Noteworthy News Articles on Mental Health Topics, September 1- 16, 2005

Poker Boom Pulls Youth Into Gambling
Larry McShane, Associated Press- 9/2/2005

Kevin figures about half the male students at-his suburban high school are regular poker players. It's the latest teen rite of passage: Texas Hold 'Em with the boys, a little low-budget action on the weekend. He started playing at age 15. By the end of his senior year, the now 17-year-old was hunting bigger games. He frequented illegal poker clubs on Long Island, where your birthday took a back seat to your bankroll. He dropped $2,000 betting during a family vacation in the Caribbean. When his job managing an ice cream shop conflicted with poker nights, he quit. As his losses inevitably swelled, Kevin -- without hesitation or remorse -- started looting a $30,000 college fund set up by his parents. "I didn't care if I won or lost," said Kevin, who went through $7000 in three months. "I just wanted to gamble. He wasn't alone.
      This summer, while school was out, a growing number of America's teens were going all in as the nation's poker craze mesmerized a group that grew both larger and younger. Experts fear the obsession is putting America's youth at its highest risk ever for compulsive betting and worry that assistance programs are lagging. "I get calls from parents and kids, some as young as 14, every day," said Arnie Wexler, a counselor and former head of the New Jersey Council on Compulsive Gambling. "This thing has exploded. I've never seen anything explode like this has in the last year."
     Poker, particularly the incredibly popular Texas Hold 'Em version played in the $56 million World Series of Poker, stands alongside hip-hop and video games as pillars of America's youth culture. And as schools reopen this fall, the pool of potential under-aged gamblers is spreading from the upper grades into the middle schools. According to a study by the Louisiana State University Health Sciences Center, 15.9 percent of in-state students between the sixth and 12th grades admit to gambling-related woes or signs of addiction. Four percent report they were already stealing money from relatives to gamble. A national survey showed a huge increase in card-playing among males ages 14 to 22, with the number of youths reporting they gambled in card games at least once a week, jumping from 6.2 percent in 2003 to 11.4 percent last year -- an increase of 84 percent. The vast majority of poker players are males. It's easier for a teenager to place a bet than to buy a six-pack of beer or a pack of cigarettes. And more teens are taking advantage of the easy access to gambling, with dreams of making easy money. "Poker is huge," said Kevin.

Teens in trouble
There are no definitive statistics on the number of teenagers battling compulsive gambling problems nationwide. But Ed Looney, who followed Wexler as head of the New Jersey council, cites the 80-15-5 rule. "Eighty percent of the kids who gamble, there will be no impact on their lives," Looney said. "Fifteen percent will have some problem. And 5 percent will become addicted." It's a scary number. The risk of pathological gambling runs about twice as high among adolescents (5 percent) as it does among. adults {3 percent), said Dr. Carlos Blanco, head of the gambling clinic at the Columbia University Medical Center.
     As the number of young gamblers increases, so does the number of young gamblers saddled with a problem. Those odds, experts say, are unforgiving and indisputable. Many teens pick up the game from television, with its endless permutations of professional gamblers and celebrity wannabes, wlth its explanations of intricacies of the seven-card game. But there's more than television at work here. Online-gambling is just a mouse click away, accessible 24 hours every day, 365 days per year. A Goggle search of play and Texas Hold 'Em turned up more than 2 million results.
     Serious gamblers often play multiple hands simultaneously, cranking up the endorphins and the risk. "Everybody loves to win a hand," said Dr. Neil Capretto, medical director of the Gateway Rehabilitation Center in Aliquippa, Pa. "It's really a high." Capretto's facility treats drug and alcohol addiction, although within the last 18 months he noted an increase in younger addicts suffering from gambling woes. Cross-addiction is a fairly common problem; researchers at the National Council on Problem Gambling found that teens with a gambling problem were more likely to engage in risky behavior such as unsafe sex, binge drinking and skipping school.
     Gamblers also have the highest suicide rate of any addicted group. A 19-year-old New Yorker lost $6,000 on the 1997 World Series, then killed himself and left a note citing his debt. Of course, most of the consequences fall far short of death: A college freshman forced to drop out of school after turning into a 24-hour-a-day Internet poker player. The teenage girl looting her mother's checking account The teenage boy who graduated from neighborhood : poker games to stealing his parents' credit cards. "I know kids in the 10th grade right now who are gambling their brains out," said Andrew, 18, whose own gambling woes drove him to Gamblers Anonymous. "I see it in my town, I see it in the towns around us."
     Even those who a name and a living from professional poker wonder about the impact on adolescents. "I shudder to think how many kids have dropped out of college because of us," said poker-playing celebrity Dutch Boyd in a Rolling Stone magazine profile. "TV makes it look glamorous and like something anyone can do, but it's neither." Boyd, 24, mentions in his official biography that he "arrived in living rooms around the country during ESPN's 2003 World Series of Poker." Kids like Kevin, the Long Island high schooler, took notice. "I thought I could quit any job and play poker for a living," he recalled. "I thought, 'I can do that."'

