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June 7, 2010 — Embargoed ContentJAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives of 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. ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
Complete Table of Contents
(Embargoed Until: 3 P.M. (CT), Monday, June 7, 2010)
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
Complete Table of Contents
(Embargoed Until: 3 P.M. (CT), Monday, June 7, 2010)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 7, 2010
About One-Tenth of Soldiers Returning from Iraq May Be Impaired by Mental Health Problems
CHICAGO—Between 8.5 percent and 14 percent of soldiers returning from Iraq report serious functional impairment due to either posttraumatic stress disorder or depression, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals. "A growing body of literature has demonstrated the association of combat in Iraq and Afghanistan with post-deployment mental health problems, particularly posttraumatic stress disorder (PTSD) and depression," the authors write as background information in the article. "However, studies have shown varying prevalence rates of these disorders based on different case definitions and have not assessed functional impairment, alcohol misuse or aggressive behavior as comorbid factors occurring with PTSD and depression." Between 2004 and 2007, Jeffrey L. Thomas, Ph.D., of the Walter Reed Army Institute of Research, Silver Spring, Md., and colleagues collected anonymous mental health surveys of 18,305 U.S. Army soldiers three and 12 months following deployment. The soldiers were members of four Active Component (non-reserve) and two National Guard (reserve) infantry brigade combat teams. They were screened for PTSD, depression, alcohol misuse and aggressive behaviors, and asked if these problems caused difficulties doing work, taking care of things at home or getting along with other people. "Using the least stringent definition, we observed PTSD rates across Active Component and National Guard study groups, study time points ranging from 20.7 percent to 30.5 percent, and depression rates ranging from 11.5 percent to 16 percent," the authors write. "Using the strictest definitions with high symptom rates and serious functional impairment, PTSD prevalence ranged from 5.6 percent to 11.3 percent and depression prevalence from 5 percent to 8.5 percent." Alcohol misuse or aggressive behavior—including slamming a door, punching a wall or threatening or perpetrating physical violence in anger—was present in about half of the cases of PTSD or depression. Between the three- and 12-month time points, depression and/or PTSD rates remained the same among Active Component soldiers but increased among National Guard soldiers, despite similar rates of combat experiences and similar prevalence rates of mental health problems three months after deployment. "Therefore, the emergence of differences by 12 months likely does not have to do with differences in the health effects of combat but rather with other variables related to readjustment to civilian life or access to health care," the authors write.
The results suggest consequences not only for the care of returning soldiers and their families, but also peers in their units, they conclude. "The findings of the study show that at 12 months following combat, the prevalence of mental health problems among veterans does not abate, and in many cases, increases. It is a virtual certainty that soldiers who remain in service will deploy again; this study shows that a sizable proportion (9 percent to 14 percent) have depression or PTSD symptoms with serious functional impairment," they write. "If soldiers who are struggling with serious functional impairment as the result of a previous deployment are deployed again, there is potential that this could impair their performance in combat. This has implications for the safety of unit members and mission success."
Editor's Note: This study was supported by the Military Operational Medicine Research Area Directorate, U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 7, 2010
Posttraumatic Stress Disorder Associated With Dementia Among Older Veterans
CHICAGO—Older veterans with post-traumatic stress disorder (PTSD) appear more likely to develop dementia over a seven-year period than those without PTSD, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals. PTSD is a common psychiatric symptom and often occurs in veterans returning from combat, according to background information in the article. As many as 17 percent of veterans returning from Iraq and Afghanistan are estimated to have PTSD, and 10 percent to 15 percent of Vietnam veterans had PTSD symptoms 15 years or longer after their return. Previous studies have associated PTSD with a wide variety of medical conditions in younger and middle-aged veterans, along with declines in cognitive (thinking, learning and memory) performance. Kristine Yaffe, M.D., of the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, and colleagues studied 181,093 veterans 55 years and older (average age 68.8, 96.5 percent men) between 1997 and 2000. Of these, 53,155 had PTSD and 127,938 did not. Over seven years of follow-up, from 2000 to 2007, 31,107 (17.2 percent) of the veterans developed dementia. Veterans with PTSD had a 10.6 percent risk of developing dementia, whereas the risk among those without dementia was 6.6 percent. Those with PTSD were still more likely to develop dementia when the analyses were adjusted for important differences, including demographic variables and other medical and psychiatric illnesses. "There are several reasons why patients with PTSD may have an increased risk of developing dementia," the authors write. PTSD may contribute to the cause of dementia, or chronic stress may link the two conditions. Stress may damage the hippocampus, a brain area critical for memory and learning, or cause alterations in neurotransmitter and hormone levels that could precipitate dementia.
