Research update

CrossCurrents

School-based intervention reduces PTSD symptoms
Cognitive-behavioural therapy (CBT) at school for students who have been exposed to violence may decrease symptoms of post-traumatic stress disorder (PTSD) and depression, according to research from RAND in Santa Monica, California. The study asked 769 sixth-grade students from two Los Angeles schools about their exposure to violence, as either victims or witnesses, excluding domestic violence or media depictions. Of those, 126 students displaying PTSD symptoms were selected for the trial that involved 10 sessions of CBT. Sixty-one students were randomly assigned to an early intervention group, and 65 were placed in a wait-list delayed intervention group that began treatment three months later. All students were assessed at baseline and then three months after the intervention.

The study found that the early intervention group had significantly lower scores for PTSD, depression and psychological dysfunction than the late group at three months. There was no notable difference in classroom-related behavioural or learning problems, as reported by teachers. Students in the delayed intervention group also improved on their levels of PTSD, depression and psychological dysfunction after the intervention. The authors conclude that a standardized 10-session CBT group intervention offered at school could significantly decrease symptoms of PTSD and depression in violence-exposed students.

Journal of the American Medical Association, August 6, 2003, v. 290: 603-611. Bradley D. Stein et al, RAND, Santa Monica, California.

Homeless seniors' unique mental health needs require attention
Older adults who are homeless have unique health needs and reasons for accessing shelters, according to researchers at the University of Toronto. The researchers conducted a combined literature search, demographic data collection and survey of 11 Toronto-area hostels to establish the demographics of older adults who are homeless, including reasons for shelter use, problem behaviours and physical and mental health needs. The literature search included studies from Medline, AgeLine and PsycINFO databases. Demographic data were from the Toronto Community and Neighbourhood Services Department. A 21-item service needs survey asked hostel front-line and administrative staff about client needs, reasons for homelessness and common problem behaviours. The literature search revealed a high prevalence of psychiatric disorders and cognitive impairment.

Older adults who are homeless were also more likely than younger people who are homeless to report medical conditions and to have poorer health than other older adults. The shelter-use data for Toronto indicated that since 1997, 12 per cent of shelter users were over age 50, with a male-female ratio of three to one. Hostel staff identified a need for more targeted psychiatric services on-site and for staff education about the needs of older hostel users. The researchers suggest that centres for homeless older adults, staffed by multidisciplinary teams that include geriatric specialists, would address the specific health needs of these individuals. The authors state that more research is needed to fully assess the health needs of older adults who are homeless.

Canadian Journal of Psychiatry, July 2003, v. 48: 374-380. Vicky Stergiopoulos and Nathan Herrmann, St. Michael's Hospital, Toronto, Department of Psychiatry, University of Toronto.

ADHD may predict later substance use problems
Children with attention deficit hyperactivity disorder (ADHD) have a higher risk of developing later substance use problems, according to research from the University of Pittsburgh, in Pennsylvania. Researchers interviewed 142 teens between age 13 and 18 who had been treated for ADHD as children, and 100 non-ADHD controls. They followed the participants for five years after diagnosis. Compared to controls, ADHD teens were more likely to report drunkenness from using alcohol, daily cigarette smoking and using multiple illicit drugs. Twenty-three per cent of the ADHD group had been drunk in the past six months compared to 12 per cent of the control group. Their alcohol problem scores were twice as high as those of controls. Thirty percent of ADHD teens reported daily cigarette use compared to 12 per cent of controls. Twenty per cent reported lifetime illicit drug use compared to seven per cent of controls. The ADHD group also reported earlier first-time cigarette and non-marijuana illicit drug, although age of first drinking, inebriation and marijuana episode did not differ between the two groups.

Severity of childhood ADHD symptoms predicted problems with multiple substances. Persistent ADHD symptoms through adolescence were linked to repetitive drunkenness, alcohol problems and daily smoking. Persistent ADHD symptoms, plus development of conduct disorder, were linked to alcohol problems in nearly half of ADHD teens, as well as marijuana and illicit drug use. The authors recommend that future research examine other factors, such as family history, that may contribute to substance use among youth with ADHD.

Journal of Abnormal Psychology, August 2003, v. 112(3): 497-507. Brooke S.G. Molina and William E. Pelham, Jr., Western Psychiatric Institute and Clinic, and University of Pittsburgh School of Medicine.

Panic related to smoking and nicotine dependence
Smoking increases the risk of panic attacks and panic disorder, according to researchers at the Max Planck Institute of Psychiatry in Munich, Germany. A four-year follow-up survey of 3,021 youth between ages 14 and 24 found that panic attacks and panic disorder were strongly associated with regular smoking and nicotine dependence. Findings revealed that 10 times as many regular, nicotine-dependent smokers suffered from panic attacks as non-smokers. Panic attacks also occurred in two per cent of occasional and non-nicotine-dependent regular smokers. Panic attacks were three and four times as likely in non-dependent and dependent, regular smokers, respectively, compared to non-smokers. The criteria for panic disorder were met by less than one per cent of non-smokers, one per cent of occasional smokers, two per cent of non-dependent smokers and almost four per cent of nicotine-dependent smokers. Results also showed an association between regular smoking and generalized anxiety disorder. A weaker association emerged between panic and subsequent nicotine dependence.

The authors caution that the results do not extend into later adulthood, but only indicate the high-risk onset period associated with smoking and panic. And while the study suggests a relationship between panic and nicotine dependence, any link between panic and subsequent smoking was blurred, since many participants who experienced panic episodes had already smoked at baseline.

Archives of General Psychiatry, July 2003, v. 60: 692-700. Barbara Isensee et al, Clinical Psychology and Epidemiology Unit, Max Planck Institute of Psychiatry, Munich, Germany.

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