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Traumatic Stress in the Military

In the past eight years, the United States has experienced a series of manmade and natural disasters. Large numbers of people in this country have been exposed to potentially traumatic events. In this National Institute of Mental Health (NIMH) video, Drs. Robert Heinssen and Farris Tuma discuss NIMH research in the areas of traumatic stress reactions and specifically mental health issues among U.S. service members. What we learn from the military experience can help us understand stress risk predictions for the entire population.

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Description

Introduction: (Narrator, Jim McElroy) In today's "Speaking of Science" Vodcast-Natural disasters and violent attacks have combined in recent years to make all of us aware of the mental and emotional repercussions of exposure to traumatic events.

Dr. Robert Heinssen, the Acting Director of the Division of Services and Intervention research at NIMH is joined by Dr. Farris Tuma, Chief of the institute's traumatic stress research program. Their discussion centers on NIMH efforts to deal with the affects of trauma in both the military and civilian populations.

Dr. Tuma can you tell us about research that NIMH has supported since 2001 to increase our scientific understanding of traumatic stress reactions?

Dr. Tuma: I’d start off by saying a fair amount has been learned about acute stress reactions in human response to trauma and extreme trauma. What we know from prior research is that most people, including you and I exposed to something extremely stressful and traumatic, are likely to have some symptoms that look like disturbances in sleep, meaning difficulty sleeping and concentration were likely to be somewhat agitated and easily aroused. And this, of course, plays out in how we relate to people at work, at home, at other functions of our life.

The issue that we’re most concerned about is the significant minority of people for whom they don’t resolve, and they go on to develop conditions like depression, anxiety disorders including post traumatic stress disorder.

Dr. Heinssen: So first let me see if I understand this. So you’re saying that after these events happen, like the terrorist attacks or the natural disasters, just about everybody is prone to having these strong reactions that you mentioned.

Dr. Tuma: That’s right and one of the most challenging topics—and you’ve asked about research that we’ve been funding. One of the most challenging problems is understanding, among all those people who are trauma-exposed and have these acute reactions, who is likely to not have that recovery trajectory, or to get better essentially on their own without formal treatment or intervention. And this has been a major thrust of our investments in the last several years. Some of this is being done at universities with academic investigators. Some of it in collaboration with the Departments of Defense and Veterans Affairs focused around military, active duty military and separated veterans. But our efforts are broader in terms of trying to learn this risk prediction information because we think it will be very useful for the U.S. population in general, which is exposed to a lot of trauma, and globally and elsewhere. So this has been a major focus of our research.

Dr. Heinssen: So prevention may be something that is a possibility for the future, but we may not be able to do that today. But what can we do today?

Dr. Tuma:  I don’t want to present this as all the things that we don’t know. It is true that we don’t have ready-to-go prevention programs in place, but we’re invested and are working seriously in that direction. What we do know, again this comes from decades of research and clinical experience, is that for most people who are experiencing these acute reactions, having a generally supportive, nonjudgmental family member, colleague, community member, perhaps somebody associated clergy person to talk to and confide in is pretty helpful for most people. And for some people, that’s likely to be sufficient, meaning it’ll help them to put their experience into perspective and to move forward with good engagement in their prior life.

Dr. Heinssen: So talk to trusted relatives and confidants. If, after a period of time the stress you are experiencing isn’t going away, that’s a good time to talk to a mental health professional. And it may help in talking to those individuals to use some of the resources that are available on the NIMH website, that describe traumatic stress reactions and treatments, to have an educated discussion with you caretaker about your treatment options.

Dr. Tuma: With regard to our current conflicts and situations in the Middle East and the large number of men and women that are in harm’s way and experiencing quite diverse extreme traumatic exposures, there are some open questions. So part of our research focus in the recent years has been to try to understand how the dimensions of the current conflicts and stressors that the military is experiencing in terms of multiple deployments,, extended deployments, their all-volunteer nature, the fact that a large number of guard and reserve are involved. All of these are sort of unique characteristics to the current time that we live in. One of the most challenging areas that has been a tragic, seen a tragic reemergence or increase is in the area of suicide and health-risking behaviors.

Dr. Heinssen: Our forces have been at war now for almost eight years, and it’s created some significant strain on this all-volunteer force. And over several consecutive years we’ve seen a systematic increase in the rate of suicide among soldiers in the Army. The Army has taken this very, very seriously in looking at ways that they can understand the problem and try to get ahead of it. It was a little over a year ago in June of 2008 that the Army reached out to NIMH and said rather courageously, I think, that we’re putting a lot of effort in trying to understand this problem. But we want to make sure that we’re not missing anything. Any resource that we can bring to bear, we want to bear. And they asked us whether we knew of any area of science or body of findings that they had not applied that could be used to help them not only understand the problem better but to intervene earlier to prevent suicide.

NIMH has been very lucky. It took us a year to put all the pieces together and to find the best team of researchers that were capable of conducting this study. So after a very rigorous vetting process and review process, we have a team of partners from the academic community from the Uniformed Services University of the Health Sciences, Harvard University, Columbia University, and the University of Michigan that are joining with us—with the NIMH scientists and Army scientists—to investigate in a very systematic way risk and protective factors both for suicide and mental disorders. We think that this study, which is going to follow a large number of soldiers—we’re talking about close to 400,000 soldiers over the course of their career in the Army—that we’ll be able to describe the pathway, pathways to resilience, pathways to distress, and pathways to suicide that are going to give us unique opportunities for intervening very early in the process.

Dr. Tuma: Cause it sounds like we may very well learn somethings that are important that extend beyond the military, meaning these are difficult problems to understand in the general population because of the relatively low occurrence of conditions and behaviors like suicide.

Dr. Heinssen: We know that there are some risk factors that are related to suicide risk that tell you groups of individuals are at higher risk, but none of them are sufficiently powerful to allow us to predict for an individual what their risk status is. So it tells us that the research that we’ve done to date has probably missed a lot of risk factors that may not be so strong individually, but as I said before, link together, emerge over time. Well, to study that, you not only need large numbers but you need a research platform that allows you to pull together very different domains of data to be able to see what kinds of interactions you’re getting between personal characteristics, between training events, between exposures in the work environment. The Army gives us a unique opportunity to do just that.

Dr. Tuma: Our investments in this area really are about trying to develop these risk prediction tools, to develop more effective treatments that are really driven by a clearer understanding of what is not working well. What I mean by that is in the neurobiological process that’s involved in stress, something has gone wrong for people who develop PTSD. Understanding that is helping us to develop targets for treatment.

Dr. Heinssen: So Dr.Tuma, I think we can conclude by saying the message of hope for today is that we have a variety of effective treatments that can be utilized for depression, for anxiety disorders, for PTSD. Although they are not perfect, if people stick with treatment and work with their provider to find the mix of perhaps medicines and talking therapies that work for them, they can expect a considerable degree of relief. So we’ll look forward or hearing updates on that progress in the future, and perhaps future installments of this series will cover those issues.

Dr. Tuma: Very good.

Dr. Heinssen: Thank you very much.

Dr. Tuma: Thank you.