From Combat to Counseling: Comprehensive mental health in the military-affiliated population

It is important to understand what we are talking about when we discuss mental health in the military-affiliated population. As mental health professionals, it is equally important to understand the potential psychological impacts that our clients have experienced.

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Thrashing Sleep More Common Among Veterans With PTSD

Military veterans with post-traumatic stress disorder (PTSD) or concussion are much more likely to develop REM sleep behavior disorder (RBD) — a thrashing form of sleep behavior — compared to the general population, according to a new study published in the journal SLEEP.

Next, the researchers from the VA Portland Health Care System and Oregon Health & Science University (OHSU) want to investigate whether RBD might provide an early signal of neurodegenerative conditions such as Parkinson’s disease.

Typically, during REM (rapid eye movement) sleep, a person’s muscles are effectively paralyzed. In cases of RBD, however, the brain’s control of muscle paralysis is impaired, resulting in people acting out their dreams, sometimes causing injuries to themselves or their partners.

RBD is estimated to affect less than 1% of the general population. However, the researchers found that 9% of the 394 veterans in this study had RBD, and this number increased to 21% among those with PTSD.

“This is important because, in the general population, RBD has been linked to Parkinson’s disease, and RBD often precedes classic symptoms of Parkinson’s by years,” said senior author Miranda Lim, M.D., Ph.D., a staff physician at the VA and assistant professor of neurology, medicine and behavioral neuroscience in the OHSU School of Medicine.

“We don’t know whether veterans who have PTSD and higher rates of RBD will go on to develop Parkinson’s, but it is an important question we need to answer.”

Researchers suspect chronic stress on the brain may play a role in causing the sleep disorder in veterans with PTSD, as many veterans have been exposed to concussion which potentially accelerates neurodegenerative processes.

Each participant underwent an overnight sleep study at the VA Portland Health Care System between 2015 and 2017 to determine the presence of dream enactment during episodes of REM sleep. Muscle activity was monitored constantly during the 8 hours of the study in order to diagnose RBD. The findings show that participants with PTSD had over 2-fold increased odds of RBD compared to veterans without PTSD.

“RBD seems to be highly prevalent in veterans with a history of trauma,” said lead author Jonathan Elliott, Ph.D., a research physiologist at the Portland VA and assistant professor of neurology in the OHSU School of Medicine.

Doctors involved in the study, including co-authors Kristianna Weymann, Ph.D., R.N., a clinical assistant professor in the OHSU School of Nursing, and Dennis Pleshakov, a student at the OHSU School of Medicine, will continue to track research participants with RBD, looking for early signs of Parkinson’s or other neurodegenerative conditions.

Although there are several approaches to ease certain Parkinson’s symptoms, including tremor and fatigue, there is no definitive therapy to prevent the condition.

Clinical trials for promising therapies are usually conducted well after patients have been diagnosed with Parkinson’s, at a stage which may be too late to reverse the symptoms. Lim said that identifying patients with RBD presents an opportunity to identify people earlier in the disease course, and potentially provides a more viable window to test promising interventions.

“By the time a patient shows classic symptoms of Parkinson’s, it may be too late,” Lim said. “If you could intervene when people first start to show RBD, maybe you could prevent later symptoms of Parkinson’s.”

Source: Oregon Health & Science University

 

Veterans With Traumatic Brain Injury More Than Twice as Likely to Die by Suicide

Military veterans with a history of traumatic brain injury (TBI) are more than twice as likely to die by suicide compared to veterans without a TBI diagnosis, according to a new study appearing in the Journal of Head Trauma Rehabilitation.

In addition, among all veterans who died by suicide, the odds of using firearms as a means of suicide was significantly increased for those with moderate or severe TBI compared to those without a history of TBI.

For the study, a research team led by the University of Colorado (CU) School of Medicine looked at the electronic medical records of more than 1.4 million military veterans who had received care from the Veterans Health Administration (VHA) between Oct. 1, 2005 and Sept. 30, 2015.

Combining these records with National Death Index data, the team assessed the severity of TBI, and diagnoses of psychiatric and other medical conditions. Among those that died by suicide, the method was also analyzed.

After adjusting for psychiatric diagnoses, such as depression, the research team discovered that those with moderate or severe TBI were still 2.45 times more likely to die by suicide compared to those without a TBI diagnosis.

“Together, these findings underscore the importance of understanding Veterans’ lifetime history of TBI to prevent future deaths by suicide, and support the implementation of screening initiatives for lifetime history of TBI among all individuals utilizing the VHA,” the researchers write.

The findings also support the need for more research into suicide safety among those with moderate to severe TBI.

During the period of time they studied, the rate of suicide was 86 per 100,000 person years for those with TBI compared with 37 per 100,000 person years for those without TBI.

“Person years” is a type of measurement which takes into account both the number of people in the study and the amount of time each person spends in the study.

Overall, among those in the sample who died by suicide, 68 percent used firearms. Veterans with moderate or severe TBIs had the highest proportion of suicides by firearms at 78 percent.

The corresponding author of the article is Lisa A. Brenner, PhD, professor of physical medicine and rehabilitation at the CU School of Medicine and director of the Veterans Health Administration Rocky Mountain Mental Illness Research Education and Clinical Center, which supported the project.

Source: University of Colorado Anschutz Medical Campus

 

Sweat-Triggered Brain Stimulation Proposed for PTSD, Other Disorders

A new study in Frontiers in Neuroscience suggests that a closed-loop brain stimulator, based on sweat response, can be developed not only for PTSD patients, but also for those who suffer an array of neuropsychiatric disorders.

believes the new or additional approach presents great value. The study is published in Frontiers in Neuroscience.

