Defense Department Studies Families Mourning Service Members

By Lisa Daniel

American Forces Press Service

WASHINGTON  – The Defense Department’s Uniformed Services University of the Health Sciences is conducting the nation’s first large-scale study of the impact of a service member’s death on surviving family members.

The university’s Center for the Study of Traumatic Stress, based in Bethesda, Md., received funding through DOD’s Congressionally Directed Medical Research Program to conduct the five-year study to fill a void in understanding the myriad ways families are affected by a service member’s death ranging from the emotional impact to loss of benefits, Dr. Stephen J. Cozza, director of the center’s child and family program and a principal investigator of the study, said today.

“This is an opportunity for recognizing that military service has certain unique challenges, certain strengths, certain risks or potential protective factors,” Cozza said in an American Forces Press Service interview. “So this is an important opportunity to really understand the experiences of surviving family members and by understanding, to inform future policies.”

In the first phase of the National Military Bereavement Study, the center is seeking about 3,000 participants through its website whose family member died while on active duty since 9/11, Cozza said, noting that several hundred participants already are lined up. One-third of those deaths have been combat-related, one-third have been from accidents, and a significant number have been from illnesses and suicide, he said. The study will include any causes of death, and participants may be spouses or ex-spouses, parents, siblings or children by birth, marriage or adoption.

Participants will be asked to fill out a questionnaire in the study’s first phase. Then, they will be asked if they and their families will participate in the second phase, which studies families, including children ages 6 to 18, with in-person interviews.

In the first phase, participants also will be asked if they are willing to provide a saliva sample to provide genetic information to help understand whether a genetic factor applies to risk and resilience, Cozza said.

“Most people after a death – adults or children – have clear and significant mourning,” he said. “Over time, most return to healthy functioning, even if they continue to harbor grief and sadness. … But there does seem to be some population of adults and children where there are more complicated courses of bereavement. … We want to understand the likely risk factors for that.”

The study will follow families over the course of two years to understand how bereavement changes over time, Cozza said, adding that investigation of families isn’t well-known in the civilian world either.

“No two people’s experiences are the same,” Cozza said. “We really want to give as broad a description of these surviving family members as possible in all these relationship categories.”

The center has several nonprofit partners with the study, including the National Military Family Association, the Military Child Education Coalition, the Tragedy Assistance Program for Survivors and others.

New Suicide Prevention Therapy Tackles Psychological Trauma

By Jeffrey Soares, USAMRMC Public Affairs

The protection and treatment of warfighters was a primary focus of the 2012 Military Health System Research Symposium held in Fort Lauderdale, Fla., Aug. 12-16, and the prevention of suicide among military personnel both during active duty and upon their return was of paramount importance to both researchers and attendees.

In a breakout session dealing with advances in military suicide and psychological health research Aug. 15, Dr. Laura Neeley of the Uniformed Services University of the Health Sciences in Bethesda, Md., offered insight regarding her study of Post Admission Cognitive Therapy, or PACT, for the prevention of suicide in military personnel with histories of trauma. 

Working with Dr. Marjan Holloway, Neeley’s research supports a link between psychological trauma and suicide-related behaviors.  Neely said PACT may help patients to cope effectively with suicidal thoughts and actions.

“The goal of our research,” Neeley explained, “is to develop and empirically evaluate a brief inpatient cognitive behavioral treatment for individuals with psychological trauma who have attempted suicide.”

The PACT program has three phases.  Phase I begins with an analysis of the patient’s current suicide attempt, and this leads into a cognitive conceptualization of the events leading up to the attempted suicide.  This involves retracing the thoughts of the individual to determine a mood set and behavior.  Phase II moves into cognitive restructuring, to review the negative automatic thoughts of the individual while looking for ways to modify these negative thoughts. 

Neeley said that when someone is in a highly emotional state, it is sometimes difficult to generate alternative ways of thinking, so she suggests the use of coping cards.  These cards contain positive statements that provide support to the person who may be in jeopardy of self-destruction.

“Patients can carry these cards in their pocket,” Neeley said, “and every time that they have an [event] that leads to an emotional reaction, they can take [one] out and read it to themselves, to start working on changing their thinking patterns, and working on emotional regulation.”

