Hemispheric asymmetry in non-linear interdependence of EEG in post-traumatic stress disorder.

AIM: While volumetric and metabolic imaging on post-traumatic stress disorder (PTSD) patients has been intensively performed, few studies using electroencephalograms (EEG) have been done as yet. The aim of the present study was to investigate abnormalities in functional connectivity of cortical networks in PTSD. METHODS: Non-linear interdependence (NI), a measure of bidirectional, non-linear information transmission between two time series, was used. Resting EEG were recorded for 18 PTSD patients and 18 sex-matched healthy subjects on 16 channels with their eyes closed. RESULTS: The NI patterns in PTSD patients were hemisphere asymmetric: an increase in NI in the fronto-parieto-temporal regions of the left hemisphere (F7, F3, T3, C3, T5 and P3) and a decrease in the fronto-parieto-occipital regions of the right hemisphere (F4, C4, P4 and O2). The non-linearity of NI in EEG, estimated from the surrogate data method, exhibited an increase in the PTSD patients as compared with that of healthy subjects, particularly in the left hemispheric cortex. CONCLUSION: Abnormal functional connectivity in PTSD can be assessed using NI, a measure of multi-channel EEG.

Parental involvement with the criminal justice system and the effects on their children: a collaborative model for researching vulnerable families.

Despite the existing body of research examining the effects of imprisonment on incarcerated adults, as of yet, there is no solid empirical evidence for understanding the effects of parental involvement with the criminal justice system involvement (CJSI) on children and families. Accordingly, Columbia University-New York State's Child Psychiatric Epidemiology Group (CPEG), supported by a strong collaboration with The Bronx Defenders, a holistic public defender providing free legal representation, is conducting a longitudinal study examining the effects of parental involvement with the criminal justice system on this population. The study aims to understand, over time, the impact of parental CJSI on their children's mental health, including the effects of the collateral legal damage of CJSI (such as eviction and deportation), substance use, the development of risky behaviors leading to the child's potential involvement with the criminal justice system, as well as protective factors and identification of potential intervention points, which has the ability to inform public policy.

Media use by children and adolescents from New York City 6 months after the WTC attack.

Six months after the World Trade Center (WTC) attacks of September 11, 2001 (9/11), a representative sample of New York City students (N = 8,236) in Grades 4 through 12 reported their use of TV, Web, and combined radio and print media regarding the WTC attack. Demographic factors, WTC exposure, other exposure to trauma, and probable posttraumatic stress disorder (PTSD) were used to predict intensive use of the 3 types of media. Intensive use was associated with direct exposure to the WTC attack (with the exception of Web use) and to having reported symptoms of PTSD. Stratified analyses indicated that the association between probable PTSD and intensive media use was more consistently present among those who had no direct or familial exposure to the WTC attack. As well, media, particularly TV, was intensively used by children after the WTC attack. Variations existed in the factors associated with intensive media use, which should be considered when planning postdisaster media coverage and advising families.

Attention orientation in parents exposed to the 9/11 terrorist attacks and their children.

While trauma affects both parents and their children, minimal research examines the role of information-processing perturbations in shaping reactions to trauma experienced by parents and, in turn, the effect this trauma has on their children. This study examines familial associations among trauma, psychopathology, and attention bias. Specifically, group differences in psychopathology and attention bias were examined in both adults and their children based on trauma exposure. In addition, the association between attention bias in parents and attention bias in their children was examined. Parents exposed to the 9/11 World Trade Center attacks and their children were recruited from the New York City Metropolitan area. Levels of trauma exposure, psychiatric symptoms, and attention bias to threat, as measured with the dot-probe task, were each assessed in 90 subjects, comprising of 45 parents and one of their children. These measures were examined in parents and their children separately; each parent and child was categorized on the presence of high or low levels of trauma exposure. Although trauma exposure did not relate to psychopathology, parents who were highly exposed to trauma showed greater attention bias towards threat than parents with low trauma exposure. However, the children of high trauma-exposed parents did not show enhanced attention bias towards threat, though threat bias in the high trauma-exposed parents did negatively correlate with threat bias in their children. This association between trauma and attention bias in parents was found four-to-five years after 9/11, suggesting that trauma has enduring influences on threat processing. Larger, prospective studies might examine relationships within families among traumatic exposures, psychopathology, and information-processing functions.

Attack-related life disruption and child psychopathology in New York City public schoolchildren 6-months post-9/11.

In the aftermath of disasters, understanding relationships between disaster-related life disruption and children's functioning is key to informing future postdisaster intervention efforts. The present study examined attack-related life disruptions and psychopathology in a representative sample (N = 8,236) of New York City public schoolchildren (Grades 4-12) surveyed 6 months after September 11, 2001. One in 5 youth reported a family member lost their job because of the attacks, and 1 in 3 reported their parents restricted their postattack travel. These forms of disruption were, in turn, associated with elevated rates of probable posttraumatic stress disorder and other anxiety disorders (and major depressive disorder in the case of restricted travel). Results indicate that adverse disaster-related experiences extend beyond traumatic exposure and include the prolonged ripple of postdisaster life disruption and economic hardship. Future postdisaster efforts must, in addition to ensuring the availability of mental health services for proximally exposed youth, maintain a focus on youth burdened by disaster-related life disruption.

