Popular wisdom has long held that young children survive traumatic events better than adults do, in part because they suffer less. Being too young to understand fully the nature of what’s happening around them - during war or natural disaster, for instance - they should bounce back with much more resilience.

But new research on child survivors of Hurricane Katrina and witnesses of the 9/11 terrorist attacks suggests otherwise. “There is increasing evidence that kids know what is going on if they are directly exposed and see something like planes crashing into the [World Trade Center] towers,” says child psychologist Claude Chemtob of New York University, lead author of one of several new papers on children and disaster, published in a special section of the July and August issue of Child Development. (See the top 10 scientific discoveries of 2009.)

Together, the new studies show that young children and teens not only exhibit symptoms of posttraumatic stress and depression that are similar to those of adults, but that they may react more strongly to trauma because adults do. They also show that younger children and girls are more likely to develop symptoms of posttraumatic stress disorder (PTSD) than boys and older kids.

In the first two studies, researchers analyzed the long-term effects on children and their parents of the 9/11 attacks. In one analysis, led by Chemtob, researchers followed 116 preschool children and their mothers in Lower Manhattan who had been directly exposed to the World Trade Center attacks. Interviews were conducted with the mothers and with the children’s preschool teachers nearly three years after 9/11. (See pictures of the World Trade Center’s destruction.)

Chemtob found that compared with children whose mothers did not report symptoms of PTSD or depression, those whose mothers were affected were three times more likely to be emotionally reactive - being clingy and quick to become upset - and seven times more likely to exhibit aggressive behavior three years after the traumatic events. “Kids are very attuned to their moms because moms send cues to their kids about what’s safe and what’s not. If Mom is less available and more focused on the fearful aspects of life, then she is not helping,” Chemtob says. (Comment on this story.)

In contrast, a second study on 9/11 that looked at more than 400 children, aged 12 to 20, and their mothers, found that those who were directly exposed to the attacks - those who witnessed the planes hit the towers, for example - were only slightly more likely to suffer PTSD than children who did not directly experience the trauma, but were significantly more likely to be depressed. Only 4% of these children had PTSD 15 months after the attacks, but 12% were depressed.

Notably, this study, led by child-development researcher Elizabeth Gershoff of the University of Texas at Austin, mirrors the findings of a 2008 study that Chemtob conducted with the same group of children involved in his current paper. In the 2008 study, he also found that children who were directly exposed to the events of 9/11 - seeing dead or injured people, watching people jump out of a building or witnessing a tower collapse - were three times more likely to be depressed or anxious than those who were not directly exposed. “We have tended to say that young kids don’t need help, but in fact they are very vulnerable,” says Chemtob. (See pictures of an army town coping with PTSD.)

Chemtob’s and Gershoff’s conclusions are further supported by two other studies appearing in the current issue of Child Development on the child survivors of Hurricane Katrina. In the first study, a team of researchers from Louisiana State University (LSU) interviewed 387 public schoolchildren in St. Bernard Parish, one of the areas most devastated by Katrina, and found that young children were more profoundly affected than adolescents. Three years after the hurricane, children between the ages of 9 and 11 were four times more likely to show symptoms of PTSD than were teenagers between the ages of 15 and 18.

Although the study reported that behavioral problems among the study sample had decreased overall over time - with nearly half of the children showing no lasting signs of stress - more than 25% of the younger kids were still exhibiting significant symptoms of PTSD and depression, such as feeling sad or nervous and having trouble sleeping or concentrating.

It may be that older children had more emotional resources to call on, which made it easier for them to bounce back. “Whereas younger children are more dependent on their caretakers, adolescents can turn to their friends or others in the community,” says Joy Osofsky, a child psychologist at LSU who co-authored the study. Indeed, the children who fared best post-Katrina were those whose schools were quickly rebuilt and who had supportive relationships, both at home and at school. (Read “Study Points at a Clear-Cut Way to Diagnose PTSD.”)

Despite the age advantage, girls of any age were twice as likely as boys to have problems adapting after the disaster - an effect reported by both Osofsky’s current research as well as several prior studies. One explanation, put forth by the second Katrina study in Child Development, is that girls may simply be more expressive of their feelings of stress than boys are, even if boys have the same emotions. In the study, which analyzed saliva samples from 62 boys and girls between the ages of 12 and 19 who had been relocated to camps after the hurricane, researchers found no significant difference in levels of salivary cortisol, a hormone associated with stress, between the genders.

Jacob Vigil, a psychologist at the University of New Mexico and lead author of the study, hypothesizes that the differences in the way boys and girls react to trauma may be due to social conditioning rather than actual physiological effects. It may also be possible that similar levels of stress hormones affect males and females differently.

