Report: The Community Service Desires, Civic Lives of Returning OEF/OIF Veterans

Flush with important skill sets and valuable experiences, military veterans can be counted among a community's greatest assets. Unfortunately, one barrier they face when out of uniform and in a civilian capacity is a feeling of disconnection from the very people they wish to serve.

So says a a 44-page report, All Volunteer Force: From Military to Civilian Service [pdf]. Published last November on Veterans Day by public policy firm Civic Enterprises, it presents the findings of a first ever nationally representative survey focusing on veterans' homecoming transition and civic lives.

The survey found that "only 13 percent of veterans strongly agree their transitions are going well. Yet those veterans who said they had volunteered since returning home had better transitions than those who had not." More:

• Nearly 9 out of 10 veterans said Americans could learn something from their example of service, yet only half considered themselves leaders in their communities as a result of their military service.
  
  
• Nearly 7 in 10 veterans had not been contacted by a community institution, local non-­‐profit, or place of worship after their return home.
  
  
• 92 percent of OIF/OEF veterans agreed that serving their community is important to them.
  
  
• Veterans said a diverse range of issues was important or very important to them: helping military families (90 percent), being involved with disaster relief (88 percent), working with at-risk youth (86 percent), and being involved with the environment/conservation (69 percent).
  
  
• 7 in 10 non-volunteering veterans said they do not have enough information of meaningful service opportunities.

In extended, a portion of the report's statistic-heavy intro.

Found Links: Traumatic Stress, Brain Injury Research, Related Military News

Shared on facebook recently:

• Blood protein triggers scars in the brain after injury | EurekaAlert release -- Clip: "A protein called fibrinogen that is known to help form blood clots also triggers scar formation in the brain and spinal cord, according to new research in the April 28 issue of the Journal of Neuroscience. Researchers found that fibrinogen carries a dormant factor that activates when it enters the brain after an injury, prompting brain cells to form a scar. Scars in the brain or spinal cord can block connections between nerve cells and often keep injury patients from reaching full recovery."
  
  
• It pays to remember what made you sad | New Scientist
  
  
• Pentagon: Boost Training With Computer-Troop Mind Meld | Wired -- Clip: "The Pentagon is looking to better train its troops — by scanning their minds as they play video games. Adaptive, mind-reading computer systems have been a work-in-progress among military agencies for at least a decade. In 2000, far-out research agency Darpa launched “Augmented Cognition,” a program that sought to develop computers that used EEG scans to adjust how they displayed information — visually, orally, or otherwise — to avoid overtaxing one realm of a troop’s cognition."
  
  
• A brain-recording device that melts into place | PhysOrg.com -- Clip: "...the ultrathin flexible implants, made partly from silk, can record brain activity more faithfully than thicker implants embedded with similar electronics. ...In people with epilepsy, the arrays could be used to detect when seizures first begin, and deliver pulses to shut the seizures down. In people with spinal cord injuries, the technology has promise for reading complex signals in the brain that direct movement, and routing those signals to healthy muscles or prosthetic devices."
  
  
• Placebo effect beats God, Prozac | SF Chronicle -- An intense opinion piece with lots of interesting data and ideas to consider.
  
  
• Aging: The Secret Life of the Middle-Aged Brain | Huffington Post -- A few tips and clearing up of myths.
  
  
• The Conversation: Brain research brings wonders and worries | Sacramento Bee -- Important read. Intro clip: "What ethical concerns will arise from new technology and medicine that can reveal our thoughts and enhance our brains?"

Does Guilt and Disillusionment Play a Role in Combat PTSD?

Yes.

A recent study confirms the role of guilt and the need to resolve meaning-of-life issues in those attempting to move beyond PTSD:

Combat veterans commonly report guilt and depression following stressful military experiences. More depressed veterans often report higher levels of posttraumatic stress disorder (PTSD; Dohrenwend et al., 2006). Guilt also appears to be a distress-related response, potentially increasing both avoidant coping and PTSD (Henning & Frueh, 1997; Street, Gibson, & Holohan, 2005), potentially worsening prognosis and treatment response (Kubany et al., 1995; Owens, Chard, & Cox, 2008). Understanding the multiple influences on PTSD is a pressing priority, particularly with current military deployments.

