Posts Tagged Alcohol Abuse
Current and former soldiers who seek treatment for post-traumatic stress disorder (PTSD) should be screened closely for major depression since the disorder is the single strongest driver of suicidal thinking, say authors of a new Canadian study.
Researchers evaluated 250 active duty Canadian Forces, RCMP members and veterans. The study comes at a time when record numbers of suicides are being reported among American troops returning from Afghanistan and Iraq, and the number of suicides reported among Canadian forces last year reached its highest point since 1995.
In veterans suffering from post-traumatic stress disorder, about half also have symptoms of major depressive disorder during their lifetime, said the researchers.
But “the task of predicting which people may be at an increased risk of completing suicide is a complex and challenging care issue,” they said.
The study included 193 Canadian Forces vets, 55 active troops and two RCMP members referred to the Parkwood Hospital Operational Stress Injury Clinic in London, Ontario.
Soldiers and vets were screened for PTSD, major depression, anxiety disorders and alcohol abuse. The depression questionnaire also included questions about suicidal thinking.
Study participants served an average of 15 years and had been deployed an average of three times. About one-fourth had been deployed to Afghanistan at least once. Ninety-two per cent were men.
Most met the criteria for “probable” PTSD, and almost three-fourths screened positive for probable major depression.
Overall, about one-fourth — 23 percent — said that they had experienced thoughts of self-harm, or that they would be better off dead, for several days over the prior two weeks.
Another 17 percent said they had those thoughts more than half of the days in the past two weeks; six percent reported feeling this way almost every day for the previous two weeks.
As found in other studies, the researchers showed that PTSD is linked to suicidal thoughts. But “what became the biggest predictor was, specifically, depression severity,” said Dr. Don Richardson, a consultant psychiatrist at the Operational Stress Injury Clinic and an adjunct professor in the department of psychiatry at Western University in London.
“It really stresses the importance that when you’re assessing someone for PTSD it’s also critical that you assess specifically for major depression,” Richardson said. “From our limited study, it was depression severity that was the most significant predictor of having suicidal ideation.”
The concern is that soldiers seeking treatment for military-related trauma might not receive aggressive therapy for depression. Instead, the focus might be more focused on PTSD and exposure therapy.
“There’s potentially a lot of people out there who are suffering who might not be aware that there are effective treatments, and that there are clinics available across Canada that specialize in military trauma,” said Richardson.
New research has demonstrated that the effects on white matter brain volume from long-term alcohol abuse are different for men and women.
Researchers from Boston University School of Medicine (BUSM) and Veterans Affairs (VA) Boston Healthcare System also suggest that when they stop drinking, women recover their white matter brain volume more quickly than men.
Previous research has linked alcoholism with white matter reduction, according to the researchers, who explain that white matter forms the connections between neurons, allowing communication between different areas of the brain.
In this latest study, a research team, led by Susan Mosher Ruiz, Ph.D., a postdoctoral research scientist in the Laboratory for Neuropsychology at BUSM and research scientist at the VA Boston Healthcare System, and Marlene Oscar Berman, Ph.D., professor of psychiatry, neurology and anatomy and neurobiology at BUSM and research career scientist at the VA Boston Healthcare System, employed structural magnetic resonance imaging (MRI) to determine the effects of drinking history and gender on white matter volume.
They examined brain images from 42 abstinent alcoholic men and women who drank heavily for more than five years and 42 nonalcoholic men and women. The researchers found that a greater number of years of alcohol abuse was associated with smaller white matter volumes in the alcoholic men and women. In the men, the decrease was observed in the corpus callosum, while in women this effect was observed in cortical white matter regions.
“We believe that many of the cognitive and emotional deficits observed in people with chronic alcoholism, including memory problems and flat affect, are related to disconnections that result from a loss of white matter,” said Mosher Ruiz.
The researchers also found that the number of daily drinks had a strong impact on alcoholic women, with the volume loss 1.5 to 2 percent for each additional drink. Additionally, there was an 8 to 10 percent increase in the size of the brain ventricles, which are areas filled with cerebrospinal fluid (CSF) that play a protective role in the brain. When white matter dies, CSF produced in the ventricles fills the ventricular space.
The researchers also found that in men, white matter brain volume in the corpus callosum recovered at a rate of 1 percent per year for each year of abstinence. For people who abstained less than a year, the researchers found evidence of increased white matter volume and decreased ventricular volume in women, but not in men. However, for people in recovery for more than a year, those signs of recovery disappeared in women and became apparent in men.
“These findings preliminarily suggest that restoration and recovery of the brain’s white matter among alcoholics occurs later in abstinence for men than for women,” said Mosher Ruiz. “We hope that additional research in this area can help lead to improved treatment methods that include educating both alcoholic men and women about the harmful effects of excessive drinking and the potential for recovery with sustained abstinence.”
The research was published online in Alcoholism: Clinical and Experimental Research.
Source: Boston University Medical Center