said. "They certainly shouldn't be considered as alternatives to the treatments known to be effective for depression, but they are good for overall health."

http://www.sciencedaily.com/releases/2015/03/150318145501.htm

Longer duration of breastfeeding linked with higher adult IQ and earning ability

March 17, 2015

Science Daily/The Lancet

Longer duration of breastfeeding is linked with increased intelligence in adulthood, longer schooling, and higher adult earnings, a study following a group of almost 3,500 newborns for 30 years.

"The effect of breastfeeding on brain development and child intelligence is well established, but whether these effects persist into adulthood is less clear," explains lead author Dr Bernardo Lessa Horta from the Federal University of Pelotas in Brazil.

"Our study provides the first evidence that prolonged breastfeeding not only increases intelligence until at least the age of 30 years but also has an impact both at an individual and societal level by improving educational attainment and earning ability. What is unique about this study is the fact that, in the population we studied, breastfeeding was not more common among highly educated, high-income women, but was evenly distributed by social class. Previous studies from developed countries have been criticized for failing to disentangle the effect of breastfeeding from that of socioeconomic advantage, but our work addresses this issue for the first time."

Horta and colleagues analysed data from a prospective study of nearly 6000 infants born in Pelotas, Brazil in 1982. Information on breastfeeding was collected in early childhood. Participants were given an IQ test (Wechsler Adult Intelligence Scale, 3rd version) at the average age of 30 years old and information on educational achievement and income was also collected.

Information on IQ and breastfeeding was available for just over half (3493) participants. The researchers divided these subjects into five groups based on the length of time they were breastfed as infants, controlling for 10 social and biological variables that might contribute to the IQ increase including family income at birth, parental schooling, genomic ancestry, maternal smoking during pregnancy, maternal age, birthweight, and delivery type.

While the study showed increased adult intelligence, longer schooling, and higher adult earnings at all duration levels of breastfeeding, the longer a child was breastfed for (up to 12 months), the greater the magnitude of the benefits. For example, an infant who had been breastfed for at least a year gained a full four IQ points (about a third of a standard deviation above the average), had 0.9 years more schooling (about a quarter of a standard deviation above the average), and a higher income of 341 reais per month (equivalent to about one third of the average income level) at the age of 30 years, compared to those breastfed for less than one month.

According to Dr Horta, "The likely mechanism underlying the beneficial effects of breast milk on intelligence is the presence of long-chain saturated fatty acids (DHAs) found in breast milk, which are essential for brain development. Our finding that predominant breastfeeding is positively related to IQ in adulthood also suggests that the amount of milk consumed plays a role."

Writing in a linked Comment, Dr Erik Mortensen from the University of Copenhagen in Denmark says, "With age, the effects of early developmental factors might either be diluted, because of the effects of later environmental factors, or be enhanced, because cognitive ability affects educational attainment and occupational achievements...By contrast, Victora and colleagues' study suggests that the effects of breastfeeding on cognitive development persist into adulthood, and this has important public health implications...However, these findings need to be corroborated by future studies designed to focus on long-term effects and important life outcomes associated with breastfeeding."

http://www.sciencedaily.com/releases/2015/03/150317195937.htm

Stress may partly explain worse heart attack recovery in young and middle-aged women

February 9, 2015

Science Daily/American Heart Association

Stress is associated with worse recovery after heart attack among young and middle-age patients. Women patients perceive greater psychological stress than men. Greater stress among women partially explained their worse recovery.

Although 35,000 women under age 65 experience heart attack each year in the United States, there's limited data on psychosocial characteristics and recovery outcomes of young and middle-aged women.

"Our study found a significantly higher level of mental stress in women 18-55 years old with heart attack compared to their male counterparts," said Xiao Xu, Ph.D., lead author of the study and assistant professor of obstetrics, gynecology and reproductive sciences at Yale University in New Haven, Connecticut.

Previous research suggests that mental stress may reduce blood flow and promote plaque forming in the arteries. Stress is also associated with behaviors that may adversely affect health outcomes such as treatment noncompliance.