Cognitive restructuring models of coping (e.g., Park & Ai, 2006) may explain why PTSD develops in some trauma survivors and not others. Posttraumatic stress disorder is believed to result when a traumatic event shatters core beliefs that enable people to establish meaning in life (Janoff-Bulman, 1992). If people cannot cognitively restructure traumatic events, regain meaning in life, and rebuild core beliefs, depression and guilt may develop. ...

Veterans of various service eras (N =174) completed an Internet survey about combat exposure, posttraumatic stress disorder (PTSD) symptoms, depression, guilt, and meaning in life. Results of a hierarchical regression indicated that younger age; higher levels of combat exposure, depression, and guilt; and lower meaning in life predicted greater PTSD severity. The interaction between meaning in life and depression also was significant, with a stronger inverse relation between meaning and PTSD at lower levels of depression. Meaning in life may be an important treatment concern for veterans with PTSD symptoms, particularly at higher levels of functioning.

Source: "Posttraumatic stress disorder, guilt, depression, and meaning in life among military veterans," Journal of Traumatic Stress, Volume 22 Issue 6, Pages 654-657

VA Research: 'Improving Veterans Lives' Brochure Series on PTSD

The Veterans Health Administration as part of its VA Research: Improving Veterans Lives brochure series, has produced a six-pager on Posttraumatic Stress Disorder [pdf]. Written by the communicators at VA's Research & Development Department, the slant is on treatment modalities currently being developed and tested:

This brochure presents examples of VA’s recent accomplishments in PTSD research. These studies, it is hoped, will benefit veterans and many other Americans now and in the future and spare them from PTSD’s life-disrupting symptoms and complications.

One of nearly 10 other offerings to choose from (Iraq & Afghanistan Veterans [pdf], Mental Health [pdf], Rural Health [pdf], TBI [pdf] Women's Health [pdf] and more) -- all worth at least a glance.

Are Veterans Who Kill in Combat More Likely to Get PTSD?

Yes. (Not a very surprising conclusion, is it?) Recent research shows this to be true for Iraq War veterans:

[A study led by Shira Maguen of the San Francisco VA Medical Center and University of California-San Francisco] examined the mental health impact of reported direct and indirect killing among 2,797 U.S. soldiers returning from Operation Iraqi Freedom. Data were collected as part of a postdeployment screening program at a large Army medical facility. Overall, 40% of soldiers reported killing or being responsible for killing during their deployment. Even after controlling for combat exposure, killing was a significant predictor of posttraumatic disorder (PTSD) symptoms, alcohol abuse, anger, and relationship problems. Military personnel returning from modern deployments are at risk of adverse mental health conditions and related psychosocial functioning related to killing in war. Mental health assessment and treatment should address reactions to killing to optimize readjustment following deployment. ...

Military personnel who have killed may experience significant shame and/or guilt and need to know that they will be allowed to explore the impact of killing in a safe and supportive environment (e.g., Veterans Affairs). They also may have received criticism or been subject to insensitive questioning by acquaintances, friends, or family members that cause them to be weary of speaking to others about this sensitive issue, especially when they fear others will not understand or judge them for their actions.

Source: "The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans," Journal of Traumatic Stress, Volume 23 Issue 1, Pages 86 - 90

An earlier study by the same research team shows a similar correlation between killing in combat and increased incidence of PTSD in the Vietnam War veteran population.

Is There Anything 'Good' About Traumatic and/or Intense Life Experiences?

Yes.

Studies suggest posttraumatic growth can be a significant, positive outcome of surviving and even thriving following a traumatic event. Controversial in some quarters, at this juncture the data shows such life experiences may be character-building:

That which does not kill us makes us stronger. — Friedrich Nietzsche

In contrast to Nietzsche’s well-known quote, life-threatening experiences may lead to psychiatric conditions such as posttraumatic stress disorder (PTSD; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Furthermore, greater exposure is usually linked to more severe symptoms (Brewin, Andrews, & Valentine, 2000). Psychopathology nevertheless occurs only among a minority of those exposed to such events, leaving open the possibility of other outcomes, including benefits (Bonanno, 2004). Tedeschi and Calhoun (1995) identified the positive psychological changes that can occur following a potentially traumatic event as posttraumatic growth: improved relationships with others, openness to new possibilities, greater appreciation of life, enhanced personal strength, and spiritual development. ...

