Social Work Today E-Zine

Certain circumstances may predict suicidal thinking or behavior among teens with treatment-resistant major depression who are undergoing second-step treatment, according to an analysis of data from a study published online in the American Journal of Psychiatry.

In the Treatment of SSRI-resistant Depression in Adolescents (TORDIA) study, 334 teens who did not get well after taking a selective serotonin reuptake inhibitor (SSRI) before the trial were randomly assigned to one of four treatments for 12 weeks: switched to another SSRI; switched to venlafaxine (Effexor); switched to another SSRI with added cognitive behavioral therapy (CBT); or switched to venlafaxine with added CBT.

Results showed that teens who received combination therapy, with either type of antidepressant, were more likely to get well than those on medication alone. Using data from spontaneous reports by the participants and from systematic assessment by clinicians, researchers aimed to identify characteristics or circumstances that may predict whether a teen is likely to have suicidal thoughts or behavior during treatment.

Fifty-eight suicidal events—which include serious suicidal thinking or a suicide attempt—occurred in 48 participants during the trial, most of which happened early in the trial. The researchers found that teens who had higher levels of suicidal thinking, higher levels of parent-child conflict, and who used drugs or alcohol at the trial's beginning were more likely to experience a suicidal event during treatment and less likely to respond to treatment. They were also less likely to have completed treatment.

— National Institute of Mental Health

The American College of Occupational and Environmental Medicine (ACOEM) has formally adopted a new position statement on depression in the workplace—a condition it says is an increasing drain on workforce productivity.

In its statement, “Depression in the Working Population,” the ACOEM identifies workplace depression as a major contributor to absenteeism and presenteeism (a condition in which workers are on the job, but not fully functional) among employers, with an estimated cost of $36 billion in lost productivity per year.

The new position statement provides a comprehensive update on the incidence and impact of workplace depression and calls for a new approach to managing the disorder, including programs to improve coping skills, screening programs, and the promotion of early treatment.

Among the findings in the ACOEM’s new statement:

• Only about half of depressed workers are receiving any treatment and less than one half of these receive care that is consistent with current treatment guidelines for organizations such as the American Psychiatric Association.

• Because so few workers are treated for depression, workplace productivity is impacted significantly. Studies show increases in absenteeism and unemployment, as well as disruptive effects on work organization and increased health and disability costs.

• Depression tends to strike workers earlier than other chronic diseases and may affect productivity for a much longer period. Unlike conditions such as cardiovascular disease or hypertension, depression often strikes very early in a worker’s career, creating a disease burden that may last for decades in the workplace.

— Source: American College of Occupational and Environmental Medicine

Interpreting and expressing emotion are defining characteristics of being human. The psychiatric rehabilitation community confirmed in recent years that as many as 50% of patients with traumatic brain injury (TBI) had lost this ability. Based on his pilot-study results, Barry Willer, a University at Buffalo professor of psychiatry and a specialist in TBI, has received a grant to carry out a three-year controlled trial of his affect recognition training program. It is the first structured intervention designed to treat this disability among those with brain injury.

These interventions, which now are being tested in the three-year trial, are titled "facial affect recognition" (FAR), and "stories of emotional inference" (SEI). The investigation will randomize 108 participants with TBI into one of these two groups or to a control training group.

Participations in the FAR group will view faces on a computer screen equipped with cues that direct them to concentrate on specific elements of each face. "Look at the eyes. What are the eyes doing? What is the mouth doing?" .and asks them to name the emotion. The SEI intervention uses examples to teach what a person is likely to be feeling in various situations. Participants randomized to this group are asked to read stories on the computer that describe events, along with character's beliefs, wants and behaviors. From this information, participants are asked to infer the emotions imbedded in the story. The control group will receive computer-based educational instruction in areas such as banking or applying for a job, and will learn how to use Word and Excel programs and how to search the Internet.

Perhaps the most important observation from Willer's research is the plasticity of the neural structures involved with affect recognition. "What was so exciting about our preliminary study," says Willer, " is that someone may lose the ability to recognize emotions, but even 10 years later, they can relearn the skill if given the right assistance."

— Source: The University at Buffalo

Doctors may be able to use certain cognitive tests to help determine whether a person with Alzheimer's disease can safely get behind the wheel. The research is published in Neurology.

"The number of people with dementia is increasing as our population ages, and we will face a growing public health problem of elderly drivers with memory loss," says study author Jeffrey Dawson, ScD, of the University of Iowa in Iowa City.