Parental exposure to mass violence and child mental health: the First Responder and WTC Evacuee Study.

Children's reactions after being exposed to mass violence may be influenced by a spectrum of factors. Relatively unexplored is the extent to which family exposure to mass violence may affect child mental health, even when these children have not been directly exposed. In a representative sample of NYC public school children assessed 6 months after the September 11, 2001 attack on the World Trade Center (WTC), seemingly elevated rates of psychopathology were recorded among children of WTC evacuees. Children of NYC First Responders (police officers, EMTs, and fire fighters) displayed a complex pattern of response to the WTC attack. Overall, the findings from this previous study support putative transmission of trauma to children whose parents were exposed to the WTC attack. The "Children of First Responder and WTC Evacuee Study"-a two-site longitudinal study-is currently underway in the United States (New York City) and in Israel (Tel Aviv area) in an effort to understand the impact of different patterns of mass violence. The NYC sample permits us to examine the impact of a rare instance of mass violence (e.g., WTC attack), while the Israeli sample provides information about repeated and frequent exposure to mass violence brought about by acts of terrorism. In addition, children's exposure to mass violence is considered in the context of their exposure to other potentially traumatic events. This study aims to improve our general understanding of the impact of mass violence on children, especially the psychological effects on children whose parents' work experiences are by nature stressful. Knowledge generated by this study has implications for guiding efforts to meet the needs of children who have, directly or through a family member, been subjected to rare or infrequent mass violent event as well as to children whose exposure to mass violence is part of daily life.

Awareness in nine countries: a public health approach to suicide prevention.

Suicide is an important public health problem, increasing worldwide, and on a yearly basis accounting for the death of more than one million people, with estimates as high as 10-20 times that many attempting to take their own life. Because successful suicide prevention depends upon recognition of symptoms of mental ill-health, awareness of these signs is a necessary precondition. The ability and responsibility for recognizing signs and symptoms of suicide, until most recently, however, was the exclusive purview of mental health professionals. Lately, there have been efforts to screen high risk populations and to train others to effectively respond to suicidal behavior, including classic first responders, primary care providers, hot line operators, teachers, etc. But what about everyone else who may have an opportunity to prevent a suicide simply by knowing when to ask questions, what to listen for, and understanding when additional assistance is warranted? What about the suicidal person who wants to tell someone about their distress but "knows" that such a conversation will not help nor be well-received? Where does a person living where mental health services are lacking or are beyond one's financial means turn to for relief and assistance? Does not Public Health have something to offer in response to these pressing questions? In 2002-2005, a study was carried out in nine countries, distributed over five continents, under the auspices and support of the Presidential Commission of the World Psychiatric Association (WPA), the World Health Organization (WHO), and the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP), to test the feasibility and effectiveness of raising awareness and increasing knowledge about child mental health, including suicidality, among students, teachers and parents. Implications for this approach as a model for suicide prevention are presented.

Worldwide child and adolescent mental health begins with awareness: a preliminary assessment in nine countries.

To temper untoward mental health outcomes in children and adolescents, the World Psychiatric Association's Presidential Global Child Mental Health Programme, in collaboration with the WHO and the International Association of Child and Adolescent Psychiatry and Allied Professionals, established a Child Mental Health Awareness Task Force headed by Sam Tyano. Its task was to develop methodologies to increase awareness among policy-makers, community leaders, health professionals, teachers, parents, and children. Based on a prior comprehensive international search for effective techniques for information dissemination, an awareness manual was written for use by health professionals in diverse communities so as to guide the design and implementation of location specific awareness campaigns. We assessed the children, parents and teachers both before and after the campaign to determine changes in knowledge, attitudes and understanding of mental health. The school-based studies were conducted in selected communities in nine countries on five different continents distinguished by their different languages, cultures and their differing levels of economic development: Armenia, Azerbaijan, Brazil, China, Egypt, Georgia, Israel, Russia, and Uganda. In the six sites that completed all assessments, indicators of positive change in awareness of child mental health were identified, and results demonstrated an increased willingness to discuss emotional problems freely. These data support the utility of collaborating with schools so as to foster better child mental health in such under-resourced communities.

Posttraumatic stress in children with first responders in their families.

High levels of exposure and occupational stress of first responders may have caused children in first-responder families to become traumatized following the September 11th, 2001 terrorist attacks. New York City public school children (N = 8,236) participated in a study examining mental health problems 6 months after the World Trade Center attack. Results revealed that children with emergency medical technician (EMT) family members had a high prevalence of probable posttraumatic stress disorder (PTSD; 18.9%). Differences in rates of probable PTSD among EMTs' and firefighters' children were explained by demographic characteristics. Where EMTs are drawn from disadvantaged groups, one implication of this study is to target EMT families in any mental health interventions for children of first responders.