Past studies have shown that PTSD is more likely to manifest itself in boys as concentration and behavioral problems, while girls tend to exhibit emotional reactions like guilt and anxiety. “Girls tend to internalize their problems, whereas boys are more likely to act out,” says Gershoff. Other common symptoms of the disorder may include nightmares, upsetting thoughts about the past trauma, avoidance of reminders of the event and persistent worrying about more bad things happening.

Although there was no significant difference in the levels of cortisol in boys and girls in Vigil’s study, he did note that cortisol levels in the traumatized population of kids living in relocation camps were lower on average than those of a control group. That suggests the Katrina survivors had lived with constant stress for so long that they had become almost inured to its effect - they became less reactive to relatively minor, day-to-day stressors. “It’s like a rubber band that gets stretched too much. Folks who are not reactive to stress seem to have more stress in their life,” notes Vigil. Low cortisol levels have been associated with depression in adults, and while depression is a separate condition from PTSD, they share many of the same symptoms such as trouble sleeping and concentrating.

Child advocates say that one way to minimize long-term PTSD in kids is to provide them with the same level of psychological support that is regularly offered to adults. “It is important that kids have access to mental-health services right after a disaster,” says Gershoff. “We can’t just assume that kids are going to get over it. They need someone who can help them cope,” especially when their parents can’t.

Technorati Tags: posttraumatic depression, posttraumatic stress

When you’re depressed, do you need to meet a therapist in person? Maybe not, suggests a small new study, which finds that therapy by telephone is almost as effective as face-to-face.

Researchers at Brigham Young University had 30 people who were newly diagnosed with depression talk to a therapist by phone for 21 to 52 minutes. They did this instead of making eight visits to a clinic.

None of the participants got antidepressant medicine.

Six months later, 42 percent of the participants had recovered from depression. About 50 percent of patients recover from depression when face-to-face therapy is provided, the researchers said.

“Offering a phone or webcam option for psychotherapy does appear warranted from an efficacy point of view,” said study co-author Diane Spangler, a psychology professor, in a statement. “It’s more user-friendly — no commutes, more flexibility of place and time and has no side effects.”

But not everyone is willing to try phone therapy. A third of eligible participants declined it.

The study is published in the June issue of Behavior Therapy.

Technorati Tags: antidepressant medicine, Depression

Asthma may affect more than your ability to breathe, it may also make you more prone to developing psychological problems, new research suggests.

People with asthma are more than twice as likely to have depression or anxiety as people who don’t have the chronic airway disease, according to a report in the March issue of the journal Chest.

To make matters worse, the study authors found that when rates of serious psychological distress went up, health-related quality-of-life scores went down.

“The prevalence of serious psychological distress was 2.5 times higher among adults with asthma, and as serious psychological distress increased, health-related quality went down. So, asthma makes quality of life worse and serious psychological distress makes quality of life worse, and together they synergistically make quality of life even worse,” said study senior author Dr. David Callahan, a medical epidemiologist at the U.S. Centers for Disease Control and Prevention and the U.S. Public Health Service in Atlanta.

Study author Emeka Oraka said these findings may apply to other chronic diseases, such as diabetes, and that serious psychological distress may make it harder for people to manage these diseases properly.

“Any kind of mental distress impedes your ability to manage the disease well, whether it’s asthma, diabetes or something else,” said Oraka, who’s an Oak Ridge Institute for Science and Education fellow at the CDC.

Oraka noted that the findings should raise a red flag for clinicians. “Serious psychological distress is a powerful predictor of quality of life, and even more so in the presence of chronic illness,” he said. “Don’t disregard the importance of mental health in the quality of life of patients with chronic illness.”

For the study, the researchers reviewed data from 186,738 adults who had participated in the U.S. National Health Interview Survey between 2001 and 2007. From this database, they discovered that the rate of asthma was 7 percent.

Among all of the study participants, the average prevalence of serious psychological distress was 3 percent, but in people with asthma, the rate of serious psychological distress was 7.5 percent, the researchers found.

Adults with asthma who had other chronic conditions, a history of smoking or alcohol use, and those with a lower socioeconomic background had a greater risk of having serious psychological distress, according to the study.

Oraka said that the study wasn’t able to tease out whether asthma is a cause of serious psychological distress or whether asthma medications may make serious psychological distress more likely, or whether people with serious psychological distress may be more likely to have asthma or to report having asthma.

“This study found an association, but no causation,” Oraka said.

Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital and Medical Center in Detroit, said it was troubling to see that “the prevalence of anxiety or mental distress is higher in asthmatics than normal, and this is something we need to look for and try to prevent and address it.”

She said the subject definitely warrants further study, and that she would like to see a study that assesses asthma more objectively. In the current study, asthma was identified by the study participants, who were asked if a doctor had ever told them they had asthma, and if they still had asthma.

But, “even if you have mild asthma, it’s definitely an anxiety-provoking diagnosis,” Appleyard added.