In the study, 40 drivers with early Alzheimer's disease and 115 elder drivers without this diagnosis underwent a combination of off-road tests that measured thinking, movement, and visual skills. The participants also drove a 35-mile route in and outside the city. Driving safety errors were recorded by a driving expert, based on a video review of the drive.

The research found drivers with Alzheimer's disease committed an average of 42 safety mistakes, or 27% more than the drivers without Alzheimer's disease, who made an average of 33 safety errors on the test drive. The most common mistakes were lane violations. For every five years older the participant was, the number of safety errors went up by about two and a half, whether or not they had Alzheimer's disease.

Among drivers with Alzheimer's disease, those who performed better on the off-road tests made fewer on-road safety errors. "The goal is to prevent crashes while still maximizing patients' rights and freedom to be mobile," says Dawson. "By measuring driver performance through off-road tests of memory, visual, and motor abilities, we may be able to develop a standardized assessment of a person's fitness to drive."

— Source: American Academy of Neurology

An National Institute of Mental Health-funded program already shown to reduce risky sexual and substance abuse behavior among HIV-infected adults also appears to be effective in improving the lives of HIV-infected homeless or near-homeless adults, according to a new report published in the American Journal of Public Health.

Researchers examined the effectiveness of the Healthy Living Program among a subgroup of HIV-positive adults. The program was designed for HIV-infected adults in general who continued to engage in risky behavior after learning of their infection. It consists of three intervention modules of five sessions each, designed to help participants reduce risky sexual behavior and drug use, improve their quality of life, and stick to healthy behaviors. For this study, the authors analyzed data from 270 participants who were homeless or had been homeless in the three years prior to and during the study.

Compared with a control group who did not receive the Healthy Living intervention, the authors found a significant reduction of risky sexual behavior among the subgroup. Up to 34% fewer risky sexual acts took place, and 72% fewer sexual encounters occurred with partners who were HIV negative or of unknown HIV status. In addition, individuals in the subgroup experienced up to 26% fewer days of alcohol, marijuana, and hard drug use.

Future research into intervention programs such as Healthy Living are needed to identify the most effective components and determine if the programs can be applied on a wider scale. Future research also can examine how, in what format, and by whom the next generation of programs can be implemented.

— Source: National Institute of Mental Health

Growing up with a heroin-addicted parent exposes children to a variety of detrimental experiences before the age of 18 and new research indicates that girls are four times more resilient than boys in overcoming such adverse events, according to a study published in the Journal of Adolescent Health.

In addition to having a heroin-addicted parent, these experiences include family mental illness, having a parent jailed, family violence, being a victim of abuse and having a parent die, and the study found 70% of the children were exposed to two or more of these events. In addition, 62% had three or more adverse experiences and 22% reported four or more. By contrast, just 3% reported no adverse experiences other than having an opiate-dependent parent.

“What we mean by resilience is a reasonable transition to adulthood by working or being in school, avoiding substance abuse and staying out of trouble with the law in the past five years, says Martie Skinner, PhD, a research scientist with the University of Washington’s Social Development Research Group and lead author of the study. “These seem like ordinary expectations, but only 30 of the 125 young adults we studied met them.” Women were more likely to be resilient, primarily because males were more likely to have had criminal charges, she adds.

In addition to having a drug-addicted parent, the most common detrimental events experienced during childhood in the study were having a parent who was jailed (84%) and having mental illness in the family (78%).

— Source: University of Washington

In a study published in The American Journal of Psychiatry, a team of researchers led by Mayo Clinic psychiatrist Mark Frye, MD, attempted to identify what factors make some people with bipolar depression more likely to experience treatment-emergent mania (TEM). “TEM is a serious and sometimes volatile adverse event, and we wanted to better understand who was at risk for developing this problem,” says Frye.

Frye’s team did a secondary analysis of data obtained in an earlier study that followed 176 study participants diagnosed with bipolar depression to measure the effectiveness of three different antidepressants. The secondary analysis focused on 44 patients who experienced TEM after starting an antidepressant. Frye’s team compared this TEM group with 84 patients who responded favorably to an antidepressant and 44 patients who stopped taking the antidepressant due to lack of effectiveness or worsening depressive symptoms.

“We found that people who had minimal manic symptoms or a ‘mixed depression’ presentation were at greatest risk for experiencing TEM,” says Frye. Experts have begun to acknowledge that the common understanding of bipolar illness, once thought to be a disorder with two distinct phases, may be incomplete. A recent study of more than 1,300 patients reported that two thirds of the depressed bipolar patients had minimal or mild manic symptoms “mixed” together.