How are strengths of character related to growth following trauma? A retrospective Web-based study of 1,739 adults found small, but positive associations among the number of potentially traumatic events experienced and a number of cognitive and interpersonal character strengths. It was concluded that growth following trauma may entail the strengthening of character.

Source: "Strengths of character and posttraumatic growth," Journal of Traumatic Stress, Volume 21 Issue 2, Pages 214 - 217

Combat Clips: A Selection of OEF/OIF Veteran Statistics, Feb/Mar 2010

Recent statistical data found in news reports regarding today's veterans. First up from HealthDay News:

Between 2002 and 2008, nearly 50,000 veterans from the Iraq and Afghanistan wars received diagnoses of post-traumatic stress disorder. But fewer than 10 percent of those completed the recommended treatment of 10 to 12 weekly sessions within four months; the number only grew to fewer than 30 percent over a year, the study authors found.

Some types of veterans are less likely to receive recommended care: males, veterans who are under the age of 25, those who live in rural areas and those who got their diagnoses at primary-care clinics and needed referrals to mental health programs, according to the report published online Feb. 9 in the Journal of Traumatic Stress.

Dr. Karen Seal, the study's head researcher and a practitioner at the San Francisco Veteran Affairs Medical Center, said in a news release that most veterans did attend at least one mental-health appointment. But problems -- including those at the system and personal levels -- led to lack of follow-up.

Found Links: Combat Trauma, PTSD, and Related Military News (February 16-24)

Content shared on my facebook profile recently:

• Death toll in Afghan war nears 1,000 | Washington Post
  
• Milwaukee VA Hospital Changing To Serve Female Veterans | WISN-ABC [this link will take you to news program clip on YouTube, which doesn't allow embedding]
  
• Army Studies Virtual Reality Therapy for Soldiers With PTSD | iHealthBeat
  
• US Military Utilizes Holistic Healing Methods | BioVeda Wellness
  
• Good vibrations aid mind-controlled steering | New Scientist
  
• Battlefield camaraderie yields long-term dividends for veterans, study find | Science Centric
  
• The mental scars of soldiers | James Denselow, Guardian [UK]
  
• Memory-melting protein is key to fly forgetfulness | New Scientist
  
• Videoconferencing could help vets manage anger | Reuters
  
• University of Michigan Using Buddy System to Help Vets With PTSD | The Epoch Times
  
• Building fit minds under stress | ScienceDaily

Combat Clips: A Selection of OEF/OIF Veteran Study Statistics, January 2010

News clips examining recent PTSD, TBI and other combat trauma or deployment-related study insights. First, Jennifer Thomas for HealthDay via BusinessWeek:

War isn't just tough on soldiers. Army wives whose husbands were deployed have higher rates of depression, anxiety, sleep disorders and other mental health issues than the wives of soldiers who stayed home, a new study shows.

Researchers looked at the medical records of more than 250,000 wives, accounting for most women married to active-duty U.S. Army personnel. Between 2003 and 2006, about 34 percent of the women's husbands deployed for one to 11 months, 35 percent deployed for longer than 11 months, while 31 percent of soldiers were not sent overseas.

Among wives of soldiers deployed for up to 11 months, researchers found almost 3,500 more diagnoses of depression, anxiety, sleep disorders and other mental health issues than among wives who[se] husbands stayed home.

Click on image above to see Mansfield discuss study.

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."

Volunteers Sought for Stanford PTSD Emotion Regulation Study

Received the following from the Department of Psychiatry at the
Stanford University School of Medicine:

Stanford University Anxiety Brain Imaging Study
...................................................................................
Do you qualify?