This second phase also includes the implementation of a hope kit, in which patients keep positive reminders inside of a box that they can pull out to remind themselves of the good things in life -- things worth living for.  These items can include photos, coping cards, journals, gifts or other things associated with good memories for the patient.

Finally, sessions in Phase III focus on relapse prevention and safety planning.

“In the final stage, we go through the suicide story again, but this time we rewrite it so the patient can incorporate her newly learned skills,” Neeley said.

In this stage, the patient must look for ways to challenge thoughts of negativity and suicide, and in doing so, should realize their own self-worth as well as the worthiness of people and things around them.

“We also have them create a safety plan for when they’re discharged,” Neeley said, “so that they know exactly what to do when they’re in crisis.”

Created by the patient, this safety plan not only contains certain scenarios of negative actions that the patient should watch for, but more importantly, it contains a list of positive reactions to use in order to squelch negative thoughts, as well as a list of contact persons who may help to calm down and reassure the patient.

Neeley said the patient’s own readiness to change may often provide a roadblock which is difficult to overcome. In the case of her clinical study patient, “We focused on changing her negative automatic thoughts, which related to a sense of poor self-efficacy, coping with trauma and other life domains.”

Neeley believes the results of this study support the need for evidence-based psychotherapy research for traumatized suicidal individuals.  Currently, her group is working on an inpatient cognitive behavioral treatment protocol for the treatment of trauma and suicide behavior.

Center Works to Optimize Warfighters’ Performance

By Donna Miles

American Forces Press Service

WASHINGTON, June 20, 2011 – A new high-intensity workout regime promises to build strength and endurance. Ads tout dietary supplements as formula for getting stronger, smarter and even less-stressed-out. A “how to” book presents a sure-fire way to bounce back from physical or emotional setbacks.

With the wealth of ever-changing and often-conflicting information on the Internet and on the street, what are warfighters to believe about the best way to improve their performance, particularly in combat?

Getting to the bottom of that, and putting word out to the troops whose lives and missions depend on their ability to perform in demanding and often extreme conditions, is the mission of the Defense Department’s Human Performance Resource Center, Dr. Stephen Frost, the center’s director, told American Forces Press Service.

DOD stood up the center in September 2009 under the auspices of the Uniformed Services University of the Health Sciences to gather and develop solid science for warfighters, their leaders and their health care providers.

Part research arm, part information clearinghouse and education center, the center provides a single DOD focal point for human performance optimization, encouraging better coordination, collaboration and communication among the services and with other government agencies, Frost explained.

The staff seeks out scientifically proven data to post on its website and answers warfighters’ questions submitted through an online link. When it identifies an information gap, it reaches out to experts within the military and civilian professional communities to research the issue or evaluate research already conducted.

To date, the center has issued a White Paper on the pros and cons of a high-intensity physical training program popular with many military members. Its findings, in a nutshell: It may be great if you’re already fit, but could be too physically demanding if you’re not.

The staff also evaluated the prudence of taking specific dietary supplements in extreme temperatures or altitudes after some deployed service members experienced liver and kidney problems, Frost said. The results, posted on the center’s website, showed that high-protein supplements such as creatine can be extremely dangerous, especially when users aren’t properly hydrated, he reported.

“One of our missions is to provide the warfighter information that is evidence-based [and] scientific so that they can make decisions about things like dietary supplements in a better way than just ‘Googling’ on the Internet and getting commercialized information,” Frost said.

The center plans to look into possible ways to mitigate problems associated with the sickle cell trait. Another project on the center’s radar screen, to be conducted with NASA and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, will look into the issue of sleep, particularly sleep deprivation.

“That’s a big problem through the services,” Frost said. “We know that missions sometimes require warfighters to remain vigilant for long periods of time. So the big question is: How much sleep do you really need? And are there ways of enhancing your ability if you don’t have enough sleep? Are there ways of catching up on your sleep? There are a lot of questions around sleep that apply around the services, and NASA is interested, too.”