Finding help
When Denis M. walks into a Gamblers Anonymous meeting these days, the 15-year veteran of the self-help group can't help but notice the changing crowd. "Particularly over the last five, six years, it's getting younger and younger," said the 50-year-old New Jersey resident. "We've seen more teens than ever before." His early days in the program were spent among men -- almost exclusively older white men -- at the GA meetings. No more. On Long Island, there are now two GA meetings devoted exclusively to teens. Kevin, who started attending after his angry parents discovered the depleted tuition fund, is a regular. "That was a big thing for me, to realize I was not alone," said the teen, who will start college this fall and start paying his parents back the missing cash.
     Many parents, while concerned about drugs, alcohol and sexual activity view poker games
as benign and typically, they're right. But experts warn parents to watch out for specific signs: sudden windfalls of cash, unexplained financial losses, a general preoccupation with betting.
     Although the problem is national, education about problem gambling remains a mostly local concern. But local money is tough to find. Of the 48 states with legalized gambling, only 22 devote any government funding to help people with gambling problems, said Keith Whyte, executive director of the National Council on Problem Gambling.
     In California, with a teen population in the millions, there is no statewide educational program on teenage gambling. The same is true in New York, despite a prescient 1998 study by the state Council on Problem Gambling that found four of five students ages 13-to-17 had placed at least one bet. A December symposium in New York hopes to illuminate the problem and develop some solutions. The state council reports a 42 percent increase in calls from gamblers 18 and under between 2003 and 2004.
     Some schools are trying to find their own answers. In New Jersey, officials at the Tenafly Middle School arranged for a school assembly in May after students began showing up with poker chips and cards in their back packs. Returning students at Ridge High School in Somerset will find that carrying a deck of cards is a violation of school policy in Orange County, Fla., will receive anti-gambling lessons this fall as part of the curriculum. The Massachusetts Council on Compulsive Gambling ordered 50 copies of a video, "The Big Win," aimed at warning youthful poker players. Copies of the video were also sent to school districts in Wisconsin and Connecticut. But it's difficult to find anyone who thinks the problem is fully addressed. "Even if just 2 percent of kids become compulsive gamblers, that's a huge number," said Jim Maney, head of the New York council. "And we don't know who they are."

FYI
• Gamblers Anonymous operates a hotline serving Michigan residents. The number is (313) 792-2877.
• There's information online at www.gamblersanonymous.org
• The State of Michigan operates a hotline through the Department of Community Health in cooperation with the state Lottery Commission. The number is (800) 270-7117. Calls are confidential.
• There's information online at the link on the righthand side of the Lottery Commission's home page, www.michigan.gov/lottery.
• The National Council on Problem Gambling also provides information at www.ncpgambling.org.

Traumatized by 9/11, Fired Over Drug Rule
Michelle O'Donnell, New York Times- 9/6/2005