"The finding that PTSD is associated with a near doubling of the risk of dementia has important public health, policy and biological implications," the authors conclude. "It is important that those with PTSD are treated, and further investigation is needed to see whether successful treatment of PTSD may reduce the risk of adverse health outcomes, including dementia. In addition, it is critical to follow up patients with PTSD, especially if they are of an advanced age, to screen for cognitive impairment. Finally, mechanisms linking PTSD and dementia must be identified in hope of finding ways to improve the care and outcomes of patients with PTSD."
Editor's Note: This study was funded by a U.S. Department of Defense grant. Dr. Yaffe was supported in part by the National Institute on Aging and an anonymous foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 7, 2010
Secondhand Smoke Associated With Psychiatric Distress, Illness
CHICAGO—Exposure to secondhand smoke appears to be associated with psychological distress and the risk of future psychiatric hospitalization among healthy adults, according to a report posted online today that will appear in the August print issue of Archives of General Psychiatry, one of the JAMA/Archives journals. "A growing body of literature has demonstrated the harmful physical health effects of secondhand smoke exposure," the authors write as background information in the article. "Given the highly prevalent exposure to secondhand smoke—in the United States, an estimated 60 percent of American non-smokers had biological evidence of exposure to secondhand smoke—even a low level of risk may have a major public health impact." Mark Hamer, Ph.D., of University College London, and colleagues studied 5,560 non-smoking adults (average age 49.8) and 2,595 smokers (average age 44.8) who did not have a history of mental illness and participated in the Scottish Health Survey in 1998 or 2003. Participants were assessed with a questionnaire about psychological distress, and admissions to psychiatric hospitals were tracked over six years of follow-up. Exposure to secondhand smoke among non-smokers was assessed using saliva levels of cotinine—the main product formed when nicotine is broken down by the body—"a reliable and valid circulating biochemical marker of nicotine exposure," the authors write. A total of 14.5 percent of the participants reported psychological distress. Non-smokers with a high exposure to secondhand smoke (cotinine levels between 0.70 and 15 micrograms per liter) had higher odds of psychological distress when compared with those who had no detectable cotinine. Over the six-year follow-up, 41 individuals were newly admitted to psychiatric hospitals. Smokers and non-smokers with high exposure to secondhand smoke were both more likely than non-smokers with low levels of secondhand smoke exposure to be hospitalized for depression, schizophrenia, delirium or other psychiatric conditions. Animal data have suggested that tobacco may induce a negative mood, and some human studies have also identified a potential association between smoking and depression. "Taken together, therefore, our data are consistent with other emerging evidence to suggest a causal role of nicotine exposure in mental health," the authors write.
"To our knowledge, this is the first study to demonstrate a prospective association between objectively assessed secondhand smoke exposure and mental health in a representative sample of a general population," they conclude.
