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Geisinger doctor looks at PTSD, suicide risk in Army veterans

by on March 07, 2013 10:23 PM

STATE COLLEGE — Not a topic that was well versed or widely identified in the past, Post-Traumatic Stress Disorder and suicide risk in Army veterans is reaching new levels of understanding through current research and studies, including that of Geisinger’s Dr. Joseph Boscarino.

Boscarino, senior investigator with Geisinger’s Center for Health Research, has been conducting PTSD research, and examining suicides and suicide risk, for more than 35 years, and is an active researcher of the psychological health of former soldiers.

While treating these issues remains a priority, determining risk factors for, and what may protect against them, has attracted new levels attention. And local experts and resources on the topic provide a wealth of both information and support.

The bigger picture

Taking into consideration years of studies and research, Boscarino said he has found, when looking at the picture of trauma patients and veterans in a larger context, is that it’s not necessarily only PTSD that contributes to suicide; there are a variety of different factors.

One of these factors, he said, is access to firearms.

“They’re going to have a higher rate to suicide,” he said.

Another risk factor is mental health issues. However, mental health issues may be comparable to other groups associated with PTSD, he said.

Boscarino said he has discovered that suicide cases in veterans are not directly associated with deployment.

“It’s just complicated,” he said.

In 2006, Boscarino and his colleagues looked at 15,000 Army veterans through Geisinger Health System, and found suicide to be associated with different personality traits and factors, such as drug abuse and dishonorable discharge.

Oftentimes, rates of suicide are “not reported in proper context,” Boscarino said. There can be a lot of bias and contradictions.

“Sometimes the story’s more complicated,” he said.

According to his studies, PTSD cases are lower than initial reports. One of his studies through Geisinger involved a “suicidal thoughts cohort,” which examined who had suicidal thoughts and what they were related to. The goal was to try to determine what factors can predict suicidal thoughts, Boscarino said. This involved looking at the genetic makeup of study participants, and determining who is resilient to these types of thoughts.

Independently, suicide rates after the Vietnam War were “staggering,” he said.

When looking at veterans as a group, suicide rates were higher among Vietnam veterans, he said, though this could be contributed to a combination of various factors, such as aging and diseases related to aging.

Another important point of note is that Post-Traumatic Stress Disorder can reactive when veterans age, Boscarino said.

This may be due to loss of social support, or a change in job or family life, he said.

“It does recur,” Boscarino said. “It does re-emerge. Suicide can occur at that point.”

Understanding risk and prevention

Today, when doctors and researchers examine risk factors for PTSD and suicide, they also look at what can protect these patients.

“That’s important to do now,” he said.

Genes and personality traits, among other agents, attract focus in current studies to try to determine not only who might be susceptible, but how to possibly protect against it.

“We need to use that in therapy,” Boscarino said.

A Geisinger Health System study, released in March 2012, reconfirms specific genetic risks associated with PTSD. The study, which appeared in the journal Neuropsychiatric Disease and Treatment, hopes to identify better screening and treatment options for the condition, according to a press release by Geisinger.

Boscarino led the study which found that individuals with a certain set of “at-risk” genes were at seven times higher risk for lifetime PTSD than those without these genetic variants. Genetic screening of individuals for these genetic factors in the future may lead to better post-trauma treatments and genetic counseling related to career options in the military or in uniformed civil services, such as police work or firefighting, Boscarino said in the release.

“We believe our research has the potential to improve the lives of thousands of people who suffer from this debilitating condition,” he said.

Another study released by Geisinger Health System, and led by Boscarino, found that gender also plays a role when diagnosing PTSD.

A press release by Geisinger explains part of the study: “The study found that for men being screened for PTSD, depression symptoms and sleep disturbance may be the factors to be used to classify them as a PTSD case. The study found that for women being screened for PTSD, actual PTSD symptom onset and health care access issues may be … critical in classifying them as a PTSD case.”

Among others, Boscarino authored studies on “Mental Health Service Use After the World Trade Disaster” and “PTSD onset and course following the World Trade Center disaster: findings and implications for future research,” the first of which appeared in The Journal of Nervous and Mental Disease in February 2011.

