About 37% of veterans returning from Iraq and Afghanistan have mental health problems, a nearly 50% increase from the last time the prevalence was calculated, according to a new study published today analyzing national Department of Veterans Affairs data.
The study, which examined the records of about 289,000 veterans who sought care at the VA between 2002 and 2008, also found higher rates of post-traumatic stress disorder and depression.
“What’s really striking is the dramatic acceleration in mental health diagnoses, particularly PTSD, after the beginning of the conflict in Iraq,” said the study’s lead author, Dr. Karen Seal, a staff physician at the San Francisco VA Medical Center and an assistant professor at UC San Francisco.
The researchers said they could not pinpoint the exact causes of the increase, but suggested: “Waning public support and lower morale among troops may predispose returning veterans to mental health problems, as occurred during the Vietnam era.”
They also suggested that more and longer deployments could have also contributed to the increase in diagnoses.
The previous study of national VA data, which examined Iraq and Afghanistan war veterans seeking care between 2001 and 2005, found that 25% of those veterans received mental health diagnoses. About 13% were diagnosed with the anxiety disorder PTSD and 5% with depression.
The new study by Seal and her colleagues, published in the American Journal of Public Health, found that 22% of the veterans in the study had PTSD and 17% had depression.
When the researchers compared veterans of Afghanistan from early in the war to veterans of Iraq four years later, they found the rates of PTSD diagnosis more than tripled.
The newest study correlates closely to a 2008 report by the Rand Corp., based on a much smaller sample of Iraq and Afghanistan veterans. In that study, about 14% met the criteria for PTSD and 14% for depression.
In related news:
The National Institute of Mental Health announced it has commissioned a $50-million study to identify risk and protective factors for suicide among soldiers, calling it “the largest study of suicide and mental health among military personnel ever undertaken.”
The institute said in a statement that the study was a direct response to the Army’s request to use the most promising scientific approaches to address the rising suicide rate. Though the suicide rate in the Army had been historically lower in the military than among civilians, that pattern reversed in 2008, when the suicide rate in the Army became about 20 suicides in every 100,000 soldiers.
The research teams will be based at the Uniformed Services University of the Health Sciences, University of Michigan, Harvard University and Columbia University.
-- Jia-Rui Chong
Photo: U.S. soldiers walk through the streets of Baquba, Iraq, in June.
Personal and family secrets are contributing factors toward poor mental health, says Maureen McCormick, a star of the 1970s sitcom "The Brady Bunch." Appearing at the annual meeting of the American Psychiatric Assn. on Tuesday in San Francisco, McCormick described discovering her family’s history of mental illness as a child and her own reluctance to tell her daughter, now 20, about her own battles with drug addiction, bulimia and depression.
“Secrets are no good," said McCormick. "I was brought up in a family where we had so many secrets. It felt so good to let the world know I was human and suffered from depression and I wasn’t that perfect person everyone thought I was."
McCormick, 52, appeared on “The Brady Bunch” from 1969 to 1974 as the sweet and popular Marcia Brady. But after the show ended, McCormick battled severe drug addiction (cocaine, quaaludes), bulimia and depression. She re-entered the TV world in 2007 appearing as a contestant on “Celebrity Fit Club,” which follows celebrities as they try to lose weight. McCormick won the contest, and talked about the link between her weight gain and depression. After the show, she realized she wanted to publicly address her mental health and addiction problems. The result was a book, published late last year, titled “Here’s the Story: Surviving Marcia Brady and Finding My True Voice,” and a commitment to fighting the stigma and silence that can surround mental illness.
McCormick has a horrifying family history of mental illness, from suicidal grandparents to a mentally ill mother to brothers who are schizophrenic. In her appearance at the APA, she described feelings of emotional pain and sadness that began early in her life, even before she discovered her family’s turbulent mental health history.
“I felt alone and had this deep down sadness, that I didn’t know what it was," she said. "It was this pain that didn’t go away."
McCormick appeared at the event as part of the annual "Conversations" series at the APA conference that showcases unique perspectives on mental illness from well-known people. "Conversations" is in its eighth year and, by now, it should be apparent that being wealthy and famous and admired isn’t protection against mental illness. Past speakers have included Patty Duke, Brooke Shields, Mariel Hemingway, Greg Louganis, George Stephanopoulos, Tipper Gore and Carrie Fisher.
