Edited by Annette Flanagin, RN, MA, and Thomas B. Cole, MD, MPH
Three research articles in this theme issue address posttraumatic stress
disorder (PTSD). The first, by Krakow and colleaguesArticle, is a randomized trial
of the effectiveness of imagery rehearsal therapy for the treatment of nightmares
among women with PTSD who had experienced sexual assault. Disturbing dreams,
sleep quality, and posttraumatic stress symptoms all improved at study end
point (3- or 6-month follow-up) in women who received imagery rehearsal therapy.
The other 2 studies assessed PTSD in populations that have survived war-related
trauma or mass violence. Mollica and colleaguesArticle, in a 3-year follow-up study
of Bosnian refugees who had been living in a refugee camp in Croatia in 1996,
report that 45% of respondents who had met DSM-IV
criteria for depression, PTSD, or both in the original study continued to
have these disorders; 16% of initially asymptomatic individuals became symptomatic
for psychiatric disorders. In a study of PTSD in postconflict, low-income
countries, de Jong and colleaguesArticle found that the prevalence of PTSD was 37.4%
in Algeria, 28.4% in Cambodia, 15.8% in Ethiopia, and 17.8% in Gaza. In a
commentary, DavidsonArticle emphasizes that PTSD is a worldwide health problem associated
with serious morbidity and reviews the presentation and treatment of this
Humanitarian organizations are not regulated or monitored by professional
bodies and may fail to provide timely or adequate interventions during public
health emergencies. In this epidemiologic survey in the Gode district of Ethiopia,
the center of the famine in the Somali region that began in 1999, Salama and
colleaguesArticle found that most of the 293 deaths during the famine were due to
wasting and communicable diseases, including 47 potentially preventable measles-related
deaths among children aged 14 years or younger. Approximately 77% of the deaths
occurred before the major humanitarian relief interventions began in April/May
2000. In another study, Gustafson and colleaguesArticle report that among patients
with tuberculosis, interruption of regular tuberculosis treatment during the
civil war in Guinea-Bissau was associated with a significant increase in mortality
compared with that among patients with tuberculosis in treatment 12 months
before the conflict. In a commentary, WaldmanArticle stresses the importance of establishing
humanitarian and technical guidelines for emergency relief to correct deficiencies
in humanitarian assistance, such as reported from the Somali region of Ethiopia
and from Guinea-Bissau.
Research among adults has shown that younger age is a risk factor for
intimate partner violence. In this analysis of data from the 1997 and 1999
Massachusetts Youth Risk Behavior Surveys, Silverman and colleagues found
that approximately 1 in 5 female students in the 9th through 12th grades reported
being physically and/or sexually abused by a dating partner. Health risk behaviors
among adolescent girls that were associated with reported abuse by dating
partners included substance use, unhealthy weight control behaviors, high-risk
sexual behavior, prior pregnancy, and suicidality.
Individuals who are stalked, including physicians, who are overrepresented
among those who are stalked, may experience long-lasting adverse effects.
Some stalkers may benefit from psychiatric help.
Results of a survey of attitudes of female emergency department patients
toward mandatory reporting of domestic violence injuries to police.
Content analysis of 55 home video games rated E (for "everyone") found
that 35 games involved intentional violence.
For your patients: Information about posttraumatic stress disorder.
This Week in JAMA. JAMA. 2001;286(5):503. doi:10.1001/jama.286.5.503