If anyone seemed an able candidate for the harrowing recovery work at ground zero, it was Firefighter Tom Kelly, a former marine and sandhog who had spent most of his 14-year career pulling people out of fires and accidents. But at the site, where he logged long hours, he rescued no one. A face, an arm, a leg, a scalp with hair, shoes with feet in them, a headless body. Those were some of the remains that Firefighter Kelly found, and in the months that followed, he said, they kept finding him. Overwhelmed with death, he rarely slept. When he did, he often awoke to nightmares, still swatting at the maggots he dreamt were on his face and helmet. He became depressed and suicidal and began to engage in risky behavior, including, he said, the occasional use of cocaine. In January, he failed a random test at his firehouse in Queens and was suspended. He is now slated to be fired, ending his career and, under civil service law, forfeiting his pension. "What man in his right mind would ignore the warnings?" Firefighter Kelly wrote earlier this year in a journal. "And the answer to me is, nobody in their right mind would do that."
     Firefighter Kelly, who was found to have post-traumatic stress disorder in February by a psychiatrist at Safe Horizon, a nonprofit treatment center, acknowledges that much of his problem was of his own making. But friends and co-workers say they consider him one of the latent casualties of 9/11, a rescue worker whose inability to process the horrors of what he saw on his job ran counter to the Fire Department's zero tolerance policy on drug use.
     That policy was tightened after a spike in reported substance abuse within the department's ranks after 9/11 and a series of embarrassing incidents, including an accident last year in which the driver of a fire truck was found to have had cocaine in his system. (An administrative judge recommended that the charges be dismissed on the grounds that the accident was too minor to justify a cocaine test.) The policy stipulates that firefighters caught once using drugs are fired unless they have come forward to report their problem. The Fire Department says the policy, and a decision last year to do random testing, are sensible, necessary measures to protect the safety of other firefighters and the public.
     The department says most of the 49 firefighters who have been fired, or are slated for firing, for drug and alcohol problems in the past two years have been young firefighters who were not working for the department in September 2001. But several of those caught have been veteran firefighters, viewed by many in the department as solid workers with no prior disciplinary problems and whose drug use may have been related to the trauma of 9/11. One is a 10-year veteran from Lower Manhattan who on the morning of Sept. 11 dodged falling bodies to help set up a command post in the north tower lobby. Another is a firefighter from a battalion that lost an entire company of men that day. On Sept. 12 three years later, a day after the memorials to the 2,749 who died, he contacted the department's counseling unit, seeking help for a growing drug problem. Told he had to enroll in a residential counseling program, he balked. The next day he was caught in a random drug test and, after 19 years, he was dismissed last October.
     Fire officials say that that after more than 2,000 random drug tests, the small number of firefighters who have failed is an indication that the policy is a reasonable one that all but a few have been able to comply with. "There was a consensus," said Francis X. Gribbon, a spokesman for the department, "that drug use had no place in an occupation that is so dangerous."
     But mental health professionals question whether it was wise to make the policy stricter at a time when the department was facing a possible surge in substance abuse. "As an outsider, this one-shot policy strikes me as a little extreme," said Dr. James Pennebaker, a social psychologist at the University of Texas who studies how people cope with trauma. "Somehow, we view mental health as totally under a person's control, whereas physical health is not.
     In Oklahoma City, after the 1995 bombing, one study found that firefighters who drank began to drink more heavily as they struggled to deal with their anguish, although city officials there do not believe that the number of substance abusers actually increased. The city resisted enacting a zero tolerance policy even as it upgraded its counseling efforts. "The whole policy was put in place to help our folks," said Maj. Kim Woodring, a human resources supervisor for the Oklahoma City Fire Department. "The whole basis of the policy was to try to get our employees to be productive employees."
     Zero tolerance works, officials say, because it is a bracing deterrent to those who do not take the prohibition seriously. After the volunteer Army adopted such a policy in 1980, alcohol and drug abuse in the military decreased considerably, said Dr. Ronald Rosenheck, the director of the Veterans Administration Northeast Program Evaluation Center. "As in so many areas of public policy, it's a matter of balancing the well-being of the individual against the well-being of the public," Dr. Rosenheck said. "And it's clear that the Fire Department's position, sticking to the no-tolerance policy, comes down on the side of their responsibility to the public."
     In New York, in the years before 9/11, fire officials did not strictly enforce the zero tolerance policy, which had been adopted in 1996. In 1999, for example, not one of the 32 firefighters charged with alcohol or drug violations was fired. Firefighters say the leniency was particularly apparent in the weeks after 9/11, when they said officials seemed to recognize the toll taken by the deaths of 343 department members and the long hours spent at the site and attending funerals. But as the number of incidents involving alcohol and drugs began to climb, Fire Commissioner Nicholas Scoppetta said he became concerned about the uneven application of discipline and announced in April 2002 that the department would strictly enforce the zero tolerance policy. Critics say the department uses the policy to get rid of troubled firefighters without considering whether the substance abuse they suffer from may directly stem from their experiences on the job. "They have all this talk about rebuilding the department," said Stephen Cassidy, the president of the firefighters' union, "but the truth of the matter is they are willing to throw guys aside."
     In the months following 9/11, the department made a historic outreach, bringing in hundreds of counselors and volunteers to work with its wounded force. Though some firefighters have complained that the efforts fell short, there seems little question that much more counseling has been done. The agency's counseling unit now sees about 500 firefighters a month, or 10 times the number before September 2001. Many of the new cases are firefighters coming forward to report problems with drugs and alcohol. Before 9/11, counselors typically saw 180 firefighters a year who were suffering from alcohol and drug abuse, both new and old cases. In 2004 alone, the department opened up 185 new cases, and by last month it was treating a total of 723 firefighters for substance abuse.
     Dr. Rachel Yehuda, the director of the Post Traumatic Stress Disorder program at the Bronx Veterans Administration Hospital, said many rescue workers resisted counseling early on because it was contrary to the image of strength associated with firefighting. As adults, she said, they should be held responsible to seek the help they need. Dr. Rosenheck said if the department adjusted its policy to one with more discretion, it would be taking on the unenviable task of distinguishing between those whose drug use really did spring from the trauma of 9/11 and others who might be using the misery of the day as an excuse. Still, Dr. Yehuda said, drug abuse is a treatable problem and one that argues for an approach that gives employees a second chance.
     If Firefighter Kelly had come forward to report his problem, he could have saved his job, under the city's policy. Yet this opportunity is not taken by some firefighters, according to private counselors who report seeing firefighters who pay for their own treatment because they do not trust the department to keep their problem a secret. Firefighter Kelly said he did not feel comfortable opening up to the counselors he was assigned to see after working at ground zero. He said he did not think they could understand what he was going through. The remains were haunting him, he said, first at the site, where he encountered them as he sifted through debris, and later at home, where he could not escape what he had seen.
     During one shift, about 4 a.m., after finding additional body pieces, Firefighter Kelly said he alerted a supervisor. The supervisor began asking him a series of questions: Name? Rank? Badge number? The information was used to tag the remains with the identity of the person who had found them, quite possibly the only identifying markers they might ever have. "Is this in case we go nuts a few years from now?" Firefighter Kelly asked. There was no reply, he said.
     Firefighter Kelly said he felt anxiety and guilt. He had lived. Others close to him had died, including three lifelong friends. A co-worker, Firefighter John Hegeman, said he saw a transformation in Firefighter Kelly during that period, though he did not know about any drug use. He said Firefighter Kelly had been known as the General, a no-nonsense man who barked commands. Now, Firefighter Hegeman recalled, he could be brought to tears by firehouse teasing.
     In 2003, Firefighter Kelly stunned co-workers by leaving Engine Company 281, his busy unit in East Flatbush, for one with less fire duty in the Rockaways. There, he said, he spent hours on the roof, scanning the skies for incoming planes or smoke over the other boroughs. "I was shocked," Firefighter Hegeman said. "Nobody transfers out of our firehouse -- no one." Firefighter Kelly said simply, "I didn't want to be around any more dead people -- people who burned to death, got shot to death, fell off a roof, car accidents, suicides, dead babies, crib death or by parents rolling over and killing them."
     In January, he tested positive, was suspended and was given a desk job at a cubicle, where he had little to do but dwell on what he had seen. As the breadwinner for five children, he said, it weighed on him that, three years from being eligible to retire with a full, lifetime pension, he was now in danger of losing it all. He said he began to view his predicament and the zero tolerance policy as deeply unfair and, despite the stigma of being viewed as a drug user, came forward to speak out about it at length. Other firefighters in similar positions declined to be interviewed, saying they viewed their drug use as a personal matter. "I did what I could for 17 years for the Fire Department," Firefighter Kelly said last Friday. "It got me into this trouble. They don't want me anymore, and under these conditions, it stinks." At the same time, he said he knew he could not blame the department entirely for his problem. "I'm trying to say," he said, "with all the humility I can, that I made a mistake."