-- Shari Roan
Photo credit: Maureen McCormick / American Psychiatric Assn.
You know them. I know them. And, increasingly, psychiatrists know them. People who feel they have been wronged by someone and are so bitter they can barely function other than to ruminate about their circumstances.
This behavior is so common -- and so deeply destructive -- that some psychiatrists are urging it be identified as a mental illness under the name post-traumatic embitterment disorder. The behavior was discussed before an enthusiastic audience Monday at the annual meeting of the American Psychiatric Assn. meeting in San Francisco.
The disorder is modeled after post-traumatic stress disorder because it too is a response to a trauma that endures. People with PTSD are left fearful and anxious. Embittered people, however, are left seething for revenge.
"They feel the world has treated them unfairly. It's one step more complex than anger. They're angry plus helpless," says Dr. Michael Linden, a German psychiatrist who named the behavior.
Embittered people are typically good people who have worked hard at something important, such as a job or a relationship or activity, Linden says. When something unexpectedly awful happens -- they don't get the promotion, the wife files for divorce or they fail to make the Olympic team -- a profound sense of injustice overtakes them. Instead of dealing with the loss with the help of family and friends, they cannot let go of the feeling of being victimized. Almost immediately after the traumatic event, they become angry, pessimistic, aggressive, hopeless haters.
"Embitterment is a violation of basic beliefs," Linden says. "It causes a very severe emotional reaction.... We are always coping with negative life events. It's the reaction that varies."
There are only a handful of studies on the behavior, but psychiatrists meeting Monday were in agreement that much more research is needed on identifying and helping these people. One estimate is that 1% to 2% of the population are embittered, says Linden, who has published several studies on the behavior.
"These people usually don't come to treatment because 'the world has to change, not me,' " Linden says. "They are almost treatment resistant.... Revenge is not a treatment."
Nevertheless, Linden suggests that people once known as loving, normal individuals who suddenly snap and kill their family and themselves may have post-traumatic embitterment syndrome. That's reason enough for researchers to study how to treat the destructive emotion of bitterness.
If you're looking to boost your brain power and shopping for a product that promises to help you do that, start by thinking twice. Many of the products don't have much of a track record.
The Stanford Center on Longevity is offering some guidance, backed up by more than two dozen brain scientists, on these so-called memory aids.
The statement begins: "There is no greater concern among aging people than the prospect of diminished capacity and the loss of independence."
It goes on to acknowledge the desperation people feel to keep their mental fitness, and explains just what is possible -- and what isn't. That is, supplements haven't been proven to work; software-based programs show little real-world effect; and there's no such thing as a cure or prevention for Alzheimer's (and don't let anyone tell you otherwise).
But learning in general, community involvement and exercise ... those are all good.
Today's story by Eric Bailey, "Propositions 1D, 1E ask voters to think again," explains the goals of propositions 1D and 1E on the upcoming May 19 special election ballot -- and puts them in some historical context.
The measures would take money from programs intended to benefit young children and the mentally ill and use it to help balance the state's out-of-whack books. Voters had approved the programs' funding in recent years; now they're being asked to approve their un-funding.
The story quotes Larry Gerston, a San Jose State political science professor, as saying: "The voters have been as responsible for this budget mess as anyone else. ... Election after election, they have authorized money for this or that. And it ties the hands of the Legislature at budget time."
So if you're feeling guilty, curious or rebelliously analytical, head over to HealthVote.org before you make a decision.
Offered by the California Healthcare Foundation and the Center for Governmental Studies, the nonpartisan site provides not just non-inflammatory overviews (rare enough) and the official ballot summaries and arguments, but also an analysis and history of each measure as well as information on just who's giving money to the campaigns.
-- Tami Dennis
Photo: Voters cast ballots in the November election, likely to prove a higher-participation event than the upcoming one.
She writes: "In recent years Adderall and Ritalin, another stimulant, have been adopted as cognitive enhancers: drugs that high-functioning, overcommitted people take to become higher-functioning and more overcommitted."
She tells her story in some part through a recent Harvard graduate named Alex. He makes a compelling case for what can be accomplished with a little help.