“We’re learning that this illness does not occur in two neat, clear-cut phases, but rather a mix of the two,” says Frye. “Our data would suggest that people with mixed depression may need to stay away from antidepressants and work with their health care providers to find alternative treatments, such as mood stabilizers, to help manage the depressive phase of their illness.”

— Source: Mayo Clinic

Caregivers of children with special healthcare needs often do not get the respite care they need, according to the findings of a study by researchers at Wake Forest University Baptist Medical Center. Researchers found that families with private insurance have more unmet respite care needs than those with public coverage. They also found that families or caregivers who need respite care the most—those caring for children with the most severe functional limitations and unstable conditions—often do not get it.

"This is an issue that doesn't get a lot of attention," says Savithri Nageswaran, MD, MPH, lead researcher for the study and a pediatrician at Brenner Children’s Hospital of Wake Forest Baptist. Respite care, or temporary relief from caregiving, provides much needed help to families and caregivers in the form of a break from caregiving duties.

The findings, published in the Archives of Pediatrics & Adolescent Medicine, showed that 24% of caregivers who need respite care have unmet needs. Of those survey respondents who reported unmet respite care needs, 26% reported a lack of availability of services and transportation problems as the reason behind the unmet need, 22% said respite care would cost too much and 13% reported health care problems as the reason.

In addition, the study shows that caregivers with public insurance have far fewer unmet respite care needs than those with private insurance. Nageswaran suggested that this may be because many private insurance plans are not comprehensive enough to provide support services such as respite care for children with special needs. "If it is not enough, we need to advocate for more comprehensive insurance coverage for our children," she says.

— Source: Wake Forest University Baptist Medical Center

Youth programs that include boring or difficult tasks are more likely to develop responsibility in teenagers than those that are all fun and games, according to a study of youth programs and responsibility by a Wake Forest University psychologist that appeared in Child Development.

“Some programs for young people probably focus so much on entertaining members that they shy away from the activities that are most likely to help members become more responsible,” says Dustin Wood, PhD, an assistant professor of psychology at Wake Forest and lead author of the study.

Wood and his colleagues surveyed 107 high school students in 11 extracurricular programs. The programs ranging from 4-H and a high school play production to a community-based youth activist group. Wood wanted to find out what characterizes programs that foster responsibility and determine the role that demands and expectations play in the process.

The teens were interviewed about their experiences in the program and asked how they had changed from participating in the program. The researchers also gathered information from interviews with the programs’ adult leaders as well as from site observations.

About one quarter of the students reported becoming more responsible. These youths consistently mentioned performing tasks within their programs as a key to developing responsibility, Wood says. Volunteering for specific tasks was also an important element in the development of responsibility. When teens willingly took on tasks, they were more likely to persevere and to later indicate that they had become more responsible.

Program leaders also influenced the development of responsibility, Wood says. Youths reported becoming more responsible when leaders had high expectations for them. “Leaders who encouraged youth to take ownership over demanding tasks and roles provided conditions for youth to demonstrate that they could be depended on in meaningful situations,” he says.

— Source: Wake Forest University

Bipolar disorders appear to increase the risk of early death from a medical illness, according to a literature review study published in Psychiatric Services. The researchers comprehensively reviewed 17 studies involving more than 331,000 patients. Evidence suggested that people with bipolar disorder have a higher mortality from natural causes compared with people in the general population of similar age and gender but without mental illness.

The various studies indicated that the risk was from 35% to 200% higher. The risk is the same for men and women. The most common conditions leading to premature death were heart disease, respiratory diseases, stroke, and endocrine problems such as diabetes. "The review of data gathered from large population studies suggests that having bipolar disorder is similar to being a smoker in terms of increasing a person's risk of early death," says Wayne J. Katon, MD, a University of Washington professor of psychiatry.

In the past, the higher premature death rate among people with bipolar disorder was attributed to a higher rate of suicide and accidents. More recently, researchers are finding that suicides and accidents only partly account for the higher premature death rate. Emerging evidence shows that the majority of early deaths among people with bipolar disorder come from medical conditions.