“Optimal performance” involves much more than strength, endurance and overall physical fitness, Frost explained. It includes all the mental, emotional and physical factors that impact a warfighters’ ability to perform effectively in demanding conditions and extreme environments, to stay healthy and injury-free and recover from any injuries and illnesses.

This involves everything from what goes into their mouths to what kind of exercise routine they follow to behavioral issues such as drug, alcohol and tobacco use.

But equally important are what Frost calls “mind tactics” -- a warfighter’s mental toughness and resilience.

“In the past, the emphasis has always been on the physical part, and we have become pretty good at managing the physical resilience and physical capabilities of our warfighters” he said. “But only recently have we come to recognize that the mind and body go together. So unless you have that same optimal capability for your mental performance, then your physical performance can’t be optimal, either.”

For this reason, the Human Performance Resource Center addresses family and social issues that can impact performance.

“We recognize that if a warfighter is worried about his family, he is not going to be in his optimal condition,” Frost said. “If he doesn’t have the social support systems he needs when he comes home from deployments, or if he is going to be deployed, he is not going to be in his optimal mental condition.”

Ultimately, Frost hopes the military community will come to recognize the Human Performance Resource Center as the place to go for unvarnished, scientifically proven information about factors that affect warfighter performance.

“If we can get the Human Performance Resource Center to truly become the go-to place for our warfighters, our health care providers, the line leadership and researchers so they aren’t simply Googling for information, I think we can go a long way toward enhancing the coordination, communication and collaboration among the services and DOD around human performance,” Frost said. “I think that will be a wonderful goal.”

Study to Seek Clues to Soldier Suicides

By Steve Vogel

Washington Post Staff Writer
Monday, August 10, 2009

Doctors leading the largest study ever of suicide and mental health in the military are developing intensive soldier surveys that they hope will provide clues as to why suicide rates among Army personnel have grown dramatically in recent years.

The study, a collaboration between the National Institute of Mental Health and the Army, will seek data from every soldier recruited into the Army over the next three years as well as from about 90,000 soldiers already in the service, and the project could eventually involve half a million participants.

The soldiers will be asked on a volunteer basis for personal information that can be used to make psychological assessments. Family members might be contacted for further information. In some cases, saliva and blood samples will be collected for genetic and neurobiological studies.

The information will serve as an "ongoing natural laboratory," officials said, as researchers follow these soldiers for years, looking for common strands as to which individuals are more likely to commit suicide.

"We're looking at suicide as the culmination of a long chain of events," said Robert K. Heinssen, the NIMH study director.

In 2008, 143 soldiers committed suicide, the highest number in the three decades that the Army has kept records.

"The most frustrating thing is trying to find a cause," Gen. Peter W. Chiarelli, the Army's vice chief of staff, told the Senate Armed Services Committee on July 30.

The five-year, $50 million study, which stems from an agreement in October between the Army and NIMH, is an ambitious attempt to solve the mystery.

Last month, Robert J. Ursano, chairman of the psychiatry department at Uniformed Services University of the Health Sciences in Bethesda, was named to lead an interdisciplinary team of four research institutions involved in the project.

The study will be "complex in its design, and it's looking at a rare phenomenon," Ursano said.

A number of factors may play roles in suicide, according to Ursano, including post-traumatic stress disorder, family issues, alcohol abuse and neurobiological factors.

Repeated deployment to Iraq, Afghanistan and elsewhere since 2001 is another factor, but one that does not by itself account for the increases in suicide, Ursano said.

"It's a much more complex aggregate of factors," Ursano said. "Deployment increases the stress on a family, but it's clearly not the deciding factor."

The surveys are expected to begin early next year. The information gathered on individual soldiers will be subject to strict privacy safeguards, officials said.

In addition to the planned surveys, researchers are working with the Army to identify and collect relevant information from existing databases, Heinssen said. Data on soldiers who have committed suicide since 2004 will be analyzed.

While the study will continue for years, the researchers are expected to quickly identify and report on potential risk factors to help the Army prevent suicide.

"That's kind of a different way of doing business for us," Heinssen said.

NIMH will report to the Army on a quarterly basis beginning in November. Findings will be incorporated as quickly as possible into treatment programs, according to Chiarelli.