• Have you ever experienced, witnessed or had to deal with an extremely traumatic event?
• During the past month, have you re-experienced that event in a distressing way, such as dreams, intense recollections or physical reactions?
• Have you been diagnosed with post-traumatic stress disorder (PTSD)?

We are seeking people who are currently experiencing anxiety and have been exposed to a traumatic event in the past to participate in a research study about how people process faces and emotional pictures.

The study is at Stanford University Medical Center and compensates up to $50 for participation.

Update on OEF/OIF Veterans' Mental Health, VA Benefit Issues

Building upon some of the data-rich news clips shared earlier this week, a few more grafs to consider.

Jia-Rui Chong, Los Angeles Times:

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. ... 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.

Complementary and Alternative Medicine (CAM) Used at Forts Hood and Bliss, Brain Scan Imaging Detects PTSD Sooner, Migraines and PTSD

• Acupuncture Today | Weighing the Costs - "Advocates for the integrated approach in the treatment of PTSD at both Ft. Hood and Ft. Bliss were convinced that the traditional methods of treating PTSD weren't long enough in duration, intense enough or comprehensive enough. A program was created that would address all aspects of PTSD and treat the whole soldier. This integrative approach treats many of the symptoms of PTSD that are not addressed through the standard mental health protocols, including cognitive-behavioral therapy and pharmacotherapy. The concept eventually led to the implementation of the Ft. Bliss Restoration & Resilience Center and the Warrior Combat Stress Reset Program at Ft. Hood that incorporated medical massage, meditation, yoga, acupuncture, marital/family therapy and reiki with the standard treatment protocols of cognitive-behavioral and cathartic psychotherapies and pharmacotherapy."


• Reuters | Brain scans may detect post-trauma stress sooner - "The scans of 42 U.S. soldiers who had served in Iraq or Afghanistan in the recent past showed that, compared with healthy veterans, those suffering from PTSD had marked differences in some areas of brain activity. The study, presented at the World Psychiatric Association Congress in Italy, suggested identifying certain brain patterns could one day help diagnose PTSD before symptoms appeared and better track treatment, the researchers said."


• PTSD Common in Migraine Patients: Study - "Patients with migraine, whether episodic or chronic, are more apt to have post-traumatic stress disorder (PTSD) than the general population, suggests new research reported in the April issue of Headache. Furthermore, the presence of PTSD in migraineurs is independently associated with greater headache-related disability. 'Taken together, our findings suggest that identification and treatment of PTSD in migraine sufferers is an important and potentially modifiable part of their care that may reduce migraine-related disability and progression to chronic daily headache,' Dr. B. Lee Peterlin and colleagues conclude. In their study of 593 headache patients (mean age 42.2 years; 92% women) with episodic migraine or chronic daily headache, Dr. Peterlin's team found that PTSD was present in 30.3% of those with chronic daily headache and 22.4% of those with episodic migraine. By comparison, approximately 8% of the population is estimated to have PTSD."

More PTSD Combat Diigo links.

Congressman Sestak on Veterans, TBI and Brain Awareness Week

Earlier today, Congressman Joe Sestak (PA-07) took to the floor of the House of Representatives to talk briefly about 2009's Brain Awareness Week, which began Monday and continues through March 22.

Study: PTSD Increases Obesity, High Blood Pressure and Insulin Resistance Risk

From EurekAlert:

Veterans with post-traumatic stress disorder (PTSD) are more likely to have metabolic syndrome than veterans without PTSD. New research [pdf] published in the open access journal BMC Medicine has shown that after controlling for other factors such as depression or substance abuse, there is a significant association between metabolic syndrome and PTSD.

Metabolic syndrome is composed of a cluster of clinical signs including obesity, high blood pressure and insulin resistance. It has been associated with diabetes, cardiovascular morbidity and mortality.

Any traumatic event or series of events can cause PTSD. According to the UK National Institute for Clinical Excellence (NICE), up to 30% of people who have experienced a traumatic event may go on to develop PTSD and it may affect about 8% of people at some point in their lives.

Pia Heppner, of the Veterans Affairs of San Diego, VA Center of Excellence for Stress and Mental Health (CESAMH) and the University of California San Diego, with a team of researchers from the VA, analyzed clinical data from 253 male and female veterans. They found that those with a higher severity of PTSD were more likely to meet the diagnostic criteria for metabolic syndrome.