Many factors could be contributing to poor physical health among people with bipolar disorder. These include unhealthy diet, binge eating, lack of exercise, smoking, substance abuse, biological abnormalities, social deprivation, living alone, homelessness, lack of access to health services, biased attitudes of health professionals towards people with psychiatric illnesses, medication side effects, failure among psychiatrists to address their patient's medical problems, or delaying medical care because of the overriding need for psychiatric treatment.

— Source: University of Washington Health Sciences and Medicine

This Valentine's Day, researchers at the University of Iowa have some new answers to the perennial question of what men and women want in a partner. Men are increasingly interested in an educated woman who is a good financial prospect and less interested in chastity. Women are increasingly interested in a man who wants a family and less picky about whether he's always Mr. Nice Guy.

That's according to a study by University of Iowa sociologists Christine Whelan, PhD, a visiting assistant professor of sociology, and Christie Boxer. They analyzed results of a 2008 survey of more than 1,100 undergraduates at the University of Iowa, the University of Washington, the University of Virginia, and Penn State University, comparing the results with past mate-preference studies.

In the 1930s male respondents were seeking a dependable, kind lady who had skills in the kitchen. Chastity was more important than intelligence. Now, guys look for love, brains and beauty—and a sizable salary certainly sweetens the deal. Chastity, which men ranked at No. 10 in 1939, fell to dead last in 2008.

For women of the 1930s, emotional stability, dependable character, and ambition ranked as the top three characteristics they wanted in a man. Attraction and love didn't come in until No. 5. Today, women, like men, put love at the top of the list, with dependability and emotional stability rounding out the top three characteristics in Mr. Right.

— Source: University of Iowa Health Sciences

People with mental illness alone are no more likely than anyone else to commit acts of violence, a new study by University of North Carolina (UNC) researchers concludes. But mental illness combined with substance abuse or dependence elevates the risk for future violence.

“Our study shows that a link between mental illness and violence does exist, but it’s not as strong as most people think,” says Eric B. Elbogen, PhD, lead author of the study and assistant professor in the forensic psychiatry program at the UNC at Chapel Hill School of Medicine.

“We found that several other factors, such as a history of past violence or substance abuse or a recent divorce or loss of one’s job, are much more predictive of future violence than mental illness alone,” Elbogen says. “Only when a person has both mental illness and substance abuse at the same time does that person’s risk of future violence outweigh anyone else’s.”

The study is published in the Archives of General Psychiatry. To arrive at the findings, researchers conducted statistical analyses of data collected previously as part of the National Epidemiologic Survey on Alcohol and Related Conditions. A total of 34,653 people completed interviews during the two waves. Wave 1 took place from 2001 to 2002 while wave 2 was from 2004 to 2005. Wave 1 data on severe mental illness, including schizophrenia, bipolar disorder and major depression, were analyzed to predict wave 2 data on violent behavior.

The results show “that if a person has severe mental illness without substance abuse and history of violence, he or she has the same chances of being violent during the next 3 years as any other person in the general population,” the authors wrote.

— Source: University of North Carolina at Chapel Hill School of Medicine

School children who receive more recess behave better and are likely to learn more, according to a large study of third-graders conducted by researchers at Albert Einstein College of Medicine of Yeshiva University. The study, published in Pediatrics, suggests that a daily break of 15 minutes or more in the school day may play a role in improving learning, social development, and health in elementary school children.

Romina M. Barros, MD, an assistant clinical professor of pediatrics at Einstein, and colleagues looked at data on approximately 11,000 third-graders aged 8 to 9 who were divided into two categories: those with no or minimal recess (less than 15 minutes a day) and those with more than 15 minutes a day. The children’s classroom behavior was assessed by their teachers using a questionnaire.

According to the American Academy of Pediatrics, free, unstructured play is essential for keeping children healthy, and for helping them reach important social, emotional, and cognitive developmental milestones. Unstructured play also helps kids manage stress and become resilient.

A 2005 survey conducted by the National Center for Education Statistics showed that the 83% to 88% of children in public elementary schools have recess of some sort. But the number of recess sessions per day and the duration of the recess periods have been steadily declining. Since the 1970s, children have lost about 12 hours per week in free time, including a 25% decrease in play and a 50% decrease in unstructured outdoor activities.

“When we restructure our education system, we have to think about the important role of recess in childhood development," adds Barros. "Even if schools don't have the space, they could give students 15 minutes of indoor activity. All that they need is some unstructured time."

— Source: Albert Einstein College of Medicine of Yeshiva University

A University of South Carolina study shows that key indicators of child maltreatment, such as abuse injuries and foster placements, drop when parents community-wide are offered access to proven parenting interventions. The findings were published in Prevention Science.