Treatment and recovery

Dr. William Brim, deputy director at The Center for Deployment Psychology, said 100 percent of people will experience trauma in their lives, and mostly are able to get through these events and return to normal life. However, those with PTSD are in the 10 to 12 percent of the population who have not gotten past the “blockage” to a recovery.

As part of the Family Medicine Seminar Series, Brim presented “The Invisible Wounds of War: Understanding the Psychological Health Needs of Returning Soldiers,” at Mount Nittany Medical Center, which focused on helping soldiers with PTSD to remove the impediments to recovery, according to a press release by Mount Nittany Health.

In his presentation in February 2012, Brim said the “signature injury” of the Iraq and Afghanistan wars is PTSD, but there is hope for soldiers once they are able to get past the blockage.

Brim said, in his lecture, that one of the best protective factors for recovery from PTSD is social support, including friends, family, support groups and therapists, according to information provided by Mount Nittany Health.

Additionally, family members of those suffering from PTSD need help, too, Brim said. They need to recognize the symptoms of PTSD, which include anger, and not take it personally. They should develop an understanding and compassion for the person, and not “listen” to the disease talking. It’s important family members approach the person in a non-threatening way; for the person with PTSD, the world is not a safe place, he said.

Brim said PTSD is very treatable, and sometimes can be successful within a few months. Treatment often consists of talk therapy, occasionally with medication.

The Family Medicine Seminar Series is presented in collaboration with Mount Nittany Health and the Penn State College of Medicine.

Resources and information

According to Penn State Hershey Milton S. Hershey Medical Center, PTSD is an anxiety disorder that is brought on by memories of an extremely stressful event or series of events that cause intense fear, particularly of feelings of helplessness accompanied by the fear. That event may be war, physical or sexual assault or abuse, an accident (such as an airplane crash or motor vehicle accident) or a mass disaster. PTSD can be developed by someone the event happened to, or by someone who witnessed the event happening to someone else. It persists long after the event and is characterized by the intensity of feelings, how long they last, how the patient reacts to the feelings, and the presence of particular symptoms. More than 5 million adults in the United States are affected by PTSD each year.

Veterans Affairs statistics report 12 documented cases of major depressive disorders and 36 documented cases of PTSD in Centre County, based on a December 2011 study of Iraq-era veterans, according to Mount Nittany Health.

Penn State Hershey lists the following signs and symptoms associated with PTSD, which usually develop within the first three months after the event, but may not surface until months or even years later:

1. Intrusive thoughts recalling the traumatic event

2. Nightmares

3. Flashbacks

4. Efforts to avoid feelings and thoughts that either remind the person of the traumatic event, or that trigger similar feelings

5. Feeling detached or unable to connect with loved ones

6. Depression, hopelessness

7. Feelings of guilt from the false belief that the patient is responsible for the traumatic incident

8. Irritability or angry outbursts

9. Hyper vigilance, or being overly aware of possible danger

10. Hypersensitivity, including at least two of the following reactions: trouble sleeping, being angry, difficulty concentrating, startling easily, having a physical reaction (such as rapid heart rate or breathing, or increase in blood pressure.)

Certain factors increase the risk of PTSD, according to Penn State Hershey:

1. A history of sexual or physical abuse

2. Working in a high-risk occupation, such as firefighting, military or law enforcement

3. A history of depression or other psychological disorders

4. Abusing drugs or alcohol

5. Not having adequate social support

6. Women are twice as likely as men to show signs of PTSD

7. Veterans of war

8. Survivors of unexpected events, such as car wrecks, fires or terrorist attacks

9. Depression

10. Survivors of natural disasters

The U.S. Dept. of Veterans’ Affairs community-based outpatient clinic is located at 3048 Enterprise Dr., Ferguson Square, in State College. The clinic can be reached at (814) 867-5415.

The James E. Van Zandt VA Medical Center, located in Altoona, can be accessed at www.altoona.va.gov.

The Centre County Veterans’ Affairs office can be reached at (814) 355-6812. For more information about PTSD in veterans visit www.ptsd.va.gov.



Staff Writer at The Centre County Gazette
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