JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, August 1, 2006)
JAMA NEWS RELEASES — Theme Issue on Violence and Human Rights
RETURN FROM DEPLOYMENT TO IRAQ WAR ASSOCIATED WITH INCREASED RISK FOR ADVERSE NEUROPSYCHOLOGICAL EFFECTS
ELEVATED RATES OF MENTAL HEALTH PROBLEMS AMONG SURVIVORS OF TSUNAMI
SCREENING METHOD CAN PLAY ROLE IN DISCLOSURE OF INTIMATE PARTNER VIOLENCE
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
IRAQ DEPLOYMENT LINKED TO DECREASE IN MEMORY AND CONCENTRATION, BUT IMPROVED REACTION TIME
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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TV Note: This week's JAMA video news release is on neuropsychological outcomes of Army personnel following deployment to the Iraq war. The release will be fed Tuesday, August 1, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 1, 2006
Media Advisory: To contact Jennifer J. Vasterling, Ph.D., call Phil Budahn at 202-273-6000. To contact editorial co-author Matthew Hotopf, Ph.D., email: m.hotopf{at}iop.kcl.ac.uk.
RETURN FROM DEPLOYMENT TO IRAQ WAR ASSOCIATED WITH INCREASED RISK FOR ADVERSE NEUROPSYCHOLOGICAL EFFECTS
CHICAGO—U.S. Army soldiers who return from military deployment to the Iraq war have an increased risk for mild neuropsychological compromise, including poorer memory and sustained attention performance and greater feelings of tension and confusion, according to a study in the August 2 issue of JAMA, a theme issue on violence and human rights.
Since early 2003, significant numbers of military personnel have been deployed to Iraq for Operation Iraqi Freedom (OIF). Although contemporary battlefield measures have improved war-zone survival, success in preventing fatalities has not eliminated adverse physical or mental health consequences, according to background information in the article. One major war-related health risk is often neuropsychological (i.e., cognitive and emotional) impairment. In past military conflicts, cognitive impairment figured prominently among veteran health complaints, ranking fourth among 1991 Gulf War veterans in government health registries. Because of its potential negative impact on occupational and psychosocial functioning in a predominantly young population, war-related neuropsychological impairment has significant public health implications. Yet, the consequences of war-zone deployment on neuropsychological health remain poorly understood. Knowledge gaps stem largely from a lack of predeployment health information and assessments conducted too long after war-zone exposure.
Jennifer J. Vasterling, Ph.D., of the Southeast Louisiana Veterans Health Care System and Tulane University School of Medicine, New Orleans and colleagues conducted a study to examine neuropsychological outcomes following Iraq deployment. The study included 961 male and female active-duty Army Soldiers. Deploying Army Soldiers (n = 654) were examined prior to deployment to Iraq (April-December 2003) and shortly after return (within an average of 73 days; January-May 2005) from Iraq deployment. There was also a comparison group of soldiers (n = 307) similar in military characteristics but not deploying overseas. Participants were individually administered performance-based neuropsychological tasks.
The researchers found that Iraq deployment, compared with nondeployment, was associated with mild neuropsychological compromise on tasks of sustained attention, verbal learning, and visual-spatial memory. Iraq deployment was also associated with increased negative effects on measures of confusion and tension. In contrast, deployment was associated with improved simple reaction time and no changes on other neuropsychological tasks. Deployment effects remained statistically significant after taking into account deployment-related head injury and stress and depression symptoms. The researchers interpret their findings as the carry-over into the home environment of what was likely an adaptive brain-based survival response in the combat zone.
The researchers add that because they included only active-duty Army Soldiers in this report, their results may not be generalizable to other military branches or to National Guard and Reserve personnel activated for deployment.
“Even small declines in the ability to sustain attentional focus and learn and remember new information may reflect subtle neural dysfunction, lead to problems in day-to-day life, and negatively affect performance in high-pressure contexts such as subsequent war-zone participation,” the authors write.
(JAMA. 2006;296:519-529. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: NEUROPSYCHOLOGICAL CHANGES FOLLOWING MILITARY SERVICE IN IRAQ — CASE PROVEN, BUT WHAT IS THE SIGNIFICANCE?
In an accompanying editorial, Matthew Hotopf, Ph.D., of the Institute of Psychiatry and Simon Wessely, F.Med.Sci., of the King’s Centre for Military Health Research, London, discuss the findings of Vasterling and colleagues.
“Whether veterans should be concerned about the findings of Vasterling et al depends on the answers to several other questions. First, are the reported effects clinically significant? The authors emphasize that the neuropsychological changes are ‘mild’ and ‘subtle.’ Although data on the distribution of test performances are not presented, the implication is that the effect represents a minor change for the population as a whole rather than significant impairments in a few.”