Rats and mice and monkeys do not get schizophrenia. That is lucky for the animals but bad for the millions of humans who suffer from it, often struggling with its delusions and mental damage from young adulthood until they die. With no animals to experiment on, researchers have been hampered in their efforts to crack the question of what schizophrenia does in the brain to produce such devastating symptoms. But they may be getting closer. Dr. Francine Benes of McLean Hospital has just published work showing that on the level of cells and chemicals, some of the changes of schizophrenia can be replicated in a rat's brain. ''This has never been done before, and conceptually, it's an important step forward," she said.
       The rats did not behave as if they were seeing hallucinations or hearing voices -- though who can tell? Rather, Benes used a drug to mimic some of the biological changes of schizophrenia, and recorded electrical activity in the brain showing that, indeed, schizophrenia-like effects in certain circuits in the rat's brain had resulted. Her findings could lead to new targets for schizophrenia drugs, and also could allow researchers to better pinpoint genes that are involved in the disease.
     ''This is a pioneering study that reproduces the neuropathology of schizophrenia in rodents," said Dr. Alessandro Guidotti, a schizophrenia researcher and scientific director of the Psychiatric Insitute of the University of Illinois at Chicago. It is only a partial model, he cautioned, so ''this has to be taken with a grain of salt." But it could provide a way to test schizophrenia drugs on animals for potential use in humans, he said, and the lack of such animal models up until now has been a major obstacle to the development of better drugs. Research on the basic biology of disease often can only be done in animals, because test animals are killed, dissected, or subjected to other procedures that would be unethical in humans.
     Published this month in the Proceedings of the National Academy of Sciences, Benes's findings in rats build on two decades of research, by her and others, beginning with an analysis of brain tissue from dead schizophrenics and now including high-tech brain imaging and genetic analysis.
     It was back in the 1980s, Benes recalled, that researchers began to suspect that levels of a chemical messenger in the brain called GABA were abnormal in people with schizophrenia. GABA is the main such messenger that inhibits, or dampens, the firing of neurons in the brain. Benes gradually realized that there were two particular areas of the brain where the GABA abnormalities showed up repeatedly: one area, in the cortex or rind of the brain, played a role in attention and emotion at the conscious level. The other was in the hippocampus, which is central to memory. It could be, she reasoned, that both of these areas were part of a network that is mis-wired in schizophrenia, and the source of these abnormalities was elsewhere. And yes, it turned out that major highways of nerve connections linked both these spots with the amygdala, a small almond-shaped structure deep in the brain that is important for emotion and learning. ''So then we thought we had the makings of a rat model," she said. ''We ought to be able to experimentally manipulate the amygdala and produce changes in one of these downstream sites that are similar to what we see in schizophrenia."
     With a drug called picrotoxin, Benes dampened the GABA system in the amygdala. Two hours later, when her team examined GABA-releasing cells in the rat's hippocampus, they could see changes similar to those in schizophrenia. They also used electrodes to measure the activity in neurons in the affected areas, and found GABA levels dramatically reduced. Such work, she said, is allowing her team now to dissect out the individual neurons that are likely most important in schizophrenia and figure out which among thousands of genes may be most important in the disease. ''We're inside the brain, we're inside the circuit, now we're inside the cells, and I really believe this is the trail that we have to follow," she said.