Photo: Ritalin -- the little helper for people with attention deficit hyperactivity disorder and overworked, over-stressed students -- is going mainstream.
Bad habits and willpower must be on a lot of minds these days. That's great -- I'm all for other people trying to break their bad habits and develop willpower.
In today's Health section, there's Habits can be broken, but not forgotten. Writer Karen Ravn warns us, somewhat harshly: "Chances are, you have a few habits you wish you didn't have, and quite possibly you've tried (and tried and tried) to break them. Scientists are learning why you may have failed (and failed and failed). In fact, they now know that once you have a habit, you can never really unlearn it."
She's a comfort. No, truly. Because then she advises us in Tips on breaking bad habits how to, if not unlearn bad habits, at least not to be controlled by them.
My favorite is the "if-then" plan. Essentially, if you have a specific negative thought, then you perform a specific act to help overcome it. Food cravings and tennis game performances are used as examples. You should try it. Let me know if it works.
And today, NPR weighed in as well. (The media ... we really only want what's best for everyone.)
In Your Health: Willpower: A Game of Strategy, Alix Spiegel offers up a story involving a fascinating experiment with marshmallows or cookies and 4-year-olds possessing varying degrees -- none of them large -- of self-control.
In the study, the researcher told the kids, before leaving the room, that they could have a nearby treat right away or wait until he got back and have two treats. Many succumbed immediately. Others attempted to distract themselves, then succumbed. And we all know which type of 4-year-old we would have been.
Distraction is fine and can work, but the researcher also tried to get the children to think of the way they thought about the treat. The story says: "So, for example, to help the children resist the treat, before leaving the room Mischel told the kids to imagine the treat in front of them differently. 'I told them to think about those marshmallows as if they were just cotton puffs, or clouds. Those instructions to the 4-year-old had a dramatic effect on her ability to wait for the thing that she couldn't wait for before.'"
Apparently 4-year-olds have much to teach us all.
-- Tami Dennis
Photo: They're not melt-in-your-mouth hazelnut chocolate Linzer cookies; they're just round, um, cardboard-y things. Really.
When the biopsy results arrive, the waiting will stop. You'll either resume your previous life with its commitments and deadlines and blessed routine. Or you'll begin a new life, one punctuated by blood tests and treatments and only sometimes controllable fear.
But the results aren't in yet. And so you wait, seemingly forever. To say that this state of not-knowing is stressful would be an understatement. To say that it could harm might not be.
In a study published in the March issue of Radiology, researchers periodically measured cortisol (commonly known as the stress hormone, though there are actually several) in the saliva of 126 women who had undergone breast biopsies and were awaiting the results.
At the end of the testing, those women who didn't yet have a final diagnosis had similar cortisol profiles as the women who had received a diagnosis of cancer.
As the abstract says: "Uncertainty about the final diagnosis ... is associated with substantial biochemical distress, which may have adverse effects on immune defense and wound healing. Results indicate the need for more rapid communication of biopsy results."
In other words, not knowing can negatively affect physical health -- and that's the last thing a person preparing to battle cancer needs.
And although many doctors don't like to deliver bad news over the phone, if a phone call is what it takes to end the uncertainty, then a phone call might be what is needed.
Writer Deborah Lewis makes the case for the compassionate phone call in a thoughtful essay on the benefits of hearing bad news -- "you have breast cancer" -- as soon as possible. In When getting cancer results over the phone is a good thing, she writes:
"There is no way of understanding the receipt of such tough news without understanding the particular torture involved in waiting for medical test results. Time slows down and becomes caustic. The mind fixates on floating scenarios unmoored to actual facts, intruding constantly into weak attempts at daily living.
If I am going through that slow drip of waiting, I want to end my torment as soon as possible."
Others who have awaited biopsy results would likely agree with Lewis. There's much to be said for knowing as soon as possible -- with a plan to discuss the matter in more depth immediately after the initial mind-frying shock has worn off.
Your mental and physical health might depend on it.
People with certain types of brain disorders can suffer from delusions, which are erroneous beliefs in objects or situations that remain fixed in the mind despite evidence they are incorrect. Delusions make it hard for people to function with any normalcy in the real world and confound the doctors and therapists who are trying to help them.