“Another possibility is that the effect is due to the persistence on return home of some of the psychological adaptations required during deployment. The term battlemind captures the way in which deployed military personnel develop ways of adapting that are appropriate and helpful when vigilance is required, decisions have to be taken quickly, targeted aggression is appropriate, and emotional control is essential. Many returning veterans report difficulties switching from these normal responses to the responses required at home.”
“The final question for concerned veterans is whether the changes will persist. Given the lack of prior literature on neuropsychological functioning in populations of returning veterans, the planned follow-up of this cohort, with further rigorous neuropsychological testing and clinical monitoring, will be most welcome and certainly most important,” the authors conclude.
(JAMA. 2006;296:576-578. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Drs. Hotopf and Wessely have received research funding from the U.K. Ministry of Defence for a cohort study on the health effects of the Iraq War. Dr. Wessely is honorary civilian consultant advisor in psychiatry to the British Army. No other disclosures were reported.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 1, 2006
Media Advisory: To contact Barbara Lopes Cardozo, M.D., M.P.H., the corresponding author for both studies, call the CDC’s Division of Media Relations at 404-639-3286. To contact editorial co-author Derrick Silove, M.D., email: d.silove{at}unsw.edu.au.
ELEVATED RATES OF MENTAL HEALTH PROBLEMS AMONG SURVIVORS OF TSUNAMI
CHICAGO—Adult and children in the tsunami-affected areas in Thailand have elevated rates of mental health problems such as symptoms of posttraumatic stress disorder and depression up to 9 months after the disaster, according to two studies in the August 2 issue of JAMA, a theme issue on violence and human rights.
On December 26, 2004, a massive undersea earthquake northwest of Sumatra, Indonesia, caused a giant ocean shockwave or tsunami that devastated the shorelines of Indonesia, Sri Lanka, India, Thailand, and many other countries. More than 200,000 individuals are estimated to have died from the tsunami, making it one of the deadliest natural disasters in history. In Thailand, the tsunami severely affected all 6 southwestern provinces, where 5,395 individuals died, 2,991 were unaccounted for, and 8,457 were injured, according to background information in the article.
Previous assessments among survivors of natural disasters have shown that posttraumatic stress disorder (PTSD) and other mental health problems are common. Thailand does not have a history of natural disasters and the prevalence of PTSD among individuals exposed to traumatic events has not been assessed previously. Understanding post-tsunami mental health indicators is essential for identifying vulnerable populations and developing culturally specific mental health interventions.
Frits van Griensven, Ph.D., of the Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand, and colleagues with the Thailand Post-Tsunami Mental Health Study Group, assessed the prevalence of symptoms of PTSD, anxiety, and depression and associated factors among random samples of displaced and nondisplaced persons in the three Thai provinces of Phang Nga, Krabi, and Phuket, which were the most severely affected by the tsunami. The population-based mental health survey was conducted from February 15 to 22, 2005, of displaced (n = 371) and nondisplaced persons in Phang Nga province (n = 322) and nondisplaced persons in the provinces of Krabi and Phuket (n = 368). Data were collected using an interviewer-administered questionnaire on handheld computers. Participation rates for displaced and nondisplaced in the survey were 69 percent and 58 percent, respectively. A follow-up survey was conducted in September 2005.
The researchers found that symptoms of PTSD were reported by 12 percent of displaced and 7 percent of nondisplaced persons in Phang Nga and 3 percent of nondisplaced persons in Krabi and Phuket. Anxiety symptoms were reported by 37 percent of displaced and 30 percent of nondisplaced persons in Phang Nga and 22 percent of nondisplaced persons in Krabi and Phuket. Symptoms of depression were reported by 30 percent of displaced and 21 percent of nondisplaced persons in Phang Nga and 10 percent of nondisplaced persons in Krabi and Phuket. Loss of livelihood was independently and significantly associated with symptoms of all 3 mental health outcomes (PTSD, anxiety, and depression).
“Restoration of persons’ livelihoods to prevent and diminish mental morbidity among populations affected by natural disasters is therefore of utmost importance,” the authors write.
In the 9-month follow-up survey of 73 percent of displaced participants and 80 percent of nondisplaced participants in Phang Nga, prevalence rates of symptoms of PTSD, anxiety, and depression decreased among displaced and nondisplaced persons, but remain elevated.
“This decrease may be due to spontaneous recovery under improved social and environmental conditions, such as more permanent housing for displaced persons, continued mental health support and occupational training, and restoration of livelihood programs, which were implemented in Phang Nga province by multiple governmental and nongovernmental organizations,” the researcher add.
(JAMA. 2006;296:537-548. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The research for this article was funded by the U.S. Centers for Disease Control and Prevention and the Thailand Ministry of Public Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
PTSD AND DEPRESSION SYMPTOMS AMONG CHILDREN WHO SURVIVED TSUNAMI
There has been increase in the rate of depression and posttraumatic stress disorder among children in the tsunami-affected areas of Southern Thailand, according to a study in the August 2 issue of JAMA.