Ron Prinz, PhD, at the University of South Carolina led the study. Conducted in 18 South Carolina counties, nine of which were chosen randomly for the parenting intervention, the prevention study was the first to reduce child maltreatment in a test involving several large geographic areas.

Called Triple P (Positive Parenting Program), which was developed by study coinvestigator Matt Sanders, PhD, at the University of Queensland, this system of strategies and tools provides parents with multiple levels of parenting support of increasing intensity to match each family’s needs. Triple P was made available to parents with children from birth to the age of 12 throughout each community, not just parents in crisis.

The study found that implementing Triple P broadly led to lower rates of confirmed child maltreatment, foster-care placements, and child injuries requiring hospital treatment. For the participating communities, which had about 100,000 children under the age of 8, the observed effects actually meant 688 fewer maltreated children, 240 fewer out-of-home placements, and 60 fewer injured children.

“We capitalized on the existing workforces in the intervention counties, expanded the range of workers and practitioners who could provide proven parenting supports, and publicized easy access to parenting support,” says Sanders.

— Source: University of South Carolina

New UCLA research has shown that certain marginalized groups, including people with mental illness or disabilities and ethnic minorities, experience greater terrorism-related fears and make more behavioral changes based on those fears, such as avoiding certain activities, than others. These groups also tend to overestimate the threat of terrorism, perceiving the risk as high even when the Homeland Security Advisory System's (HSAS) color-coded alert system rates it lower. The study was published in the American Journal of Public Health.

"Just like natural disasters have been shown to affect certain groups of people more than others, we're now seeing evidence that terrorism fears are having a disproportionate effect on some of our most vulnerable groups," says leady study author David P. Eisenman, MD, an assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.

The findings are based on random-digit dial surveys conducted in six languages in Los Angeles County between October 2004 and January 2005. Respondents were asked the color of the country's alert level at that time, as well as how often they worried about terrorist attacks and how often they avoided activities because of those fears.

Researchers found that those with mental illness or disability and African Americans, Latinos, Chinese Americans, Korean Americans, and non-U.S. citizens were likelier to think the HSAS alert level was higher than it was, and to worry more and change their behavior due to those fears.

— Source: UCLA Health Sciences

According to new research, our place in a social network is influenced in part by our genes. The study, published in the Proceedings of the National Academy of Sciences, is the first study to examine the inherited characteristics of social networks and to establish a genetic role in the formation and configuration of these networks.

“We were able to show that our particular location in vast social networks has a genetic basis,” says Nicholas Christakis, MD, PhD, MPH, a professor of sociology and medical sociology at Harvard. “In fact, the beautiful and complicated pattern of human connection depends on our genes to a significant measure.”

The researchers found that popularity, or the number of times an individual was named as a friend, and the likelihood that those friends know one another were both strongly heritable. Additionally, location within the network, or the tendency to be at the center or on the edges of the group, was also genetically linked. However, the researchers were surprised to learn that the number of people named as a friend by an individual did not appear to be inherited.

The study included national data (from the National Longitudinal Study of Adolescent Health) for the social networks of 1,110 adolescent twins, both fraternal and identical. The researchers compared the social networks of the identical twins to those of the fraternal twins and found greater similarity between the identical twins’ social network structure than the fraternal twins’ networks.

— Source: University of California, San Diego

Despite recent government efforts, the medical needs of about 6 million children in the United States are not being met, according to data from as recent as 2006. Even more troubling, researchers say, is the growth in those numbers from approximately 4.5 million children in 1998.

Children without insurance and children without a regular source of healthcare are the most likely to report unmet medical needs, suggesting that improvements are essential in government efforts to address the health of vulnerable children, according to a new study from the University of Michigan C.S. Mott Children’s Hospital. The study appears in the journal Pediatrics.

Researchers from the Child Health Evaluation and Research Unit in the University of Michigan division of general pediatrics set out to find how the proportions of publicly insured children (Medicaid and the State Child Health Insurance Program) and uninsured children without a usual source of care had changed from 1998 to 2006.

The time period in the study was chosen so that researchers could evaluate the influence of two federal programs in providing a usual source of care for vulnerable children. Researchers found significant decreases in the proportions of children that were privately insured. In addition, increasing proportions of uninsured children reported having no usual source of care during the study period.