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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 7, 2010
Genetic Factors Appear to Be Associated With Development of Disordered Gambling Among Women and Men
CHICAGO—Genetic influences appear important in the development of gambling disorders in both women and men, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Pathological gambling is known to run in families, according to background information in the article. In one study, 8 percent of the first-degree relatives of individuals with gambling disorders had a lifetime history of similar problems, compared with 2 percent of relatives of unaffected individuals. Almost half of the individuals in treatment for pathological gambling are women. To investigate potential genetic and environmental risk factors for development of disordered gambling, Wendy S. Slutske, Ph.D., of University of Missouri-Columbia, and colleagues studied 4,764 individuals from 2,889 Australian twin pairs (age 32 to 43 years, 57 percent women). The twins were assessed through structured telephone interviews for disordered gambling and similarity of their childhood environment. Many of the participants were frequent gamblers; almost all of them had ever gambled, about one-half had gambled at least once a month and about one-third had gambled at least once a week. A total of 2.2 percent of the participants met criteria for pathological gambling, including 3.4 percent of men and 1.2 percent of women; 12.5 percent had ever experienced one or more symptoms of pathological gambling (18.2 percent of men and 8.3 percent of women). "The estimate of the proportion of variation in liability for disordered gambling due to genetic influences was 49.2 percent," the authors write. "There was no evidence for shared environmental influences contributing to variation in disordered gambling liability." There was also no evidence of sex differences in the causes of pathological gambling. "This study represents a major step forward in that it establishes for the first time that genes are as important in the etiology of disordered gambling in women as they are in men," the authors write. "In addition to similar relative contributions of genetic vs. environmental factors to variation in liability for disordered gambling, the results suggest that the susceptibility genes contributing to variation in liability for disordered gambling may also overlap considerably in men and women."
"The discovery of the specific genes and environments involved in the development of disordered gambling remains an important direction for future research," they conclude.
Editor's Note: This work was supported by a National Institutes of Health grant. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 7, 2010
Intimate Partner Violence Against Mothers Associated With Children's Obesity
CHICAGO—Children whose mothers report being abused by their partners appear more likely to be obese at age 5, according to a report in the June issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. About 3 million to 10 million children witness intimate partner violence—physical, sexual or psychological abuse by a current or former partner or spouse—annually, according to background information in the article. "Exposure to intimate partner violence in childhood is associated with altered neuroendocrine system profiles, impaired socioemotional development, cognitive functioning, attachment to caregivers and emotional regulation, and poorer physical and mental health," the authors write. Renée Boynton-Jarrett, M.D., Sc.D., of the Boston University School of Medicine, and colleagues studied 1,595 children born between 1998 and 2000. The children's mothers were interviewed when the children were born and again after 12, 36 and 60 months; children's height and weight were measured at 36 months and five years. About half—49.4 percent—of mothers reported some form of intimate partner violence, and 16.5 percent of children were obese at age 5. Children who were exposed to intimate partner violence were more likely to be obese at age 5 than those who were not exposed to any intimate partner violence. The association was stronger in girls compared with boys, and also among children whose mothers reported they lived in less safe neighborhoods. The findings persisted even when several proposed intermediary and potentially confounding factors—including obesity at age 3, television watching, depression among mothers, smoking during pregnancy and child birth weight—were considered in the analyses, the authors note. The authors suggest that the association could work through several pathways. "First, if intimate partner violence influences maternal responsiveness to the socioemotional needs of the child, then feeding practices may be influenced," the authors write. "Second, witnessing family violence may be associated with emotional distress and emotion-focused coping using food to self-soothe and address negative emotions." In addition, early-childhood disruption of the neuroendocrine system could increase the risk for disordered eating and changes in fat storage and distribution.
"Medical and public health practitioners must consider the impact of family violence on obesity risk when designing and implementing primary obesity prevention interventions," the authors conclude. "Interventions to prevent intimate partner violence, particularly those aimed at educating adolescents about healthy relationships prior to childbearing, may play a crucial role in prevention of early childhood obesity. Moreover, interventions aimed at improving neighborhood safety may have a benefit on reducing childhood obesity risk, even among those exposed to family violence."