Warunee Thienkrua, M.Sc., of the Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand, and colleagues with the Thailand Post-Tsunami Mental Health Study Group, conducted an assessment of symptoms of mental illness among children after the tsunami. This study examines the prevalence of symptoms of PTSD and depression, and associated risk factors among children aged 7 to 14 years in tsunami-affected provinces in southern Thailand, where approximately 20,000 children were directly affected. The mental health surveys were conducted in Phang Nga, Phuket, and Krabi provinces from February 15-22, 2005 (2 months post-tsunami), and September 7-12, 2005 (9 months post-tsunami). A total of 371 children participated in the first survey (167 living in displaced guest camps, 99 not displaced from villages affected by the tsunami, and 105 not displaced from nonaffected villages).
The prevalence rates of PTSD symptoms were 13 percent among children living in displacement camps, 11 percent among nondisplaced children from tsunami-affected villages, and 6 percent among children from nonaffected villages; for depression symptoms, the prevalence rates were 11 percent, 5 percent, and 8 percent, respectively. Having had a delayed evacuation, having felt one’s own or a family member’s life to have been in danger, and having felt extreme panic or fear were significantly associated with PTSD symptoms. Older age and having felt that their own or a family member’s life had been in danger were significantly associated with depression symptoms.
In the follow-up survey, 72 percent of children from Phang Nga participated. Prevalence rates of symptoms of PTSD and depression among these children did not decrease significantly over time.
“Findings in our assessment may provide a better understanding of post-tsunami mental health problems and associated risk factors among children. Therapeutic approaches may be needed to help children understand and manage their feelings of fear, so that possible negative impacts on their development are minimized. Family counseling may be necessary to make sure that parents are able to recognize and address mental health problems, and schools may be another important venue for affected children to be identified and provided with services to reduce PTSD and depression. Teachers, in particular, may play a crucial role in the support and referral of affected children; hence, appropriate sensitivity training for mental health–related problems is recommended for school-based staff,” the authors write.
(JAMA. 2006;296:549-559. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This assessment was supported by the U.S. Centers for Disease Control and Prevention and the Thailand Ministry of Public Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: RAPID ASSESSMENTS OF MENTAL HEALTH NEEDS AFTER DISASTERS
In an accompanying editorial, Derrick Silove, M.D., and Richard Bryant, Ph.D., of the University of New South Wales, Sydney, Australia comment on the studies in this week’s JAMA on tsunami survivors and mental health.
“A critical question is whether survivors with early symptoms of PTSD, depression, and anxiety warrant psychological interventions, particularly the nonspecific counseling that commonly is offered in these settings. Studies in Western settings have shown that generic forms of counseling are ineffective in reducing early PTSD symptoms. It may be that, more than receiving counseling, what most survivors need to facilitate natural recovery from trauma exposure and the resulting stress is the restoration of conditions of safety and predictability. Stabilizing the social environment and creating opportunities for survivors to resume their livelihoods and take control of their lives may be the best ‘therapy’ for the community as a whole.”
(JAMA. 2006;296:576-578. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial disclosures - none reported.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 1, 2006
Media Advisory: To contact Harriet L. MacMillan, M.D., call Sue Johnston at 905-525-9140, ext. 22196.
SCREENING METHOD CAN PLAY ROLE IN DISCLOSURE OF INTIMATE PARTNER VIOLENCE
CHICAGO—Reported prevalence rates for intimate partner violence can vary, depending on the screening method, type of questionnaire used and health care setting, and women prefer self-completed questionnaires, compared to face-to-face interviews, according to a study in the August 2 issue of JAMA, a theme issue on violence and human rights.
As intimate partner violence (IPV) has gained recognition as a major public health problem, research efforts have focused on the development of universal screening instruments and protocols for use in health care settings to identify women exposed to IPV, according to background information in the article. Previous studies have demonstrated that women will disclose experiences of violence in response to screening; however, few studies have compared methods of screening.
Harriet L. MacMillan, M.D., of McMaster University, Hamilton, Ontario, Canada, and colleagues compared two screening instruments with the goal of determining an optimal method of screening for IPV in health care settings, based on 3 criteria: (1) 12-month prevalence, (2) extent of missing data, and (3) participant preference. The study included women age 18 to 64 years who were well enough to participate and could be seen individually. Of 2,602 eligible women, 141 (5 percent) refused participation. The randomized trial was conducted from May 2004 to January 2005 at 2 each of emergency departments, family practices, and women’s health clinics in Ontario, Canada.
