A JAMA THEME ISSUE
Edited by Thomas B. Cole, MD, MPH, and Annette Flanagin, RN, MA
To assess the efficacy of a mental health intervention for children exposed to armed political conflict, Tol and colleagues conducted a cluster randomized trial in which children—mean (SD) age of 9.9 (1.3) years—living in a violence-affected community of Indonesia participated in a paraprofessional-implemented, school-based, group intervention that involved cognitive behavioral treatment–based trauma-processing activities. Compared with children at wait-listed control schools, children receiving the intervention experienced moderate reductions from baseline in posttraumatic stress disorder symptoms and retained hope but experienced no improvement in symptoms of traumatic stress, depression, anxiety, or functional impairment.
In an analysis of data from the Millennium Cohort Study—a population-based, prospective study of long-term health of military service members—Jacobson and colleagues assessed the association of alcohol misuse with combat exposure in Iraq and Afghanistan. Among the authors' findings were significantly increased risks of new-onset heavy weekly drinking, binge drinking, and other alcohol-related problems among Reserve and National Guard personnel deployed with combat exposures compared with those nondeployed, particularly among younger members of the cohort.
After 2 decades of civil war, a fragile peace exists in Liberia. In a May 2008 population-based household survey of Liberian adults, Johnson and colleagues found that 40% of respondents (95% confidence interval [CI], 36%-45%) met criteria for major depressive disorder and 44% (95% CI, 38%-49%) met symptom criteria for posttraumatic stress disorder. Factors associated with worse mental health included combatant vs noncombatant status and having experienced sexual violence.
Kohrt and colleagues conducted a cross-sectional cohort study to compare the mental health of former Nepalese child soldiers with children never conscripted. Compared with children never conscripted, former child soldiers were at increased risk for a range of mental health problems. After adjustment for traumatic exposure and other covariates, former child soldiers remained at increased risk for depression and posttraumatic stress disorder.
In a nationally representative sample of married Indian women, Silverman and colleagues assessed the relationship between experiencing intimate partner violence and testing positive for HIV. The authors found that compared with women who did not report intimate partner violence, women who reported both physical and sexual violence from husbands had an increased risk of HIV infection, which was independent of women's personal sexual risk behaviors.
Nampiaparampil reviews the prevalence of chronic pain syndromes as a complication of traumatic brain injury, the relationship between pain and brain injury severity, effects of civilian vs combat veteran status on pain, and the association of chronic pain syndromes with comorbid psychiatric disorders.
“‘Come on, man! I need a woman's touch!’ I cringed.” From “A Stitch in Time.”
A special section on violence examines such topics as rebuilding Iraq's health care system, loopholes in laws regulating US gun sales, mental trauma of children surviving wars, and the stress of repeated deployments on US troops and their families.
Substance use disorders, traumatic brain injury, and PTSD
Mental health courts
Lessons from Afghanistan's health sector
Internally displaced persons in Iraq
Politics of relief in Burma
Join H. George Nurnberg, MD, September 17 from 2 to 3 PM eastern time to discuss sildenafil for women with antidepressant-associated sexual dysfunction. To register, go to http://www.ihi.org/AuthorintheRoom.
How would you manage a 39-year-old man with HIV-associated lipodystrophy? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is August 27.
For your patients: intimate partner violence.
This Week in JAMA . JAMA. 2008;300(6):623. doi:10.1001/jama.300.6.623