Compared with a child covered with private insurance, the odds of reporting unmet medical needs increased steadily among uninsured children between 1998 and 2006, from 4.7 to 6.2. In addition, the odds of reporting unmet medical needs among children without a usual source of care rose from 3.7 to 5.3 compared with children who identified care provider.

— Source: University of Michigan Health System

A team of psychiatric researchers based at the University of Manitoba has found a possible relationship between a person’s attendance at a religious worship service and his or her desire to commit suicide. The study, published in the Journal of Affective Disorders, was conducted using data drawn from the Canadian Community Health Survey on almost 37,000 Canadians across the country.

Daniel Rasic, PhD, the study’s primary author, says, “The main finding of this study is that religious worship attendance is associated with a decreased risk of suicide attempts.” However, the study made a distinction between people who call themselves “spiritual” and those who also regularly attend religious services. The former category did not show a decreased inclination to commit suicide, suggesting something more was involved, related to the actual attendance at a religious event occurring in a church, mosque, temple, or other spiritual gathering.

In the general population, those identifying themselves as at least somewhat spiritual were significantly less likely to report a past year suicide attempt than those not considering themselves spiritual in nature. However, this finding was not significant after adjusting for the influence of social supports such as support groups, counseling, and community networking.

Rasic cautions that the survey did not look at why the decrease in suicide attempts was related to religious worship. “The causality of relationships cannot be inferred from this study,” he notes.

Among people with a history of mental illness—those at the highest risk of suicide—religious attendance appears associated with a decrease in suicide attempts. But simply being “spiritual” was not significant enough to reduce the effect. “Further study into the relationship between active spiritual practice and suicidal behaviour is needed,” Rasic says.

— Source: University of Manitoba

The proposed federal expansion of the State Children’s Health Insurance Program (SCHIP) should help improve children with disabilities’ access to services, but more needs to be done at the state level to meet their needs, according to a new study from the University of North Carolina at Chapel Hill. The study, published in Children and Youth Services Review, examined data of nearly 39,000 children from the 2002 National Survey of Children with Special Health Care Needs.

Susan Parish, MSW, PhD, an assistant professor at the university’s School of Social Work and the study’s lead author, found that families raising children with disabilities are struggling to get services in states where qualifications for the public health insurance program are less generous, meaning that they earn too much to qualify for the insurance program based on their state’s income limits.

“The evidence is compelling and overwhelmingly confirms the need to expand and strengthen health insurance coverage for children with disabilities and their families,” she says. “Without assistance, families face high out-of-pocket costs. The tangible support provided by the SCHIP program materially influences the supports a family receives.”

Some states are more generous than others, Parish notes. In Tennessee and Arkansas, for example, children are ineligible for state health insurance if their family’s household income exceeds the poverty level or $21,200 for a family of four. In New Jersey, however, a child qualifies as long as their family’s income isn’t more than three- and-a-half times the poverty level or $74,200.

“The bottom line is we need some form of affordable health insurance for all children, regardless of their disabilities, which would go a long way toward solving these problems,” says Parish.

— Source: University of North Carolina at Chapel Hill

Individuals undergoing mental health treatment prior to exposure to a traumatic event are twice as likely to experience posttraumatic stress disorder (PTSD) within 12 months, according to a new study. In the study, Geisinger Center for Health Research senior investigator Joseph Boscarino, PhD, MPH examined risk factors for poor health outcomes immediately following the traumatic event and two years later in more than 2,000 adult victims of the World Trade Center disaster. This study was published in the International Journal of Emergency Mental Health.

Low self esteem, negative life events, and lack of a support network greatly increase the likelihood of PTSD, the study showed. Those most resilient to mental health problems following this traumatic event were male, older, with higher self esteem, and a strong support network. Generally these individuals had no history of mental health issues prior to the traumatic event and less exposure to long-term and short-term trauma and stress. While the intensity of trauma was a significant PTSD risk factor during the first 12 months post exposure, at a two-year check it appeared no longer significant.

PTSD can set in immediately or months after a traumatic event. According to Boscarino, the condition often occurs when someone has experienced a life-threatening event that evokes fear or a feeling of helplessness. Symptoms of the condition can include anxiety, flashbacks, and an emotional numbness.

While PTSD symptoms immediately following a traumatic event appear more commonly in younger persons, women, those with low self esteem, and those with a history of depression, delayed PTSD is more common among Hispanics nonnative born persons, females, those with low self esteem and/or exposed to negative life events. In general, African Americans were found to have a lower incidence of PTSD.

— Source: Geisinger Health System