Editor's Note: Dr. Boynton-Jarrett was supported by the William T. Grant Foundation, the Boston University Building Interdisciplinary Research Careers in Women's Health, a grant from the Office of Research on Women's Health and the Academic Pediatric Association Young Investigator Award. During preparing of the manuscript, co-author Dr. Wright was supported by grants from the National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 7, 2010
Childhood Hardships Associated With Pregnancy Troubles in Adulthood
CHICAGO—Childhood hardships may be related to future pregnancy outcomes, in part through their association with smoking during pregnancy and adult socioeconomic position, according to a report in the June issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Hardships faced in childhood are often associated with health behaviors later in life, which can include smoking, depression, mood and sleep disturbances, and substance use and abuse, according to background information in the article. "Mounting research evidence suggests a relation between psychosocial stressors during pregnancy and poor pregnancy outcomes, such as low birth weight, intrauterine growth retardation and preterm birth." Emily W. Harville, Ph.D., of Tulane University, New Orleans, and colleagues studied 4,865 women who experienced at least one hardship during childhood and had at least one live birth by age 41. "A shared limitation of past studies is that the period of investigation is limited to the pregnancy itself," the authors write. "Hypothetically, psychosocial and material hardships in childhood and adolescence may ultimately influence pregnancy outcome." Most of the women in the study had their first child in their 20s and most had one, two or three children in their lifetime. Also, about half were current or former smokers. Childhood hardships ranged from family problems with alcohol (1 percent) to fathers not taking an interest in child's schooling (almost 30 percent), with financial problems and minor neglect, particularly from the father, as the most common. Of the women included in the study, in their first pregnancy, 7.9 percent (385 women) gave birth to a low birth weight baby, and 7.5 (349 women) percent gave birth more than three weeks early. Overall, 5.8 percent of pregnancies resulted in a low birth weight baby, and 6.5 percent resulted in pre-term birth. Additionally, 39 percent of women had smoked at some point during their first pregnancy. "When results were examined by timing of exposure, family structure hardships and violence/mental health hardships most strongly influenced the birth outcomes if they happened in adolescence," the authors note. "Overall, the highest risk for both low birth weight and pre-term birth was in those who had multiple hardships in adolescence only, but this was also a very small group."
"Our findings suggest that mothers who have experienced childhood hardship are more likely to smoke during pregnancy," the authors write. "They also more often give birth to low birth weight babies who are born prematurely, but this association may be primarily due to health behaviors and associated social class." The authors also conclude that the findings suggest that, "there are critical periods for elevated risk, as well as a cumulative effect of hardships over time. Further research is needed to specify pathways between childhood adversities and reproductive health outcomes and to evaluate protective factors that could help to alleviate long-term influences of early adversity."
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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 7, 2010
Racial Disparities in Asthma Exist Even Among Children With Equal Access to Health Care
CHICAGO—Within a comprehensive health insurance system, black and Hispanic children appear more likely than white children to have asthma and their outcomes are often worse, according to a report posted online today that will appear in the August print issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Many factors contribute to well-documented racial and ethnic disparities in children's health and health care, according to background information in the article. Universal health care coverage is widely considered an essential component of strategies to reduce these disparities. "Because the Military Health System provides comprehensive health insurance to a racially and ethnically diverse population of beneficiaries, studying disparities in health care treatments and outcomes among this population could add significantly to our understanding of the potential effect of universal coverage on reducing disparities in health care," the authors write. Kate A. Stewart, Ph.D., of Mathematica Policy Research, Chicago, and colleagues analyzed data from 822,900 children age 2 through 17 who were continuously enrolled throughout 2007 in TRICARE Prime, a Department of Defense health maintenance organization-type plan. Asthma prevalence, treatment patterns and outcomes were assessed among children age 2 to 4, 5 to 10 and 11 to 17. Racial and ethnic differences were apparent in several measures and age groups. Black and Hispanic children were more likely to be diagnosed with asthma at all ages. Black children of all ages and Hispanic children age 5 to 10 were more likely to have potentially avoidable hospitalizations or emergency department visits related to asthma. "Our findings with regard to treatment patterns were mixed," the authors write. "Black children, who at all ages were more likely to have a diagnosis of asthma and to have poorer outcomes than white children, were also more likely to receive recommended asthma medications, especially inhaled corticosteroids." However, this could be related to the higher rates of emergency department visits and potentially avoidable hospitalizations among these children, as medications could have been prescribed and filled during or after these visits. Black children were also less likely to receive care from a specialist, who may be more likely to treat asthma according to guidelines, including appropriate use of controller medications. "Thus, even though black children filled more prescriptions for asthma medications, they may have been less likely than white children who visited specialists to control their asthma and use the medications appropriately," the authors write.
"Our findings suggest that eliminating racial and ethnic disparities in health care likely requires a multifaceted approach beyond universal health insurance coverage," they conclude.
Editor's Note: The analyses on which this article is based were performed under a contract funded by the U.S. Department of Defense. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. |
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