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Friday, November 13, 2009

Study of Combat Trauma, PTSD at Fort Hood Outlined By University of Texas Researcher

A couple of weeks ago, a facebook contact drew my attention to an exciting university study tapping into Ft. Hood's returning troops and aiming to comprehensively determine their risk factors for combat PTSD. I read the article, and then filed it away, hoping to have time to pass it along to you here.

Considering last week's shooting, the study may increase in interest for some; but, the work conducted by Dr. Michael Telch's team deserves attention on its own merits. An introduction by Jeremy Schwartz, American Statesman:

Are some soldiers more likely than others to develop post-traumatic stress disorder, a malady that affects nearly one in five service members returning from Iraq and Afghanistan? Is there anything in their genetics, brain structure or ability to handle stress that might make them more or less prone to PTSD? And if researchers can pinpoint risk factors for the disorder, is it possible to "inoculate" service members before they deploy to a war zone?

A study at the University of Texas, called the Texas Combat PTSD Risk Project, is seeking to answer some of those questions using methods that researchers say haven't been tried before. The study put 183 Fort Hood soldiers through a battery of tests before and after their first yearlong deployment to Iraq and had them fill out a monthly "stress log" over the Internet while they were on the battlefield. The result is one of the more comprehensive studies to search for risk factors for the illness, which, along with traumatic brain injury, military leaders call the signature disease of the current conflicts.

Lead investigator Michael Telch, a UT professor of psychology and the director of UT's Laboratory for the Study of Anxiety Disorders, said the research could lead to prevention programs for PTSD.

"Just like with the prevention of heart disease or many other medical conditions, the first critical step in addressing the problem of combat PTSD and other combat-stress disorders is to identify the factors that increase soldiers' risk for developing them," Telch said in an e-mail. "We hope that this study will ultimately provide important new insights into the causes of combat PTSD and ways to prevent it."

In educational interest, article(s) quoted from extensively.

Telch outlined the study's parameters and preliminary findings in detail at last month's Council for the Advancement of Science Writing conference. From the clip's introduction:

The study will provide information on possible genetic, brain, behavioral, social, and psychological factors that increase soldiers risk for PTSD and other combat-related stress disorders. That, in turn, could lead to more effective screening and prevention programs, reducing the incidence of these often debilitating disorders.

Marjorie Simoens, OnCampus:

During the past few years, soldiers have been bused from Fort Hood to Dr. Michael Telch’s anxiety disorders research lab to help determine the factors that may predispose service members to post-traumatic stress disorder (PTSD) as part of the Texas Combat PTSD Risk Project. ...

The pre-deployment assessment includes full neuroimaging at the Imaging Research Center, comprehensive clinical interviews, dozens of validated questionnaires, an eye tracking assessment and a carbon dioxide stress test where the subjects inhale a mixture of 35 percent CO2 and 65 percent oxygen for 30 seconds.

“It’s a major stressor,” Telch said. “What we do is we assess their reactions subjectively, and their hormonal response – their cortisol and testosterone responses to the challenge – and we ultimately want to link their reactions to their risk for developing combat stress problems in theater.”

Once deployed, soldiers have access to a Web-based system where they can fill out an online questionnaire every 30 days.

The questionnaire is divided into two parts, the first one assessing any stressors or stress experiences the combatants have been exposed to – such as witnessing a car bomb or participating in a firefight. After indicating exposures, soldiers are asked to specify which experience caused them the most stress. Part two of the questionnaire asks about individual stress reactions. Telch said soldiers are provided a list of symptoms related to PTSD, depression and anxiety, and asked to rate each item in terms of how severe they have experienced the symptoms in the previous 30 days.

Rather than waiting for soldiers to come home and ask them how they have been doing, we are able to track in real time, while they are still in the combat zone, which is a new innovative piece of the puzzle,” Telch said.

When they do come home, soldiers return to the anxiety disorders lab to do a full day of assessments similar to the pre-deployment stations. Telch also conducts one-on-one interviews with each participant during the third phase of testing. During these interviews, Telch has been able to craft inferences that he wasn’t expecting, such as how the accessibility to the Internet has cause added stress for combatants.

“When you think about earlier wars, you got a letter once in a while, but the way it is working now, not only are the soldiers having to experience the stress of being away from home and all of the stressors related to combat, but they also get bombarded with the stressors from back home because of the Internet,” Telch said. “So they are getting e-mails all of the time, and there have been some real horrendous horror stories.” ...

