Journal Digest

People tend to be most susceptible to posttraumatic stress disorder (PTSD) in mid life, Danish researchers reported in the July 21 Annals of General Psychiatry.

Ask Elklit, a professor at the National Center for Psychotraumatology at the University of Southern Denmark, and his colleague Daniel Ditlevesen, based their study on data collected from 25 previous PTSD studies. All of the subjects in those studies—some 6,600 in all—had been evaluated for PTSD using the Harvard Trauma Questionnaire. They ranged in age from 13 to 80.

The researchers then determined the years when people appeared most and least vulnerable to PTSD. They found that susceptibility to PTSD peaked in mid life, although the risk seemed to peak a decade earlier for men (ages 41-45) than for women (ages 51-55).

People might be most vulnerable to PTSD during these years because of mid-life stressors, the researchers speculated. For instance, men might be especially stressed at ages 41 to 45 because of work and family responsibilities, and women might be especially stressed at ages 51 to 55 because of menopause and related issues.

The researchers also found that people are least vulnerable to PTSD in their 70s. The reasons why older people might be less susceptible, they proposed, may be because they have acquired a perspective on life and a resilience that younger people lack. Other studies have likewise found that people tend to enjoy better mental health when they are older than when they are young (Psychiatric News, November 2, 2007).

The study was funded by the National Center for Psychotraumatology at the University of Southern Denmark.

The scientific literature on childhood sexual abuse has suggested that people deal with such experiences in one of three ways. One is absorbed processing, in which an individual is engrossed in abuse-related memories. The second is avoidance, in which a victim distances himself or herself from the abuse memories—say, in unconscious forgetting. The third is constructive processing, in which a person gradually works through the trauma in manageable doses.

Valerie Simon, Ph.D., of Wayne State University and colleagues wanted to determine which of these strategies is most likely to be deployed by children who have been sexually abused. They enrolled in the study 108 youngsters who were abuse victims and whose abuse was confirmed within eight weeks of abuse discovery. Subjects were aged 8 to 15 at the time. Six years later, the researchers conducted semistructured interviews with the subjects to determine what type of coping strategy they had been using to deal with their abuse.

They found that 50 percent of study participants had dealt with their abuse in an absorbed manner, 36 percent in an avoidant manner, and 14 percent in a constructive manner.

The researchers also evaluated the psychological health of their subjects using the Trauma Symptom Inventory, Child Depression Inventory, Beck Depression Inventory, and other instruments and then compared the subjects in the three different coping-style groups. The absorbed group showed the most psychopathological symptoms, such as depression, symptoms of posttraumatic stress disorder, or sexual problems, and the constructive group the least, with the avoidant group in between. The absorbed group was especially prone to depression, sexual concerns, dysfunctional sexual behavior, and shame.

Although constructive processing is the tactic least used by sexually abused youngsters, it is the one that helps them recover best from the abuse, Simon and colleagues concluded in their paper, which was published in the August Child Maltreatment. And interventions that help such youth engage in constructive processing—for example, trauma-focused cognitive-behavioral therapy—should be effective in promoting healing from sexual abuse, the researchers believe.

The study was funded by the National Institute of Mental Health.

Multiple studies have found that suicides occur more often in spring or early summer than in fall or winter. Now a new study out of Hungary—a country with one of the highest suicide rates in the world over the last century—has linked suicides with being born in spring or summer.

The sample included some 7 million people born in Hungary during the 39-year period from 1930 to 1969. Out of the sample, about 79,000 died by suicide from 1970 to 2008. The researchers looked to see if they could find links between season of birth and whether study subjects died by suicide. And they did uncover just such a link.

Individuals who had been born in the spring or summer were significantly more likely to die by suicide than those born in other seasons. This finding also held firm for all subpopulations investigated—male subjects, female subjects, suicide completers using violent methods such as guns, and suicide completers using nonviolent methods.

A weakness of the study is that the researchers did not control for variables that might have distorted their findings, such as socioeconomic factors, psychiatric history, or intrauterine development. But if being born in the spring or summer actually increases a person's risk of suicide, how could that finding be explained? By influencing levels of the neurotransmitter serotonin in the brain, the researchers conjectured, since low levels of serotonin have been found in the spinal fluid of suicide completers, and since some studies have found that serotonin levels in the spinal fluid of both infants and adults vary with the season of birth.

Researchers have also found evidence that season of birth is a risk factor for schizophrenia, schizoaffective disorder, and affective disorders.

The lead investigator was Peter Dome, M.D., a psychiatrist affiliated with Semmelweis University in Budapest. Results were published in the July 15 Biological Psychiatry.

Thanks to the Internet, bullying that used to take place only in schools has moved into cyberspace. As a July 2 Washington Post editorial noted, “Cyberbullies can be popular ‘mean girls’ or tech-savvy loners who use their skills to wreak havoc on a social hierarchy that excludes them.”

But what appears to be the first population-based study of cyberbullying, which was reported in the July Archives of General Psychiatry, found something different—that cyberbullies of both sexes tend to be hyperactive, to have conduct problems, to smoke weekly or even daily, to consume alcohol one or more times weekly, to get drunk weekly or more often, to feel uncared about by teachers, to have a lot of headaches, and to feel unsafe at school. Moreover, some girls who had been bullied at school became cyberbullies to seek revenge; this was rarely the case for boys.

The study also provided information about cyberbullying victims. They tend to have emotional and peer-interaction problems, headaches, recurrent abdominal pain, and sleeping difficulties. They also feel uncared about by teachers and unsafe at school.

Because of pressure in the United Kingdom to counter cyberbullying, Facebook there is installing a panic button so that teen users can report cyberbullying, the Washington, D.C., Examiner newspaper reported on July 12. The tool will be advertised on the home pages of teen Facebook users.

An abstract of “Psychosocial Risk Factors Associated With Cyberbullying Among Adolescents” is posted at <http://archpsyc.ama-assn.org/cgi/content/abstract/67/7/720>.