They’ll Never Be the Same

There is a new book about children and Posttraumatic Stress Disorder (PTSD), specifically written for parents. The author, the psychiatrist Michael Scheeringa, has an incredible amount of experience in treatment and research with children and young people in the USA.

I got to read a copy of “They’ll Never Be the Same: A Parent’s Guide to PTSD in Youth” provided by the publisher.

While it may not be what one would call a ‘modest’ book, it’s certainly informative. Scheeringa gives parents a helpful overview of what is known about traumatic stress among children in America, how to go about finding and choosing a therapist and what to expect from therapy. Many parents reading it will feel that Scheeringa is on their side. For clinicians and researchers it may be different, but then again they are not the intended audience.

Scheeringa shares multiple interesting insights. One that struck me was about barriers to mental health care. Only a small percentage of children who experience traumatic stress start and complete mental health treatment. What are the barriers for them and their parents? Several factors may be at play:

  • Stigma – seeking treatment is like admitting failure
  • Stoicism / Altruism – thinking that other people are more deserving of limited treatment resources
  • Privacy – talking about trauma seems more painful than having PTSD symptoms
  • Marshmallow children – adults expecting they will bounce back naturally without treatment
  • No clear ‘front door’ to care – it’s hard to find treatment even if you want to

The author’s view is that these factors can’t be the full explanation. He suspects people don’t want mental health care. Mental health is not a sufficiently attractive goal:

“Stigma, stoicism, privacy, marshmallow children, and problems of access with the lack of a ‘front door’ are all good guesses, but they do not quite add up in my mind. All of those guesses seem to have an underlying assumption that people want mental health. Through many of my interactions with patients and potential patients, over the years, I have wondered if that assumption is just plain wrong. What if people are not that interested in mental health?”

“If people truly are not too interested in better mental health, then it will never matter how much we reduce stigma or make access easier. There may be a fundamental issue that the process of asking for help is worse than the problem of living with psychiatric problems. …. (It) seems that many, if not most, trauma victims just don’t want the services bad enough to put up with our business model, or they just don’t want the services at all. Maybe we are trying to engage people the wrong way.”

Is he correct? What do you think?

Children in the ambulance: how do paramedics go about psychosocial care?

“The beer they gave Casper in the ambulance, calmed him down” she says.

The presenter is recounting the story of a boy who broke his leg in a swimming pool accident.

What? Is alcohol the latest innovation in professional care for children?

It keeps the audience in suspense for a while. Until it turns out presenter meant to say (teddy) ‘bear’, not ‘beer’. That presenter was me by the way 🙂 we had a good laugh about it.

Ambulance staff are often the first at the scene when a child is seriously injured. What do they know about children’s stress reactions? Have they had any training in psychological first aid? And how confident are they about providing it? Continue reading

Posttraumatic stress disorder a greater risk in rich countries

By New Zealand Defence Force from Wellington New ZealandOne would think that people with few friends and living in poverty are more at risk for PTSD than those with a strong support network and many resources.

And that’s true.

However, it is a different story when you look at the country-, rather than the individual level. Countries with more resources, such as the USA and the Netherlands, have higher levels of PTSD than countries with fewer resources (e.g. Colombia, South Africa).

This is the key finding of our latest study, which has just been published in the British Journal of Psychiatry. For the analyses, we made use of international data on trauma exposure, PTSD and country vulnerability. They had been collected in 24 different studies, published between 2005 and 2014.

The information on exposure and PTSD came from one, well-established and (evidently) widely used measure, the Composite International Diagnostic Interview. The country resources, or vulnerability, information came from the annual World Risk Report. It includes a mix of country characteristics, such as number of hospital beds, malnutrition, and gross domestic product per capita.

Both trauma exposure and vulnerability were major determinants of PTSD, but the latter in an unexpected way. While a higher percentage of trauma exposure in the country related to higher levels of PTSD, more vulnerability was associated with less PTSD.

Michel Dückers, the lead author of the study, calls it the “vulnerability paradox”. Continue reading

Getting rid of the Ghost People

child soldierPatrick became a child soldier at the age of 13. He was abducted by Ugandan rebels, who kept him for 3 years.

Schultz and Weisaeth (2015) describe Patrick’s story, his mental health problems, and his treatment, a local cleansing ritual. They conclude that the ritual is safe, effective, and perhaps even more powerful than Western-style therapy. That sounds fascinating and important, right?

In interviews Patrick told about his experiences, including an attack on a convoy:

“Everybody was screaming…The road was all red from the blood… My body was shaking, but I managed to appear calm. If not they would have killed me. The next day I experienced the Ghost People for the first time. I could see them get chopped up and sliced apart with axes. I saw the same scenes over and over again.”

The Ghost People only showed up when Patrick was alone, and scared him enormously. He also suffered from concentration problems and sleeping difficulties. He was clinically depressed and had moderate to severe PTSD.

When his nightmares were occurring twice a week and he saw the Ghost People every day – about 8 years after the convoy attack –, he stated that his life was ruined. He wanted to do a cleansing ritual. Continue reading

Why demographics – including sexual orientation – matter in PTSD research

A while ago I started Paper in a Day to get young trauma researchers together. It has been engaging and productive (if you’re interested, the upcoming ISTSS conference will feature one). In a recent edition, four clever minds – Drs Averill, Eubanks Fleming, Holens and Larsen – have thought through research gaps in the PTSD literature. They published a commentary and I wanted to share their thoughts here. They reflect on one of the biggest areas of trauma research, the experiences of military personnel:

As the wars in Afghanistan and Iraq continue, and military service members continue to return home from these two conflicts, more research has been conducted to examine rates of PTSD among these service members (known in the US as OEF/OIF Veterans i.e. Veterans of Operation Enduring Freedom/Operation Iraqi Freedom). This research is important so that we have an understanding of the need for healthcare in newer returning Veterans (which may differ from previous generations). In reviewing some of these articles, many of which are quite well-designed, we noticed a need for some further study to understand the nuances of who develops PTSD and why.

In particular, it would be useful to examine how PTSD prevalence in US OEF/OIF Veterans depends on 1) Veterans Affairs services use (with a particular focus on non-VA users), 2) relationship status, and 3) sexual orientation. Continue reading