Telch said he hopes to conduct one-year follow-ups with the soldiers who were deployed to Iraq, and eventually expand the number of service members in the study to 500. He said once his team obtains additional funding, it would switch to soldiers being deployed in Afghanistan.

Continuing, American-Stateman:

Michael Malchow, a 21-year-old soldier from Wisconsin, was one of the 183 Fort Hood soldiers who volunteered to take part in the UT study. He said he was motivated because he's seen the impact of the disorder on a cousin's father, a Vietnam veteran. "I've known for a long time that PTSD has been a big problem," said Malchow, whose unit spent a year patrolling an area near the Iran-Iraq border. "Hopefully, this study will help them find out in better terms how to diagnose it ahead of time, before it becomes a huge problem."

Baldwin, who helped develop the idea for the study, presented it to Fort Hood leaders, who quickly signed on, giving Baldwin access to companies and units. Baldwin said 85 to 90 percent of the soldiers briefed on the study volunteered to participate. ...

Shortly before deploying to Iraq in June 2008, Malchow and his unit journeyed south to Austin to undergo a testing process, paid for by the U.S. Department of Defense.

There were clinical interviews to identify current or previous mental illness or depression; genetic testing so researchers could study a variety of genetic markers, including the seratonin transporter gene, that might make soldiers more susceptible to combat stress; and imaging scans to allow researchers to study areas of the brain such as the amygdala and hippocampus, which are involved in stress reactivity and emotional processing.

Researchers also gave the soldiers eye-tracking tests, flashing pictures of faces in different emotional states to see whether they had a propensity to avoid or fixate on emotional stimuli.

Telch said that soldiers who tended to fixate on the emotional images might "focus on threatening stimuli in a war environment."

Finally, soldiers underwent carbon dioxide stress tests, in which they inhaled a mixture of 35 percent carbon dioxide and 65 percent oxygen and held it for five seconds. While feeling the effects of the mixture, soldiers were tested for heart rate and stress. Telch said that though the test produces light-headedness and breathlessness in everyone, some people react with intense emotional distress and even panic.

"If there was an exaggerated stress response to this challenge, they might present an exaggerated response" in a combat zone, he said.

The soldiers, none of whom were killed in combat, underwent the same testing when they returned this spring, giving researchers comprehensive before and after comparisons. And the soldiers' logs while in Iraq allowed researchers to see what kind of reactions the soldiers had to certain battlefield stressors such as roadside bombs and firefights.

Telch said that preliminary data indicated that soldiers who showed pronounced responses to the carbon dioxide stress test showed more stress in Iraq. And he said his group's research may also uncover factors that make some soldiers more resistant to PTSD, such as feeling emotionally supported by fellow soldiers and by friends and loved ones at home. ...

Telch said his team plans to apply for more financing and hopes to enroll 560 soldiers in future studies. He said that as the conflict winds down in Iraq, future studies will most likely use soldiers deploying to Afghanistan.

Telch said that whatever the results of the studies, they won't predict with certainty which soldiers will develop the illness. "It would depend also on the stressors encountered over there," he said. But armed with the results of such pre-deployment PTSD testing, military leaders could design prevention programs for those service members who are more vulnerable.

Rachel Ehrenberg, Science News:

Receiving bad news from home is one of the highest stressors of the battlefield, second only to hostile incoming fire, according to preliminary data presented in a morning session October 20.

“Not only do they have the stressors in the war zone, but they are constantly bombarded by messages from home,” said Michael Telch, (cq)director of the Laboratory for the Study of Anxiety Disorders at the University of Texas at Austin. “They are flooded with the Internet…. You wouldn’t believe the stories I’ve heard of women moving in boyfriends, then the boyfriends drove the soldiers’ cars, used their credit cards and all sorts of horrific things.”

The weight of various aspects of war emerged from data gathered in stress logs kept by more than 150 soldiers from Fort Hood who were deployed as part of Operation Iraqi Freedom. Keeping stress logs is one aspect of a project that aims to untangle what risk factors predispose soldiers to post-traumatic stress disorder, which can leave those who have experienced traumatic events with persistent emotional and physiological and psychological problems.

Diagnosing PTSD in veterans has been controversial, in part because most studies are retrospective—they try to extrapolate by looking back—and they often rely on self-reported questionnaires. Several factors, including a desire (unconscious or not) to suppress the effect of traumatizing events, can skew self-reported data.

Telch and his colleagues are taking a new approach to examining PTSD: evaluating soldiers before they are sent to Iraq, throughout their deployment and re-assessing them when they get home. The researchers are looking for correlations with factors that include genetics, data gathered from brain imaging and psychological history.

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