Dr. Heppner said, "This line of research suggests that stress and post-stress responses are related to long-term health outcomes. Studies show that veterans, prisoners of war and individuals exposed to severe trauma have higher rates of physical morbidity and mortality and increased health care utilization. Our findings suggest that metabolic syndrome provides a useful framework for assessing and describing the physical burden of PTSD and can be used prospectively to evaluate health risks that may be associated with combat exposure and PTSD."

NPR's Impact of War, Linking Higher Post-Trauma Heart/Respiration Rates to PTSD, AWOL Marine Discharged, Report on Rochester Military Families

Recent stories of interest...

• Earlier this month, NPR introduced listeners to John Blaufus, an Iraq veteran who's been hospitalized twice for acute PTSD since returning home. The segment was the latest installment in their important "Impact of War" series.
  
  
• Australian researchers have found that "elevation of the heart and respiration rates, which occur immediately after a traumatic event, are predictive of future PTSD."
  
  
• At Camp Pendleton this past Friday, a summary court-martial was held for a Marine who had gone AWOL for two years and faked his own death, all to keep from deploying to Iraq for a third time. His attorney had argued that he had a nervous breakdown after his experiences in Iraq, which included the death of a close friend who had been killed while taking his place on duty one day. In the unique case, the Marine, who grew up in Saudi Arabia as the son of oil company school teachers, has been discharged.
  
  
• Another court-martial case, this one of a Silver Star Afghanistan veteran and Air Force Captain whose actions in 2002's Operation Anaconda saved three men's lives, has ended with the officer's retirement. "Who rescues the rescuer?" asked the helicopter rescue pilot's attorney, whose PTSD was not recognized officially by the Air Force until the end of his tour when he'd already sunk deeply into illegal and erratic behavior.
  
  
• A recent study of 140 returning Rochester/Finger Lakes [NY]-area veterans, family members and service providers has found that military families "struggle needlessly because they aren't aware of benefits and services available or don't think they need them. ...The report says soldiers and families need honest information about the pitfalls of reintegration, signs to look for, strategies for coping and the fact that it's common to struggle."

Study Finds PTSD Risk Rooted in Stress as Neuroscience Field Bids Farewell to "Patient H.M."

Last week, Henry Gustav Molaison -- a name most would not recognize even though he was the neuroscience field's most famous of patients -- passed away at the age of 80. Since 1953, when experimental brain surgery to alleviate severe epileptic seizures severely damaged his ability to lay down new memories, Molaison was known simply as "H.M."

From Wikipedia:

Henry Gustav Molaison (February 26, 1926 – December 2, 2008), better known as HM or H.M., was a memory-impaired patient who was widely studied from the late 1950s until his death. His case played a very important role in the development of theories that explain the link between brain function and memory, and in the development of cognitive neuropsychology, a branch of psychology that aims to understand how the structure and function of the brain relates to specific psychological processes.

Before his death, he resided in a care institute located in Windsor Locks, Connecticut, where he was the subject of ongoing investigation. Audio recordings from the 1990s of him talking to scientists were released in early 2007. Henry loved to do crossword puzzles, play bingo, watch TV, and socialize with the people who took care of him.

Not surprisingly, in February 2007, NPR's Weekend Edition [listen] introduced their audience to the man whose ill-fated surgery gave scientists a clearer window into the body's most complex and vital organ: the brain. The program also provides a short introductory primer on memory and the brain.

Due to PTSD and memory's unique relationship -- with past traumatic experiences feeling vivid, painfully immediate and even more "real" than recent events rather than the distant memories they should be for its sufferers -- H.M. (who was an "n of 1," or the only person who is known to have had the surgical procedure performed on him; therefore, the only one available in this specific research pool) increased our knowledge base in this area, too.

In extended, a journey into the world of Molaison's amnesia, along with a host of fresh research coming out on the subject.