Depression Increasingly Common During College Years
Garret Condon, Hartford Courant- 9/10/2005

When Aimee Belisle of Woonsocket, R.I., was a freshman at Bentley College in Waltham, Mass., she thought that crying herself to sleep every night was normal. She became moody and began skipping meals. By her junior year, she was cutting herself. That's when a college friend took her -- carried her -- to the college counseling center. There, she was linked up with one-on-one talk therapy, and a psychiatrist retained by the college prescribed the antidepressant Paxil. Although Belisle had setbacks along the way, she said the treatment for depression turned her life around. She graduated in 2002 and became an advocate for depression screening.
     The reason she resisted getting treatment earlier in her college career, Belisle said, is that she thought that "depression is for older people." But depression, anxiety, sleep disorders, eating disorders and even suicide are very much part of college life these days, and experts in the field speak of the "college mental health crisis." The American Medical Association, prompted by the American Psychiatric Association, agreed this year to undertake a study of the problem.
     Nearly half of college students in a recent survey reported that at some point in time they were so depressed that they could not function. Nearly 15 percent of college students reported that they had been diagnosed with depression. About 10 percent reported that they had considered suicide at least once. There are more than 1,100 suicides on college campuses each year, making it the secondleading cause of death, after accidents, among students.
     And although stress has always been a part of collegiate life, there is evidence the burden of mental illness has gotten worse in recent years. Dr. Richard Kadison, chief of the Mental Health Service at Harvard University Health Services and co-author of "College of the Overwhelmed: The Campus Mental Health Crisis and What To Do About It", cites a 2003 study done at Kansas State University looking at student mental health complaints from 1988 and 2001. In that period, the number of students who had contemplated suicide or had serious depression doubled. The number seeking help for sexual assault quadrupled.
     Michael Kurland,, director of student health services at the University of Connecticut in Storrs, said it's a nationwide issue. "This is a problem that virtually all campuses are facing," he said. The psychiatric illnesses diagnosed at college counseling centers include anxiety disorders, depression, eating disorders and substance abuse. Major psychiatric disorders like schizophrenia, although' much less common, typically first surface during the college years.
     Experts keeping tabs on the campus mind-set say that whether someone is in college or not, the 18-to-24 age range represents one of life's most jarring transitions: the beginning of adulthood. "It is the first time you're away from home for most people," Belisle said. "And it's a lot harder than people may think."
     Many students, faced with a sudden surplus of freedom, engage in risky behavior. Kurland said they also are often under tremendous financial strain because of the cost of a college education, and that the pressure to compete and be perfect is very high. . Psychologist Randolph Lee, director of the counseling center and associate professor of psychology at Trinity College, has been on the job for 36 years. He believes that daily life is speeding up in general and that, paradoxically, many students are poorly equipped to deal with the added stress because they've been overprotected by their still-hovering parents. Students "have a harder time dealing with the roadblocks when they come up -- they're kind of flummoxed," Lee said. "We do have to let our kids go, and we have to let them screw up." At the same time, he acknowledges that students now graduate into a post-9/11 world of homeland insecurity and economic uncertainty. "There are more consequences to screwing
up now," he said.
     Dorm living often is laced with drugs and alcohol, which tend to worsen mental health problems. Psychologist Michelle Williams, director of clinical training for doctoral psychology students at the University of Connecticut, said that "substance abuse is alarmingly high for college students." And colleges are welcoming . many more students already diagnosed with emotional or developmental problems than in. the past, said Dr. David Fassler of Burlington, Vt., co-chairman of the American Psychiatric Association's Presidential Task Force on Mental Health on College Campuses. "There are` kids going to college today who would never have made it that far in previous generations," Fassler said. Such students "made it through high school with a lot of external support. Some do quite well in college, but often need a team to help provide continuing support and assistance."
     A student with Asperger's Syndrome, for example, might have the intellect for college, he said, but need help with interpersonal relations, which can be especially difficult for people with that diagnosis. Whether students are already diagnosed with emotional difficulties or suddenly need help, they must deal with the shame that continues to shadow mental illness. "It can be pretty stigmatizing for a college student, if this is really the first time they're starting to experience these kinds of issues, to seek therapy or take medication," Williams said. She said that colleges are increasingly using freshman orientation to introduce students to on-campus mental health resources -- and to academic resources as well. Students with identified disabilities, for example, can seek certain accommodations such as extra time for exams.
     Kadison said that parents would do well to ask about mental health services, wellness programs and on-campus mental health advocacy groups when considering colleges. The wise choice of a college itself can ward off many potential mental health problems, Fassler said. "Some kids can go to a huge state university and they do great," he said. "Other kids are just overwhelmed and lost in the same environment."

