I am a geek. Not the gotta-have-an-iPhone-5-NOW kind of geek but a number-crunching geek. I do computer-assisted investigative reporting. I acquire, compile and analyze data. I search for trends, anomalies and causal relationships.
I have looked for dead people on voter registration rolls and used Census data to find out where single-guys with six-figure incomes live (we didn’t publish that but it’s nice to know anyway.)
You name, I’ve probably analyzed it or thought about analyzing it.
Right now I’m wondering how I can get my hands on data on suicides in the military. We’ve been reading about increasing suicide rates among soldiers and Marines for the last few years. Rates are rising. The Army is so concerned that today the Army has issued a service-wide “stand-down,” ordering soldiers to put aside their usual duties and devote the day to suicide prevention training. This is great news.
However, what I really want to know is why so many soldiers are killing themselves. We keep hearing about multiple tours of duty, the horrors of war, financial and family hardships and substance abuse. Anecdotal evidence. How about we crunch some numbers and see if we can identify trends? Maybe if we analyze these data we can identify those soldiers who are most at risk. Of course, this assumes that the Army is actually collecting these data.
The wheels and queries are spinning in my hypomanic brain. If I had these data today I would spend the day in blissful solitude, searching for answer to these kinds of questions:
Age at enlistment. Age at suicide. Was suicide committed while on active duty? While deployed in combat zone? After discharge? Type of discharge? Length of time between discharge and suicide? Gender. Race. Education. Rank. Branch of service. Years in service. Number of tours. Length of tour. How much time between tours? Marital status. Years married. If divorced, before, after or during active duty? Number of children. Age of children. Did soldier miss birth/pregnancy? Where deployed for each tour? Combat? How many combat tours? Length of tour? Assignment (sniper/cook/transport etc) Injured? Type of injury. Fatalities/injuries in unit. Did soldier witness death/injury? Substance abuse? Family history of …
If you look at this photo of me and puppy Harmony, you can see that I’m happy. I can’t prove that I’m happy, besides telling you that I AM happy. I can’t produce any scientific evidence confirming my happiness. No one can see the levels of serotonin flowing through my brain to prove that I’m happy, but I am.
Therein lies the problem for veterans with PTSD who want some help paying the expenses of their service dogs. There is no proof that the service dogs help these warriors deal with the horrors of war. There is no research proving that a Marine’s anxiety level drops when his service dog gently awakens him from a nightmare or sweeps a darkened room and turns on the lights so he can enter without reliving a deadly ambush.
This lack of evidence is one of the reasons the Veteran’s Administration gave in deciding not to pay service dog benefits for vets who suffer from PTSD but have no physical wounds from war.
Though many commenters asserted that there is sufficient clinical evidence that VA could presently use to support administering mental health service dog benefits, the only evidence submitted in support of this assertion were anecdotal accounts of subjective benefits, including: decreased dependence on medications; increased sense of safety or decreased sense of hyper-vigilance; increased sense of calm; and the use of the dog as a physical buffer to keep others at a comfortable distance. Again, we do not discount commenters’ personal experiences, but we cannot reasonably use these subjective accounts as a basis for the administration of VA benefits.
I don’t know where I would be this morning if there was no floor beneath me.
I am not talking about the sagging hardwood floor in my little house that could use a mop. I’m talking about my anti-depressants. It’s Monday – the sun hasn’t yet risen – and I’m already weary. Not tired. Weary. There is a difference. But if it wasn’t for my antidepressants, I would’ve fallen through that floor this morning and I would still be falling.
That’s all for today.
Woman on the floor photo available from Shutterstock
I remember exactly where I was when the first plane his the tower. I had never experienced anything like that and even though I was more than 1,000 miles away, the attacks deeply disturbed me. Eleven years later, I am still overcome with sorrow and horror when I watch the towers fall. Today, the 11th anniversary, we will watch them fall over and over.
I have tried to imagine what I would have done had I been there. How I would have felt seeing, smelling, hearing, and touching that much devastation. What I spend little time thinking about is how those people who really were there are doing today. Much has been said, written, and studied regarding the physical effects of being at ground zero. Much also has been written about post-traumatic-stress disorder and 911 survivors and responders.
But, as you will see below, not nearly as much as been done to study other mental health side effects of 911 – especially when it comes to depression and substance abuse. Every year The World Trade Center Medical Working Group of New York City puts out its annual report. In the 2011 report, the most recent available, depression is mentioned 16 times – two of those in footnotes.
Below you will find each reference to depression in the 25-page report:
Expand research on the impact of 9/11 on mental health and substance use by:
•collecting additional data on the prevalence of WTC-related depression, suicide and substance use among WTC-exposed populations.
•assessing the impact of chronic WTC-related physical health conditions on long-term mental health.
•studying the impact of tobacco use on WTC-related respiratory conditions.
Increase research on mental and physical health effects on vulnerable populations who were exposed to the WTC collapse including children who went to school or who lived in the area, had first responder parents, or lost family members on 9/11… This includes research estimating the burden of WTC-related illness to help policymakers allocate resources rationally; research about the persistence of both mental and physical conditions; research into co-occurring …
As if the controversy over electronic health records is complicated enough, a new University of Florida study found that physicians using EHR were about half as likely as physicians using paper-based records to provide appropriate depression treatment to patients with three or more chronic conditions.
The study analyzed 3,467 visits adult patients with a diagnosis of depression and noted whether the patient was prescribed an antidepressant, received mental health counseling or a got a combination of the two. For patients with one or two chronic conditions, the recommended treatment for depression was not different for patients of EHR users and paper-based physicians. But for patients with three or more chronic conditions, patients of EHR users were about half as likely to receive appropriate depression care as those whose physicians use paper charts.
This is disturbing, not just because my primary care physician has switched to EHR but because many health care providers, such as the Veterans Administration, have gone to EHR. Thankfully, my therapist doesn’t even own a computer and my psychiatric nurse practitioner is still uses the old-fashioned manilla folder that contains all kinds of handwritten notes and even Christmas cards I sent her.
I have mixed feelings about EHR. As someone in a profession that is also going digital – newspapers – I have accepted the reality that despite my nostalgic love of for books, newspapers and even paper medical records, they are quickly becoming obsolete. Many of my colleagues see the demise of the “dead-tree edition” as the end of journalism as we know it. I don’t. It’s a change – a big, nasty change that I do not like, but it is going to happen regardless of my feelings. Fighting it is a waste of time. The best use of my skill and time is to work within this new paradigm. Accept it. Work with it. Most of all, keep a close eye on the ethics of this new mode of delivering information.
Same with EHRs. It doesn’t matter whether you like ERHs, they are going to replace old-fashioned paper charts. As for why physicians using EHR are less likely to provide appropriate depression …