Exposure to the World Trade Center attack and the use of cigarettes and alcohol among New York City public high-school students.

We examined exposure to the World Trade Center attack and changes in cigarette smoking and drinking among 2731 New York City public high-school students evaluated 6 months after the attack. Increased drinking was associated with direct exposure to the World Trade Center attack (P < .05). Increased smoking was not directly associated with exposure to the World Trade Center attack but was marginally significantly associated with posttraumatic stress disorder (P= .06). Our findings suggest that targeted substance-use interventions for youths may be warranted after large-scale disasters.

Psychopathology among New York city public school children 6 months after September 11.

CONTEXT: Children exposed to a traumatic event may be at higher risk for developing mental disorders. The prevalence of child psychopathology, however, has not been assessed in a population-based sample exposed to different levels of mass trauma or across a range of disorders. OBJECTIVE: To determine prevalence and correlates of probable mental disorders among New York City, NY, public school students 6 months following the September 11, 2001, World Trade Center attack. DESIGN: Survey. SETTING: New York City public schools. PARTICIPANTS: A citywide, random, representative sample of 8236 students in grades 4 through 12, including oversampling in closest proximity to the World Trade Center site (ground zero) and other high-risk areas. MAIN OUTCOME MEASURE: Children were screened for probable mental disorders with the Diagnostic Interview Schedule for Children Predictive Scales. RESULTS: One or more of 6 probable anxiety/depressive disorders were identified in 28.6% of all children. The most prevalent were probable agoraphobia (14.8%), probable separation anxiety (12.3%), and probable posttraumatic stress disorder (10.6%). Higher levels of exposure correspond to higher prevalence for all probable anxiety/depressive disorders. Girls and children in grades 4 and 5 were the most affected. In logistic regression analyses, child's exposure (adjusted odds ratio, 1.62), exposure of a child's family member (adjusted odds ratio, 1.80), and the child's prior trauma (adjusted odds ratio, 2.01) were related to increased likelihood of probable anxiety/depressive disorders. Results were adjusted for different types of exposure, sociodemographic characteristics, and child mental health service use. CONCLUSIONS: A high proportion of New York City public school children had a probable mental disorder 6 months after September 11, 2001. The data suggest that there is a relationship between level of exposure to trauma and likelihood of child anxiety/depressive disorders in the community. The results support the need to apply wide-area epidemiological approaches to mental health assessment after any large-scale disaster.

Children's mental health after disasters: the impact of the World Trade Center attack.

This paper summarizes the results of systematic studies published in peer-reviewed journals from 1999 to 2002 addressing post-traumatic stress reactions in children after mass disasters. Children's post-traumatic reactions are considered in five different contexts--natural disasters, large-scale human-induced accidents, spree shootings, war, and terrorism. Association of these reactions with gender and age, as well as longitudinal course, is addressed. Other post-traumatic reactions in children after a mass disaster, as well as the comorbidity of these with stress reactions, are reported. With this as background, the most relevant epidemiologic investigations conducted after the World Trade Center attacks are then described. It is expected that new knowledge in the area of children's post-traumatic reactions to disasters will result from the research initiatives launched after September 11, 2001.

Salivary cortisol concentrations before and after carbon-dioxide inhalations in children.

BACKGROUND: Considerable research implicates over-activity of the hypothalamic-pituitary adrenal axis in the pathophysiology of adult mood and anxiety disorders. The current study evaluates the association between salivary cortisol concentrations and response to carbon-dioxide inhalation in children and adolescents with anxiety disorders, mood disorders, or no psychiatric illness. The central question was whether response to carbon-dioxide inhalation is associated with levels of hypothalamic-pituitary adrenal axis activation. If confirmed, this would relate hypothalamic-pituitary adrenal axis activation in juveniles, as in adults, and response to a well-studied respiratory procedure. METHODS: Serial salivary cortisol samples were examined in 98 subjects (ages 9-17 years), including 62 subjects with an anxiety and/or mood disorder and 36 nonpsychiatrically ill comparisons. Samples were obtained upon arrival at the laboratory, following a tilt test, then before and immediately after a standard 5% carbon dioxide inhalation procedure. RESULTS: Salivary cortisol levels pre-carbon-dioxide inhalation were significantly higher in patients sensitive to the anxiogenic effects of carbon dioxide (n = 20) than in patients who did not respond to carbon dioxide (n = 42) and in healthy subjects, none of whom were sensitive to carbon dioxide (n = 36); cortisol concentrations in the latter two groups were indistinguishable. Salivary cortisol did not increase during carbon-dioxide inhalation, irrespective of diagnostic group or degree of reactivity to the procedure. CONCLUSIONS: The current data resemble data from studies of laboratory-induced panic among adult patients. In both groups, activation of the hypothalamic-pituitary adrenal axis is associated with the response to a standardized stressor. Similarly, as in adults, carbon-dioxide inhalation in juveniles does not produce a significant change in hypothalamic-pituitary adrenal axis activation.