Signs of depression
Parents of college students can watch for warning signs:
• Social withdrawal and loss of interest in things are key tipoffs that a student may be having problems, says Dr. Richard Kadison, chief of the Mental Health Service at Harvard University Health Services.
• Pay attention too any major shift in a student's longtime behavior, even changes that may seem to be positive, says psychologist Randolph Lee, director of the counseling center at Trinity College.
• Make sure that changes in behavior, such as trouble sleeping, decreased appetite or changes in energy level, aren't simply the temporary result of a minor setback, such as a particularly bad week, a romantic breakup or failure to make the team, advises Dr. David Fassler, an adolescent psychiatrist in Burlington, Vt. The altered behavior is likely to be significant if it lasts for a couple of weeks and is interfering with the student's ability to function. Take any such behavioral shifts seriously, says psychologist Michelle Williams, director of clinical training for doctoral psychology students at the University of Connecticut. Parents of college-bound kids often don't expect them to have difficulty adjusting to life on campus.
• Agree on a regular, check-in telephone call, Kadison says. Parents are more likely to hear things if they have a routine appointment to talk.

Local resources
If you or someone you know is experiencing symptoms of depression, here are some places where you may find help.
• University of Michigan mental health hot line: (734) 647-4440 or the U-M mental health Web site www.umich.edu/-mhealth.
• The U-M Depression Center Web site: www.med.umich.edu/depression/ (check the "links" section)

"This is unprecedented," said New York psychiatrist Spencer Eth, who was involved in treating survivors of the World Trade Center attack, which unlike the hurricane, killed many victims at the scene and destroyed several office towers, not entire communities. "People are not going to bounce back and resume their lives and recover" at the pace seen after other disasters, Eth predicted.

The previous disasters on which experts rely for lessons about how to handle the victims of mass tragedy -- plane crashes, earthquakes and hurricanes including Andrew, which struck Florida in 1992; the bombing of the Oklahoma City federal building in 1995; the attacks of

Sept. 11, 2001 -- are all dwarfed by the devastation wrought by Katrina.

Even some veteran disaster mental health specialists say they are staggered when they contemplate the enormity of what is unfolding. More than 1 million people have been displaced by Katrina, and more than 400,000 jobs have been lost.

"We've got parents and children separated from each other, and as a mother I just cannot fathom what it would be like not knowing where my child is," said Oklahoma City psychologist Robin Gurwitch, who is working with evacuated children as a member of the American Psychological Association's disaster response unit. "Young children are asked, 'What's your mother's name?' and they say 'Mommy.' "

A spokeswoman for the National Center for Missing and Exploited Children in Alexandria, the federally-designated clearinghouse for Katrina-related missing persons, reported that as of yesterday the group had reports of 1,753 children under 18, the youngest a three-week old-infant, who don't know where their relatives are.

Researchers say that the majority of survivors of mass disasters eventually rebuild their lives and most do not develop a diagnosable psychiatric disorder such as post-traumatic stress disorder (PTSD). The disorder, which is also seen among rape victims and soldiers in combat, can occur any time after a trauma; its symptoms include crippling panic attacks and terrifyingly vivid flashbacks and can last for years.

Acute stress reactions -- nightmares, pervasive anxiety and intrusive thoughts -- typically occur in the month following a traumatic event. Acute stress is more common than PTSD, which affects between 10 and 30 percent of survivors, and its symptoms usually fade in less than three months. Acute stress reactions rarely require formal treatment beyond the supportive care now known as psychological first aid.

An intervention based on scientific studies of previous disasters, psychological first aid is designed to blunt the initial fear, anger, anxiety, sleeplessness and guilt that follow a catastrophe by ensuring survivors' physical safety and fostering a sense of calm, reassurance and hope. Its chief tenets include imparting accurate information to victims and offering practical help about coping with the aftermath of a mass disaster.

Effects to Last 'For Years'
To psychiatrist Robert J. Ursano, who directs the Center for the Study of Traumatic Stress at the Uniformed Services University School of Medicine, the military medical school in Bethesda, the obliteration of Gulf Coast communities most closely resembles the Asian tsunami, which also destroyed the local infrastructure and overwhelmed resources. "We are going to be dealing with this for years," he predicted.

While little is yet known about the psychological fallout from the tsunami, one unusual characteristic of Katrina worries disaster psychiatrists: its duration. In most cases, once the rain stops, the tremors subside, the tidal wave recedes or the buildings collapse, the event is over. It doesn't go on for days.

Studies have found that the longer and more intense the threat to a person's life, the greater the likelihood of developing PTSD. The disorder is more common among people who are socially isolated, those with a history of psychological or physical trauma and people with preexisting mental health problems, including depression or anxiety.

The glaring racial and economic disparities exposed by the hurricane may complicate recovery efforts, experts predict. So will the influx of impoverished victims into a public health system that was already dangerously frayed and strapped for cash.

"Oh, hell no," replied Chicago psychiatrist Carl Bell when asked whether the mental health system is prepared for the predicted onslaught of people who need help. "This is very different than anything we've ever seen. I think the country is ignorant of how many poor people there are," the problems they face, and how to help in a sensitive way.

While many African-Americans traditionally turn to churches for help, observed Bell, a trauma expert, "I'm not sure the faith-based people have the mental health technology necessary" to deal with psychiatric problems such as PTSD, although they will undoubtedly provide solace and valuable support.

Traumatized children and teenagers may exhibit symptoms that differ from those seen in adults. Gurwitch, who is working with pediatric hurricane evacuees in Oklahoma City, said that some may become unusually aggressive or clingy, while others may withdraw. Children "who got out earlier might fare better than those who watched dead bodies float by, who saw their parents fall apart, or who witnessed violence," she said.