OEF/OIF Veteran Suicide Toll: Nearly 15% of Overall U.S. Military Casualties Result from Suicide

See Afghanistan, Iraq Veteran Army Suicide Rate Continues to Climb; PTSD Timeline Update for updated OEF/OIF veteran suicide data -- Ilona Meagher, 11/4/09

Back in February, the Marines released their military branch's updated suicide statistics. They revealed the number of Afghanistan and Iraq combat troops and veterans who took their own lives in 2007 had doubled over the previous year.

Earlier this month, the Army reported its own current soldier suicide data, reflecting another year of record increases. And just last week, the VA chimed in with their latest OEF/OIF veterans suicide figures -- also another record-breaker -- for its Afghanistan and Iraq veteran clients.

Military Kids Also Serve, Feel Stress and Strain of Nation's Wars

Did you know that about 700,000 American children have had at least one parent deployed in the Middle East since our invasion of Afghanistan? Today, over 155,000 kids have a deployed parent overseas supporting our operations in Afghanistan and Iraq.

While a resilient bunch, a lot of worry and strain are being carried on their little shoulders. Are they getting all the support they need?

Back in May, I spoke at a "Healing the Hidden Wounds" summit organized by National Public Television and NAMI-TN. Among the stream of amazing speakers drawn together that day was a 24-year military wife and mom (and active professional social worker with Ft. Campbell's Family Readiness Group and the Centerstone Community Mental Health Centers).

Susan Pease's words were among the more poignant of the day. She tried to answer the question, "What do military families need?" From my notes, here were a few of her responses:

• Military kids are desperately in need of resources and supports. Their needs appear to be among the most overlooked of all aspects of of our nation's protracted wartime stance. While Military Family Life Consultants, Military OneSource and MilitaryHOMEFRONT are wonderful resources, more are needed.
  
  
• Military children are acting out and need more peer group programs. Some are stealing prescription drugs from parents, coping with abandonment issues and angry that their deployed parents have missed so many important days (like graduation, etc.) over the years. These are signs that more substantial peer group programs are needed to help cushion their experience. Parents can't do it all.
  
  
• Parents are also under stress and need more child care tools. Left behind on their own -- as strong and capable as they are -- they are starved for supports and tools to help their kids to cope with the many emotions they feel before, during and after deployment. Parents need more adolescent care help, and parenting help, and activities that will bring kids together and foster ways for them to be able to talk their feelings and anger and worries out with each other.

Heroism, PTSD, Suicide, and September 11

From NPR:

New data from a public health registry that tracks the health effects of 9/11 suggest that as many as 70,000 people may have developed post-traumatic stress disorder as a result of the terrorist attacks.

The estimate, released Wednesday by New York City's Department of Health, is based on an analysis of the health of 71,437 people who enrolled in the World Trade Center Health Registry. They agreed to be tracked for up to 20 years after the Sept. 11, 2001, attacks, and the study was based on answers they volunteered about their health two and three years after the attack.

Of the estimated 400,000 people believed to have been heavily exposed to pollution from the disaster, data suggests that 35,000 to 70,000 people developed PTSD and 3,800 to 12,600 may have developed asthma, city health officials said.

They include rescue and recovery workers, lower Manhattan residents, area workers, commuters and passers-by.

One of those people on the scene was a man named Kenny Johannemann, a WTC janitor who worked part-time in the basement of the North Tower. Michael Daly picks up the story in the New York Daily News:

Johannemann often said he might have been killed on 9/11 had he not stopped to get a cup of coffee just before the plane hit. Otherwise, he might have been on an elevator when a jet crashed and flaming fuel poured down the shaft.

Instead, he was waiting for an elevator when he heard a huge bang and the doors burst open. A man tumbled out on fire and Johannemann helped him to an ambulance. "He was burned up bad but he was still alive," Johannemann told People magazine.

In the aftermath, Johannemann appeared on the "Jenny Jones Show" and received the letter from the White House. Privately, the hero became a reclusive alcoholic.

"He just started backing away and not bothering with anyone," Joseph Maya recalled. He avoided family, even on the holidays he had always loved. He seemed convinced he was friendless and alone.

Eleven days ago, on August 31, he committed suicide.