“Sweat primarily helps maintain body temperature; however, tiny bursts of sweat are also released in response to psychologically arousing stimuli,” said researcher Dr. Rose T. Faghih, University of Houston assistant professor of electrical engineering.

“Tracking the associated changes in the conductivity of the skin, which can be seamlessly measured using wearables in real-world settings, thus provides a window into a person’s emotions,” she said.

The research builds on the success of prior ES interventions for people with movement disorders. Currently, people with Parkinson’s disease and essential tremor, who have not responded to medication, often received significant benefit from the application of high-frequency electric current to the brain, or deep brain stimulation.

Electrodes are placed in certain areas of the brain to regulate abnormal functions and a pacemaker-like device, placed in the upper chest, controls the amount of stimulation the brain receives.

Open-loop stimulators, the most widely-used, deliver continuous stimulation until manually re-adjusted by a physician.

The new intervention takes the concept a step farther with closed-loop stimulators. These devices provide stimulation in response to biomarkers of pathologic brain activity. The technique was developed for movement disorders, but have yet to be explored for the treatment of neuropsychiatric disorders.

Faghih explains that prior to the onset of a PTSD episode, the skin develops the tiniest sheen of perspiration. That symptom of the body’s fight or flight response signals a change in the skin’s electrical conductivity and provides a window into the brain’s state of emotional arousal. This warning sign can then activate the brain stimulator and mitigate the distress an individual may experience.

The concept of using skin conductance to create the framework for a deep brain stimulator seemed logical to Faghih after reviewing group studies of Vietnam combat veterans with PTSD.

Among the findings, PTSD subjects had the largest skin conductance responses when confronted with combat-related words. In a similar study comparing Vietnam combat veterans with and without PTSD and non-combat controls, PTSD veterans had the highest baseline skin conductance levels.

“Skin conductance additionally has the advantage of being easily measured with wearable devices that afford convenience, seamless integration into clothing and do not involve risk of surgically implanted sensors,” said Faghih.

The ultimate goal will be to develop closed-loop prototypes that can eventually be used for treating patients in a variety of neuropsychiatric disorders.

Faghih’s graduate researchers Dilranjan Wickramasuriya and Md. Rafiul Amin were first and second authors, respectively, of the article.

Source: University of Houston

From Combat to Counseling: Service members, veterans and military family mental health

There are not enough veterans in the counseling career field serving others in the military population. At the same time, that truth does not minimize the need for mental health counseling for the military population.

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Combat Veterans at Increased Risk of Mental Health Concerns

New research suggests military veterans exposed to combat have an increased risk of developing depression and anxiety in later life than veterans who had not seen combat.

Oregon State University investigators explain that before the new study, the role of combat exposure on aging and in particular on the impacts of combat on mental health in late life had received scant attention.

The new findings suggest that military service, and particularly combat experience, is a hidden variable in research on aging, said Carolyn Aldwin, director of the Center for Healthy Aging Research and one of the study’s authors.

“There are a lot factors of aging that can impact mental health in late life, but there is something about having been a combat veteran that is especially important,” Aldwin said.

The findings appear in the journal Psychology and Aging. The first author is Hyunyup Lee, who conducted the research as a doctoral student at OSU; co-authors are Soyoung Choun of OSU and Avron Spiro III of Boston University and the VA Boston Healthcare System. The research was funded by the National Institutes on Aging and the Department of Veterans Affairs.

Although many aging studies ask about participants’ status as veterans, most do not investigate the differences between those who were exposed to combat and those who weren’t.

In the new review, researchers explored data from the Veterans Affairs Normative Aging Study. This dataset stems from a longitudinal study that began in the 1960s to investigate aging in initially healthy men. The researchers then explored the relationship between combat exposure and depressive and anxiety symptoms, as well as self-rated health and stressful life events among the veterans.

They found that increased rates of mental health symptoms in late life were found only among combat veterans. The increases were not seen in veterans who had not been exposed to combat.

Generally, mental health symptoms such as depression and anxiety tend to decrease or remain stable during adulthood but can increase in later life. The researchers found that combat exposure has a unique impact on that trajectory, independent of other health issues or stressful life events.

“In late life, it’s pretty normal to do a life review,” Aldwin said. “For combat veterans, that review of life experiences and losses may have more of an impact on their mental health. They may need help to see meaning in their service and not just dwell on the horrors of war.”

Veterans’ homecoming experience may also color how they view their service later in life, Aldwin said. Welcoming veterans home and focusing on reintegration could help to reduce the mental toll of their service over time.

Most of the veterans in the study served in World War II or Korea. Additional research is need to understand more about how veterans’ experiences may vary from war to war, Aldwin said.

Aldwin and colleagues are currently working on a pilot study, VALOR, or Veterans Aging: Longitudinal studies in Oregon, to better understand impacts of combat exposure. The pilot study includes veterans with service in Vietnam, the Persian Gulf and the post-9/11 conflicts.

The researchers have collected data from 300 veterans and are beginning to analyze it. Based on their initial findings, they are also planning a second, larger study with more veterans. They expect to see differences between veterans from different wars.

“Each war is different. They are going to affect veterans differently,” Aldwin said. “Following 9-11, traumatic brain injuries have risen among veterans, while mortality rates have lowered. We have many more survivors with far more injuries. These veterans have had a much higher levels of exposure to combat, as well.”

VALOR also offers researchers the opportunity to explore the impact of service on women veterans, whose experiences have not often been captured in previous research. About one-third of the participants in the pilot study were female veterans, Aldwin said.

Source: Oregon State University