"It's going to be very hard for children to make sense of this," Gurwitch added. "Young children simply don't comprehend that everything is gone." And parents who are worried about things like getting a job and finding a place to live may have trouble responding to a child who says she wants to go home right now or who is pining for a beloved stuffed animal or a missing pet.

Studies of 550 school-age children who lived through Hurricane Andrew, which flattened the poorest part of Dade County, Fla., killing 15 and uprooting 353,000, found that one year later 30 percent demonstrated moderate to severe levels of PTSD. Children who experienced the greatest threats to their physical safety, who lost their homes or possessions, and who were forced to move, were most at risk, researchers found. Children who had been anxious before Andrew also had higher rates of PTSD.

What Not To Do
Some studies have found that disaster victims who focus on practical things, even mundane ones, tend to have fewer long-term psychological problems than those who were preoccupied with who was to blame for their predicament.

A handout developed by the Center for the Study of Traumatic Stress at the Uniformed Services University, which is being circulated to mental health workers around the country, cautions them not to engage in certain behaviors, such as telling Katrina survivors how they should feel, making blanket reassurances that "everything will be okay" and criticizing services or relief efforts in front of victims because "this undermines an environment of hope and calm."

One popular intervention that should be avoided, Ursano and other experts agree, is the use of stress debriefing, in which people are encouraged -- or required -- to spend hours recounting in graphic detail what they went through. Four years ago dozens of debriefing specialists flocked to New York to offer these sessions in the days after Sept. 11 to firefighters and police officers in the hope of preventing PTSD.

Most experts oppose these sessions as ineffective and potentially damaging. A report published by the Cochrane Collaboration, a group that evaluates scientific studies, found that stress debriefing is ineffective and can increase the risk of PTSD and depression.

Psychiatrist Carol North, a trauma expert at Washington University in St. Louis who recently returned from Baton Rouge, La., said she was concerned by signs prominently posted around the command center and medical treatment areas offering debriefings.

Harold Ginzburg, a New Orleans psychiatrist who fled hours before the hurricane destroyed his house, said that the basic task now is "encouraging resilience" among survivors and helping them find jobs and housing.

"We need to keep people focused on what they can do, and make the resources available for them," said Ginzburg, who is helping direct psychiatric services in southern Louisiana out of Baton Rouge.

Psychological recovery, notes Gurwitch, the Oklahoma child psychologist, is a long process that sometimes takes the form of simple reassurance.

"I saw a 5-year-old yesterday at the airport, and he asked me whether hurricanes come to Oklahoma," she recalled. "I could answer him with 100 percent certainty that no, we never have hurricanes in Oklahoma, and he relaxed. There was no need to tell him about tornadoes."

Survey Finds More Women Try Bisexuality
Associated Press, 9/15/2005

More women -- particularly those in their late teens and 20s -- are experimenting with bisexuality or at least feel more comfortable reporting same-sex encounters, according to a new report from the Centers for Disease Control and Prevention. The survey, released Thursday by the CDC's National Center for Health Statistics, found that 11.5 percent of women, ages 18 to 44, said they've had at least one sexual experience with another woman in their lifetimes, compared with about 4 percent of women, ages 18 to 59, who said the same in a comparable survey a decade earlier. For women in their late teens and 20s, the percentage rose to 14 percent in the more recent survey. About 6 percent of men in their teens and 20s said they'd had at least one same-sex encounter.
      While those who conducted the survey took measures to protect respondents' privacy, researchers say it's unclear whether the figure for men was lower because they're are more likely to avoid same-sex experiences or whether they're not reporting them. It wouldn't surprise Kat Fowler, a 27-year-old art student who dates both women and men, if men were less likely to talk about their experiences. ''There's a certain higher level of discrimination (for men). It's a lot easier for women to have these kinds of experiences and be open about it because it's more accepted,'' said Fowler, who attends the University of Florida.
     The findings on bisexuality and other aspects of Americans' sexual habits were taken from the National Survey of Family Growth, which included 12,571 in-person interviews, done from March 2002 to March 2003. Overall, researchers said the report shows that most people have relatively few partners and are at a low risk for sexually transmitted diseases. ''Instead of just anecdotes and stories that raise people's anxieties, I think it's best to have real numbers,'' said William Mosher, the statistician who oversaw the report. ''And now we have those.''
     When it comes to women and same-sex relationships, Mosher said it would be worth studying why young women seek such relationships, and whether they may be trying to avoid diseases more commonly spread through sex with men. But some experts who study sexuality say it's even more likely that many college students simply see experimentation as a rite of passage. ''It's very safe in the academic community; no one thinks anything of it,'' said Elayne Rapping, a professor of American studies at the University of Buffalo who has written about sexuality. ''But to some extent there's more talk than action,'' she added, noting that the bisexuality label has become a ''badge of courage'' for some college women, even those who only date men. Meanwhile, she said, men who have same-sex experiences are often less likely to talk about it publicly. The trend among college women has prompted some sexual behavior experts to light-heartedly refer to the term ''LUG,'' or ''lesbian until graduation,'' said Craig Kinsley, a neuroscientist at the University of Richmond who studies the biology of sexual orientation and gender.
     In other findings, the survey said that about 10 percent of females, ages 15 to 19, and 12 percent of males had experienced heterosexual oral sex but not vaginal intercourse. While no earlier data were available for young women, percentages for young men in 1992 were about the same, researchers said. Those numbers dropped substantially for people in their 20s, who were more likely to have had vaginal intercourse.
     The survey also revealed that 39 percent of men, ages 15 to 44, who'd had at least one sexual partner in the last year said they used a condom during their most recent sexual encounter. That figure rose to 65 percent for men who'd never been married -- and 91 percent for men who'd ever had sexual contact with another man. Mosher said it was likely that men in higher-risk categories were heeding campaigns that encourage them to use condoms. ''Whether the levels (of condom use) are high enough is for others to judge,'' Mosher said. ''But I think it's at least encouraging.'' The survey of adults has a margin of error of 1 percentage point and 3 percentage points for the teen data.
     On the Net: Federal survey results: http://www.cdc.gov/nchs/products/pubs/pubd/ad/361-370/ad362.htm