Research published this week in the journal Neurology makes an important observation about the brains of people with neurological disorders, such as those with brain damage from strokes and Alzheimer's disease who suffer delusions, and suggests a novel theory for why delusions occur and persist. Researchers at New York University Langone Medical Center studied neurological patients with delusions and found a consistent pattern of injury to the front lobe and right hemisphere of the brain. It's possible that injury on the right side leads to overcompensation by the left hemisphere, thus producing delusions.
"Problems caused by these brain injuries include impairment in monitoring of self, awareness of errors and incorrectly identifying what is familiar and what is a work of fiction," said the lead author of the study, Dr. Orrin Devinsky, in a news release. "However, delusions result from the loss of these functions as well as the over activation of the left hemisphere and its language structures that 'create a story,' a story which cannot be edited and modified to account for reality. Delusions result from right hemisphere lesions, but it is the left hemisphere that is deluded."
The fact that people believe delusions despite evidence that they are wrong may be due to the dysfunction in the frontal lobe of the brain.
The research could be helpful by clarifying what psychological, cognitive and neurological mechanisms contribute to delusional thinking, the researchers said. That may lead to better strategies to treat the illness.
As many as 20% of adolescents and young adults are believed to intentionally injure themselves, usually by cutting, as a response to emotional pain or trauma. But the number of ways people self-injure seems to be growing, perhaps spurred by Internet communication.
One researcher has identified a new phenomenon he calls "self-embedding disorder." In a study presented today at the annual meeting of the Radiological Society of North America. Dr. William E. Shiels II says he has removed such items as unfolded paper clips, wood slivers, metal staples, needles, pencil lead and stones from the arms or legs of teenagers. An expert in extracting foreign objects from the body, Shiels described 19 episodes of self-embedding injury in 10 girls ages 15 to 18 and found some common characteristics. Ninety percent of the girls had self-injured before and most had attempted suicide or had thought about it. Forty percent had a history of sexual abuse. Most had other psychiatric disorders, such as bipolar disorder, depression, post-traumatic stress disorder or borderline personality.
Self-injury often takes the form of cutting, burning, biting or hair pulling. However, Shiels warned his colleagues to look for mysterious wounds that don't heal. Patients rarely admit that they've inserted objects into their skin, he says.
"They come in with swelling and say they fell or something," said Shiels, chief of radiology at Nationwide Children's Hospital in Columbus, Ohio, in an interview. "I have spoken to doctors at five different hospitals and every one of them has seen this, but they didn't know what to call it."
Shiels, who developed an expertise in removing foreign objects from the body while working at military hospitals, said more research is needed on why people self-injure and how to prevent and treat it. Parents and healthcare providers should be aware of the high rates of self-injury and that some children and teens are discussing it on the Internet. In one of his cases, he said, a girl was coached by another teenager through Internet communication on how to insert objects in the skin.
"We need to interrupt this cycle of self-harm," he said. "But parents often don't see the behavior evolving . . . Adolescence seems to be increasingly more difficult for some children to handle."
The Los Angeles Times Health section will present an in-depth look at self-injury later this week online and on Monday in the Health section.
-- Shari Roan
Photo: Several pieces of metal grouped near the wrist can be seen on these two views of a teenage girl's hand. Credit: William E. Shiels II, Nationwide Children's Hospital.
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is the Times' Health and Science editor. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, deputy Health and Science editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
Karen Kaplan covers genetics, stem cells and cloning. She and colleague Thomas H. Maugh II comprise about 25% of the unofficial MIT-Alumni-in-Journalism Club, and she is proud to have taken more math (5) than English (0) courses in college. Her contributions to Booster Shots will, she hopes, appear more frequently than postings to her mommy blog.
Thomas H. Maugh II has been a science and medical writer at the Times for 23 years. Before that, he was on the staff of the journal Science for 13 years.
He has bachelor's degrees in English and chemistry from MIT and a doctorate in chemistry from UC Santa Barbara.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
People with certain types of brain disorders can suffer from delusions, which are erroneous beliefs in objects or situations that remain fixed in the mind despite evidence they are incorrect. Delusions make it hard for people to function with any normalcy in the real world and confound the doctors and therapists who are trying to help them.
