Narrative coherence and posttraumatic stress disorder symptomatology following combat in Iraq and Afghanistan

Background Mental health problems have been identified to be the area of greatest need in the British military veteran population (The Royal British Legion, 2006). Troops serving in Iraq and Afghanistan are exposed to a number of traumatic stressors which might impact on their mental health. The most recognised PTSD population is the combat veteran (Miller, 2000) and the transition from the military to civilian life can be a challenging period for veterans as they develop a narrative of their experiences and incorporate this into their life story (Ormerod & Evans, 2008). Exposure to traumatic events and the experience of post-traumatic stress disorder (PTSD) has been reported to affect narrative development (Wigren, 1994) which is implicated in coping after trauma. This study aimed to: (i) explore the characteristics of veterans‟ narratives following combat in Iraq and/or Afghanistan through the application of Burnell, Hunt and Coleman‟s (2009) model of narrative analysis; (ii) identify whether experience of PTSD symptoms affects narrative coherence; (iii) identify common experiences amongst this group of veterans; and (iv) identify factors which affect narrative coherence in this population. Method This qualitative study used narrative analysis to explore these aims. Five male British armed forces veterans completed the Posttraumatic Stress Diagnostic Scale (PDS; Foa, 1995) and an individual narrative interview during which they were asked to discuss their experiences prior to deployment to Iraq/Afghanistan, their experiences in these areas of conflict and their life since returning to the UK and leaving the armed forces. Burnell 0910, RES, Research Report, UoL: 07091779, UoN: 4073816, Page 2 of 225 et al‟s (2009) model of narrative coherence coding was applied to the analysis to explore the characteristics of veterans‟ narratives and to determine narrative coherence. Results None of the veterans‟ narratives were analysed to be coherent and due to the characteristics of the sample no conclusions could be drawn in relation to PTSD and narrative coherence. Although the narratives were descriptive and contained many of the factors of Burnell et al‟s model of analysis, one specific factor, relating to the recognition of temporal coherence, was absent from each of the narratives, rendering them incoherent. Although emotional evaluation was present in each narrative, descriptions of combat events rarely contained statements of emotion or emotional evaluation and a detachment from emotion and cognition during these events was reported. Work for the Special Forces negatively impacted on veterans‟ narratives by causing fragmentation as they tried to decipher the information they were prohibited to share. Three factors were identified to possibly affect the development of this sample of veterans narratives, including, emotional and cognitive disengagement during combat, opportunities to speak about their experiences and societal support. Conclusions The findings of this study cannot explicitly support previous research relating to veterans‟ narrative coherence following exposure to trauma due to the small sample size. When applying Burnell et al‟s model to a younger cohort of veterans than those included in its development, adaptation is required in relation to recognition of temporal coherence. Factors other than trauma exposure are involved in the process of narrative development and integration

Lung function, asthma symptoms, and quality of life for children in public housing in Boston: a case-series analysis

BACKGROUND: Children in urban public housing are at high risk for asthma, given elevated environmental and social exposures and suboptimal medical care. For a multifactorial disease like asthma, design of intervention studies can be influenced by the relative prevalence of key risk factors. To better understand risk factors for asthma morbidity in the context of an environmental intervention study, we conducted a detailed baseline evaluation of 78 children (aged 4–17 years) from three public housing developments in Boston. METHODS: Asthmatic children and their caregivers were recruited between April 2002 and January 2003. We conducted intake interviews that captured a detailed family and medical history, including questions regarding asthma symptom severity, access to health care, medication usage, and psychological stress. Quality of life was evaluated for both the child and caregiver with an asthma-specific scale. Pulmonary function was measured with a portable spirometer, and allergy testing for common indoor and outdoor allergens was conducted with skin testing using the prick puncture method. Exploratory linear and logistic regression models evaluating predictors of respiratory symptoms, quality of life, and pulmonary function were conducted using SAS. RESULTS: We found high rates of obesity (56%) and allergies to indoor contaminants such as cockroaches (59%) and dust mites (59%). Only 36% of children with persistent asthma reported being prescribed any daily controller medication, and most did not have an asthma action plan or a peak flow meter. One-time lung function measures were poorly correlated with respiratory symptoms or quality of life, which were significantly correlated with each other. In multivariate regression models, household size, body mass index, and environmental tobacco smoke exposure were positively associated with respiratory symptom severity (p < 0.10). Symptom severity was negatively associated with asthma-related quality of life for the child and the caregiver, with caregiver (but not child) quality of life significantly influenced by caregiver stress and whether the child was in the intensive care unit at birth. CONCLUSION: Given the elevated prevalence of multiple risk factors, coordinated improvements in the social environment, the built environment, and in medical management would likely yield the greatest health benefits in this high-risk population

"Eating addiction", rather than "food addiction", better captures addictive-like eating behavior

Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved. This review has been compiled by scientists of the NeuroFAST consortium (The Integrated Neurobiology of Food Intake, Addiction and Stress; www.neurofast.eu), a research program that aims to reveal neurobiological and psychological mechanisms underlying habit-forming addictive processes related to the overconsumption of highly palatable food. The research leading to these results has received funding from the European Union's Seventh Framework programme for research, technological development and demonstration under grant agreement no. 245009.Peer reviewedPublisher PD