UNIVERSITY OF TEXAS
Study may help curb cases of combat-stress disorder
UT examining genes, reactions of Fort Hood troops to find risk factors.
By Jeremy Schwartz
AMERICAN-STATESMAN STAFF
Are some soldiers more likely than others to develop post-traumatic stress disorder, a malady that affects nearly one in five service members returning from Iraq and Afghanistan? Is there anything in their genetics, brain structure or ability to handle stress that might make them more or less prone to PTSD? And if researchers can pinpoint risk factors for the disorder, is it possible to "inoculate" service members before they deploy to a war zone?
A study at the University of Texas, called the Texas Combat PTSD Risk Project, is seeking to answer some of those questions using methods that researchers say haven't been tried before. The study put 183 Fort Hood soldiers through a battery of tests before and after their first yearlong deployment to Iraq and had them fill out a monthly "stress log" over the Internet while they were on the battlefield. The result is one of the more comprehensive studies to search for risk factors for the illness, which, along with traumatic brain injury, military leaders call the signature disease of the current conflicts.
Lead investigator Michael Telch, a UT professor of psychology and the director of UT's Laboratory for the Study of Anxiety Disorders, said the research could lead to prevention programs for PTSD.
"Just like with the prevention of heart disease or many other medical conditions, the first critical step in addressing the problem of combat PTSD and other combat-stress disorders is to identify the factors that increase soldiers' risk for developing them," Telch said in an e-mail. "We hope that this study will ultimately provide important new insights into the causes of combat PTSD and ways to prevent it."
Telch said that although it's too early to draw definitive conclusions, preliminary evidence points to some possible risk factors for the disorder, including a history of psychological problems.
Telch will present the study's findings during the Council for the Advancement of Science Writing's annual conference in Austin this month.
Brian Baldwin, a retired Army colonel and project manager at UT's Institute for Advanced Technology, said the study's results could be used to prepare soldiers to withstand PTSD and make their superiors more aware of who is at higher risk of developing it.
Lasting effects, costs: It's not clear how many service members are returning from war with the illness, because many cases go undiagnosed, according to experts. But the illness can wreak havoc on sufferers, causing flashbacks, difficulty concentrating, emotional detachment and an exaggerated startle response. The symptoms can last for decades. A 2008 Rand Corp. study estimated that in the two years after deployment, the cost of treating PTSD or major depression in service members, coupled with the value of their lost productivity, was more than $6 billion.
Increasingly concerned with the costs of PTSD and other mental disorders related to combat, the Army recently announced that its 1.1 million soldiers will undergo training in emotional resiliency, according to The New York Times. The $117 million program is expected to begin this month and gradually be phased in throughout the Army.
Michael Malchow, a 21-year-old soldier from Wisconsin, was one of the 183 Fort Hood soldiers who volunteered to take part in the UT study. He said he was motivated because he's seen the impact of the disorder on a cousin's father, a Vietnam veteran.
"I've known for a long time that PTSD has been a big problem," said Malchow, whose unit spent a year patrolling an area near the Iran-Iraq border. "Hopefully, this study will help them find out in better terms how to diagnose it ahead of time, before it becomes a huge problem."
Baldwin, who helped develop the idea for the study, presented it to Fort Hood leaders, who quickly signed on, giving Baldwin access to companies and units. Baldwin said 85 to 90 percent of the soldiers briefed on the study volunteered to participate.
They later saw action throughout Iraq, guarding the southern border, escorting convoys and serving in a medical brigade.
Many of the soldiers, who deployed in waves beginning in September 2007, found a less violent Iraq than many of their predecessors, who fought before and during a surge of troops there.
Responding to stress: Shortly before deploying to Iraq in June 2008, Malchow and his unit journeyed south to Austin to undergo a testing process, paid for by the U.S. Department of Defense.
There were clinical interviews to identify current or previous mental illness or depression; genetic testing so researchers could study a variety of genetic markers, including the seratonin transporter gene, that might make soldiers more susceptible to combat stress; and imaging scans to allow researchers to study areas of the brain such as the amygdala and hippocampus, which are involved in stress reactivity and emotional processing.
Researchers also gave the soldiers eye-tracking tests, flashing pictures of faces in different emotional states to see whether they had a propensity to avoid or fixate on emotional stimuli.
Telch said that soldiers who tended to fixate on the emotional images might "focus on threatening stimuli in a war environment."
Finally, soldiers underwent carbon dioxide stress tests, in which they inhaled a mixture of 35 percent carbon dioxide and 65 percent oxygen and held it for five seconds. While feeling the effects of the mixture, soldiers were tested for heart rate and stress. Telch said that though the test produces light-headedness and breathlessness in everyone, some people react with intense emotional distress and even panic.
"If there was an exaggerated stress response to this challenge, they might present an exaggerated response" in a combat zone, he said.
The soldiers, none of whom were killed in combat, underwent the same testing when they returned this spring, giving researchers comprehensive before and after comparisons. And the soldiers' logs while in Iraq allowed researchers to see what kind of reactions the soldiers had to certain battlefield stressors such as roadside bombs and firefights.
Telch said that preliminary data indicated that soldiers who showed pronounced responses to the carbon dioxide stress test showed more stress in Iraq. And he said his group's research may also uncover factors that make some soldiers more resistant to PTSD, such as feeling emotionally supported by fellow soldiers and by friends and loved ones at home.
Telch said he was surprised to find how much the use of technology such as e-mail and instant messaging contributed to soldiers' stress. "Not only do they have stress in theater, but they are bombarded with every little thing happening at home," he said. "It adds a whole other layer of stress." He said that for some soldiers, that closeness may have canceled out some stress because they don't miss home so much.
More research planned: Telch said his team plans to apply for more financing and hopes to enroll 560 soldiers in future studies. He said that as the conflict winds down in Iraq, future studies will most likely use soldiers deploying to Afghanistan.
Telch said that whatever the results of the studies, they won't predict with certainty which soldiers will develop the illness. "It would depend also on the stressors encountered over there," he said.
But armed with the results of such pre-deployment PTSD testing, military leaders could design prevention programs for those service members who are more vulnerable.
Matthew Schultz, 20, of Michigan, was among a group of study volunteers who were deployed to southern Iraq, where their assignment was to prevent the smuggling of arms and bombs over the nearby Iranian border. The unit built its base from scratch in a remote part of the Iraqi desert, and though most soldiers there didn't experience small-arms fire or roadside bombs, Schultz said soldiers felt the strain.
"We experienced a different kind of stress," he said. "It was more constant pressure. ... It was a big, life-changing experience."
Schultz, who wants to return to combat, said he hopes the study will illuminate an illness that he and his fellow soldiers might face.
"I think it will help me later on and will help other people," he said. "I'm excited to see what will happen when the results come out."
Contact Jeremy Schwartz at jschwartz@statesman.com