Researchers analyzed data collected from 2,397 female and 1,175 male heart attack survivors 18-55 years old in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, a prospective observational study of young and middle-aged adult heart attack patients in the United States, Spain and Australia. During their initial hospital stay for heart attack, researchers measured patients' perceived stress using a 14-item scale that gauged their lives as being uncontrollable and overloaded over the past month.

The study showed:

• Women had worse recovery one month after heart attack on multiple outcome measures such as chest-pain-related physical function and quality of life as well as overall health.
• Women had a significantly higher level of mental stress.
• Greater stress among women partially explained their worse recovery.
• Women were more likely to be concerned about family issues while men were more likely to be worried about financial matters:
• Family conflict during the past year was reported by about 33 percent of women versus 20 percent of men.
• A major personal injury or illness was reported by 22.4 percent of women versus 16.6 percent of men.
• Death or major illness of a close family member was reported by 36.6 percent of women versus 27.8 percent of men.
• A loss of crop or business failure as heavy stressors was identified more by men (7.4 percent) compared to 3.5 percent of women.

The study's results add to the growing literature on younger heart attack patients and the need to identify and understand how stress and other psychosocial issues affect recovery.

"We need to think more broadly about our patients," said Harlan Krumholz, M.D., S.M., the study's senior author and director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital and a professor in Yale's School of Medicine and Public Health. "We have to consider their state of mind and the experiences of their lives."

http://www.sciencedaily.com/releases/2015/02/150209171305.htm

Parenting and depression study: Fathers are at risk, too

February 5, 2015

Science Daily/Brigham Young University

A national study of parents found that parents with multiple parenting roles -- such as those in blended families -- are at higher risk of depression. Specifically, parents with three roles were 57 percent more likely to be depressed than those with just a single parenting role.

Scholars at Brigham Young University and Princeton conducted research that gives a better look at how various types of parents experience stress. One finding of the study is that some stepfathers -- those with multiple family roles -- experience the highest stress levels.

"If you say parenting and depression, the first thing people think of is post-partum moms," said Kevin Shafer, a professor of social work at BYU. "But both moms and dads experience stress and certain kinds of parenting roles can be very, very stressful."

Shafer and Princeton's Garrett Pace analyzed data from more than 6,000 parents around the country. The main finding of the study is that depression risk increases for both men and women when the number of parenting roles they hold increases.

Parents in a "yours, mine and ours" family hold three parenting roles: one each for the two families that blended, and a third when a child is born into the blended family. The study found parents with three roles were 57 percent more likely to be depressed than those with just a single parenting role.

Shafer said that there's inherently bumpiness that comes with the process of blending two different families.

"There are norms that govern parenting, but there aren't norms for being a stepparent," Shafer said. "Am I supposed to be an actual parent, a friend, or something like a cool uncle?"

The risk is even higher for fathers in such blended families when a father has biological children who don't live with him. Shafer says that's driven partially by feelings of guilt for spending more time with his new children than his older children. The dynamic also shifts when a new baby comes along.

"The stress doesn't come from a bad place," Shafer said. "It actually comes from a really good place. They want to be a good parent, they want to be a good stepparent, and they want to be a good new parent."

Two trends underscore the importance of these findings. The first is that men are less likely to seek professional counseling when they need it. The second is that blended families are becoming more common, so more parents feel the burden of holding multiple roles.

As a social worker, Shafer hopes these findings will help more parents seek help they need. Mental health professionals should also recognize that depression can manifest in a variety of ways.

"We hope clinicians recognize that parents aren't just a homogeneous group," Shafer said. "Parents show symptoms of depression in different ways than non-parents do."

The new study is published in the journal Social Work. This study follows a 2013 paper by Shafer that the The New York Times highlighted in a post called "What Makes a Successful Stepfather."

Pace collaborated with Shafer while a student in BYU's Master of Social Work program. He graduated in in 2013 and now works at Princeton's Center for Research on Child Wellbeing.

http://www.sciencedaily.com/releases/2015/02/150205095229.htm