“As with any chronic disease, asthma needs to be managed carefully by the patients, and serious psychological distress can get in the way of people managing their own asthma,” explained Callahan. “Clinicians need to ask about psychological symptoms in people with asthma, and they need to treat both psychological distress and asthma.”

Technorati Tags: Asthma, asthma and depression, mental distress, psychological distress

Antidepressant use among U.S. residents almost doubled between 1996 and 2005, along with a concurrent rise in the use of other psychotropic medications, a new report shows.

The increase seemed to span virtually all demographic groups.

“Over 10 percent of people over the age of 6 were receiving anti-depression medication. That strikes me as significant,” said study author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University/New York State Psychiatric Institute in New York City.

According to background information in the study, antidepressants are now the most widely prescribed class of drugs in the United States. The expansion in use dates back to the 1980s, with the introduction of the antidepressant Prozac (fluoxetine).

The study found that 5.84 percent of U.S. residents aged 6 and over were using antidepressants in 1996, compared with 10.12 percent in 2005. That’s 13.3 million people, up to 27 million people.

“This is a 20-year trend and it’s very powerful,” remarked Dr. Eric Caine, chair of the department of psychiatry and co-director of the Center for the Study of Prevention of Suicide at the University of Rochester Medical Center.

This happened despite a “black box” warning mandated for many antidepressant medications by the U.S. Food and Drug Administration in 2004, the study authors noted.

Lower rates of increases in antidepressant use were seen in blacks (3.61 percent in 1996 versus 4.51 percent in 2005) and in Hispanics (3.72 percent versus 5.21 percent in 2005), the researchers found.

Still, about the same number of people were being treated for depression (26.25 percent in 1996 versus 26.85 percent in 2005), indicating that the drugs were being used to treat other diagnoses, such as anxiety and other mood disorders.

At the same time, those receiving antipsychotic drugs increased from 5.46 percent to 8.86 percent, and the proportion of people using psychotherapy dropped from 31.5 percent to 19.87 percent.

“The reasons [for the growth] are unclear but they may include the introduction of new antidepressants over the last 10 to 12 years or so and a broadening in the clinical indications of antidepressant treatment. Years ago, these drugs were largely focused on depression. Today, more different conditions are treated with antidepressants,” Olfson said. “There’s also been an increase in direct-to-consumer advertising and a lessening of the stigma associated with seeking mental health care.”

Indeed, a study released last week found that roughly five of six Americans now have a positive opinion on psychiatric medications, a marked increase from about a decade ago.

Depression may also be more common in the population, or at least more people may be acknowledging it and seeking help, the authors suggested.

“It is encouraging that there is apparently an increased awareness and increased willingness to seek assistance for emotional distress . . . and that is a big step forward,” said Dr. Kathryn J. Kotrla, chairwoman and associate professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine.

“I think part of the increased rate is increased awareness, as well as national depression screening all over the country,” added Dr. M. Beatriz Currier, an associate professor of clinical psychiatry at the University of Miami Miller School of Medicine. “Education and screening decrease stigma.”

Of concern, however, was the finding that the majority of Americans taking antidepressants were not receiving care from a psychiatrist.

Also troubling was not knowing what the prescriptions were being written for exactly.

“One wonders if the medication is being used as a possible panacea for a number of psychosocial issues which might be better served by counseling,” Kotrla said.

“Who’s really taking these medications?” Caine said. “It’s not clear that it makes anyone healthier. That’s a fundamental issue that we don’t know. We don’t have any way of telling if this made people’s lives better.”

A second study in the same issue of the journal followed 306 preschoolers aged 3 to 6 years for 24 months and found that depression in this group tends not to just go away as the child gets older, but can linger as a chronic condition.

“This is exciting because it gives us an opportunity for early intervention,” Kotrla said.

Technorati Tags: anti depression medication, antidepressant, antidepressant use, depresson medicine, Prozac

Eli Lilly said Monday that its antidepressant Cymbalta (duloxetine) has been approved by the U.S. Food and Drug Administration to treat fibromyalgia, a chronic disorder with symptoms including widespread muscle pain and tenderness.

The condition affects about 2 percent of the American population, or about 5 million people, mostly women. While its cause is unknown and there is no known cure, it’s believed it may be related to a combination of changes in brain and spinal cord chemistry, genetic factors, and stress, the company said in a statement.

Cymbalta affects production of two naturally occurring brain substances, serotonin and norepinephrine. In addition to affecting mood, it’s believed these substances are part of the body’s natural pain-surpressing system, Lilly said.

In a pair of three-month trials involving 874 people with fibromyalgia, Cymbalta significantly reduced pain levels, compared with a non-medicinal placebo, the company said. Common adverse reactions included nausea, dry mouth, constipation, decreased appetite, and sleepiness.

Cymbalta also is approved to treat major depressive disorder and generalized anxiety disorder, and a form of nerve pain in diabetics, all in adults 18 and older.

— Scott Roberts

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