As the victims of the hurricane fan out across the country to new homes and perhaps new lives in one of the largest resettlements in U.S. history, concerns are growing about the effects the multiple tragedies may have on their lives. The fright of a catastrophic storm and the damage it wrought was bad enough. But thousands of people, including many children, subsequently faced hunger, dehydration and gut-wrenching fear as they waited for days for rescue from rooftops, attics or the Superdome. Now they face more anxiety as they settle in unfamiliar towns and cities and try to build new lives -- or get their old ones back.

Post-traumatic stress disorder, depression and anxiety are common after major disasters, mental-health experts say, because disasters frighten people and disrupt their lives. But Hurricane Katrina poses special challenges, they argue. Its victims "have been exposed to multiple traumas," says Thom Bornemann, director of the mental-health program at the Carter Center in Atlanta and an expert on psychological effects of disasters. Hurricanes and other natural disasters often can be explained away in people's minds as an "act of God," he said. But many people hit by Katrina not only lost everything they owned, but also feel abandoned by the very authorities meant to protect them.

Mental-health clinics in Baton Rouge, where many New Orleans residents have relocated, are seeing a surge in the number of patients. In Houston, another major hub for evacuees, Dr. Bornemann and a team of experts are working with local officials to strengthen mental-health services as demand rises.

Children are particularly affected. One nine-year-old girl couldn't eat or speak for four days after being plucked from the attic of her flooded home. The girl, whom Ms. Aretsky found at a church in Baton Rouge, had watched her grandmother and grandfather die in the sweltering heat as the family waited to be rescued. Then her father had left the girl and her 13-year-old sister to go find help -- and never came back. Ms. Aretsky, who has a private therapy practice in Baton Rouge, got the girl admitted to a local hospital and on medication, and insisted that her sister -- who so far had displayed no symptoms of trauma -- be allowed to stay with her.

"In a typical disaster, the vast majority of people...will get over it and go on with their lives," Dr. Bornemann says. Hurricane Katrina, though, "may be unprecedented in magnitude and ferocity. You've got compounded conditions on top of compounded conditions.

"We don't know what the effects on them are going to be, and I can't think of an event that would help us predict that," he says.

The traumas of Katrina are particularly tough on the people of New Orleans, say Dr. Bornemann and other mental-health experts. About a third of the city's residents live below the poverty line. Rates of many illnesses -- including chronic diseases and mental illnesses -- are high. And New Orleans residents rely heavily on tight-knit, family networks for much of what they need, so the forced breakup of families could be particularly wrenching for some. "New Orleanians...don't go outside the family system for many things," says Ms. Aretsky. Scanning the shelter, where she volunteers every evening, she says, "There's not one in this place who's not hugely anxious."

The hurricane's upheaval also has exacerbated the symptoms of some people who suffer from developmental disabilities and mental illnesses such as schizophrenia. Some were delusional after days of going without food, water and their medications. Others are disoriented and irritable because they have been separated from longtime caregivers and familiar surroundings, say mental-health workers who have provided aid to these people. People with autism and Down's syndrome, particularly, are very schedule-oriented and so are thrown off by change, experts say.

Health workers also are concerned about evacuees who have addictions and need methadone treatment. New Orleans has several methadone clinics, but some of the towns and cities where evacuees were sent have few.

The U.S. Substance Abuse and Mental Health Services Administration, part of the Department of Health and Human Services, has deployed teams of experts to provide support to state and local mental-health programs in Louisiana, Mississippi and Texas, and has awarded $600,000 in grants for mental-health programs to hurricane-affected states, according to the agency's chief, Charles Curie. Louisiana will use its $200,000 grant to provide counseling to disaster workers, firefighters, police and other emergency responders.

The Federal Emergency Management Agency is awarding grants for crisis counseling for which 28 states are eligible, Mr. Curie says.