Participants were randomized to 1 of 3 screening approaches: a face-to-face interview with a health care provider (physician or nurse), written self-completed questionnaire, and computer-based self-completed questionnaire. Two screening instruments–the Partner Violence Screen (PVS) and the Woman Abuse Screening Tool (WAST)–were administered and compared with the Composite Abuse Scale (CAS) as the criterion standard.
The researchers found that the 12-month prevalence of IPV ranged from 4.1 percent to 17.7 percent, depending on screening method, instrument, and health care setting. Although no statistically significant main effects on prevalence of IPV were found for screening method or screening instrument, a significant interaction between method and instrument was found: prevalence was lower on the written WAST vs. other combinations. The face-to-face approach was least preferred by participants. The WAST and the written format yielded significantly less missing data than the PVS and other methods.
“The result of least missing data by written self-completed questionnaire is worth noting, especially for research applications, but also when considering clinical policies for IPV detection and intervention. Prevalence, missing data, and preference are all important considerations for both clinical and research efforts in IPV screening,” the authors conclude.
(JAMA. 2006;296:530-536. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
IRAQ DEPLOYMENT LINKED TO DECREASE IN MEMORY AND CONCENTRATION, BUT IMPROVED REACTION TIME
VIDEO:
B-ROLL
Joshua walking into bar
Joshua checking man’s ID at door
Combat video provided by U.S. Dept. of Defense
AUDIO:
THIS IS 26-YEAR OLD JOSHUA HEPPEL (HEP-le) TODAY, WORKING SECURITY FOR THIS LOUISIANA BAR. BUT FOR MOST OF 2003, HE WAS HERE, SERVING IN THE ARMY IN IRAQ.
VIDEO:
SOT/FULL
@ :10
Super: Joshua Heppel
Army veteran
Runs :07
AUDIO:
“I suffered a shoulder injury while I was in Iraq, so I’m a little banged up still from it, but I’m trying to cope along.”
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More combat footage
GFX/JAMA COVER
Combat footage
AUDIO:
THAT’S A PHYSICAL EFFECT OF COMBAT, BUT WHAT ABOUT THE EFFECT ON HOW THE BRAIN WORKS? A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, MEASURED BRAIN FUNCTION ON ABOUT SIX-HUNDRED SOLDIERS BEFORE THEY WENT TO IRAQ, AND AGAIN WHEN THEY CAME HOME. THE RESEARCHERS COMPARED THE BRAIN TEST RESULTS TO TESTS OF ABOUT THREE-HUNDRED SOLDIERS WHO DIDN’T GO TO IRAQ, TO SEE IF DEPLOYMENT HAD AN EFFECT.
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@ :39
Super: Jennifer Vasterling, Ph.D.
S.E. Veterans Affairs Health Care System
Runs :14
AUDIO:
“We had a mixed pattern of findings. On some measures we saw no changes, but on other measures, especially on specific measures of memory and attention, we saw a negative effect of deployment.”
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Dr. Vasterling walking into her office, sitting at desk, unzipping backpack
AUDIO:
DR. JENNIFER VASTERLING IS ONE OF THE VETERANS AFFAIRS RESEARCHERS WHO STUDIED BRAIN FUNCTION IN SOLDIERS COMING HOME FROM IRAQ. SHE DID FIND A DECREASE IN MEMORY AND CONCENTRATION, AND AN INCREASE IN CONFUSION AND TENSION.
VIDEO:
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Jennifer Vasterling, Ph.D.
S.E. Veterans Affairs Health Care System
Runs :16
AUDIO:
“On the other hand, deployment seemed to offer an advantage in reaction time, so as a function of deployment soldiers seemed to react more quickly to targets when they came back than soldiers that didn’t deploy.”
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Joshua setting up to play pool
Combat video
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JOSHUA SAYS HE HAS NO PROBLEMS WITH MEMORY OR CONCENTRATION, BUT HE STILL HAS THAT QUICK REACTION TIME HE DEVELOPED IN IRAQ.
VIDEO:
SOT/FULL
Joshua Heppel
Army veteran
Runs :08
AUDIO:
“You have to have a heightened awareness of what was going on in your surroundings because you didn’t know what was going to happen. That’s the only way you can survive, really.”
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Combat video
Joshua playing pool
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DR. VASTERLING SAYS QUICK REACTION TIME CAN BE A POSITIVE, AS LONG AS IT DOESN’T MEAN THE SOLDIER OR VETERAN IS ALWAYS ON GUARD AND SIMPLY NOT ABLE TO RELAX. SHE SAYS ARMY PROGRAMS ARE IN PLACE TO HELP RETURNING SOLDIERS LIKE JOSHUA TRANSITION FROM COMBAT TO HOME SUCCESSFULLY.
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NAT SOT UP FULL FOR :02
Joshua hitting ball with cue
AUDIO:
“sound of pool cue hitting ball”
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Ball going into pocket
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THIS IS MAVIS PRALL WITH THE JAMA REPORT.
