Disaster and trauma studies often focus on identifying the incidence of PTSD as the sequel to traumatic events.

Early interventions with those affected after a disaster or traumatic event increasingly utilize psycho-education to clarify and normalize common post-traumatic stress reactions and coping strategies.

While mentioned as a possible response, the high incidence of depression after trauma is less delineated and often goes unrecognized by those suffering.

Depression Occurs after Trauma:

• A Rand corporation study reports that nearly 20 percent of military service members who have returned from Iraq and Afghanistan – 300,000 in all – report symptoms of Post-Traumatic Stress Disorder or major depression.
• In the first long-term study of the health impacts of the World Trade Center (WTC) collapse on September 11, 2001, findings indicate that seven percent of police officers were diagnosed with depression, nine percent with PTSD and eight percent with panic disorder. Twenty eight percent of other rescue and recovery workers had symptoms of depression.
• A survey of survivors from the Oklahoma City bombing showed that 23% had depression after the bombing.
• Depression affects approximately 15 percent to 25 percent of cancer patients.
• After a myocardial infarction, the incidence of major depression is from 15 percent to 20 percent, and an additional 27 percent of patients develop minor depression.

Both major depression and Post-Traumatic Stress Disorder (PTSD) occur frequently following traumatic exposure, both as separate disorders and concurrently.

Depression is the most common disorder suffered in conjunction with Post-Traumatic Stress Disorder.

Depression is nearly three to five times more likely in those with PTSD than those without PTSD.

Almost everyone has some experience with hope: We hope for the best. We hang on to hope. We despair when we lose hope.

It would seem that hope, which is broadly defined as an emotional state that promotes the belief in a positive outcome, is in inherent in human nature.

Reflections of the importance of hope are found in early mythology, religion, philosophy and literature.

Pandora, although forbidden, opened the box given to her by Zeus, and in a moment, all the curses were released into the world and all the blessing escaped and were lost- except one: hope.

“To have faith is to be sure of the things we hope for, to be certain of the things we cannot see.” ― The King James Version of the Bible

“Hope is a waking dream.” –Aristotle

“Where there is no hope, it is incumbent on us to invent it.” -Albert Camus

“Hope is that thing with feathers that perches in the soul and sings the tune without the words and never stops — at all.” -Emily Dickinson

Clearly we need hope, but even as we embrace it we often wonder – Does hope really make a difference? Is it myth, fiction, collective denial?

There is actually increasing scientific evidence that hope changes us psychologically and physiologically – that it makes a difference.

The definition of catastrophe is an event causing great and often sudden damage or suffering. The early morning shooting and killing of 12 people and wounding of others as they eagerly began viewing the latest Batman movie; “The Dark Knight Rises,” tragically qualifies.

As we shockingly take stock of this horrific event, we once again dare to imagine the pain of the families or resonate with memories of having faced similar pain. In the face of traumatic loss we are left without words, helpless to understand ‘Why’ and needing to believe there is a way to prevent such events.

We have come to know that even as we can still barely catch a breath and struggle for answers, there are some initial steps of Psychological First Aid (PFA) that offer some relief.

Here are some suggestions worth knowing and owning when life has suddenly become so darkened.

Many people face a traumatic event in adult life. Be it a serious car accident, combat, rape, a natural disaster or the loss of a child, people are often confronted with a horrific event that threatens death or serious injury to themselves or someone else, or involves the traumatic loss of a friend or loved one.

While such trauma is in itself physically and emotionally assaultive, trauma theorist Robert Stolorow proposes that beyond the actual event, it is the emotions suffered after the event that become the unbearable emotional pain of trauma.

• Difficult to articulate and unrecognized by many, the emotional aftermath of adult trauma often goes unvalidated and unhealed.
• Drawing upon his own traumatic loss of a young wife, Stolorow reports that in the unreal time that stretches slowly after a trauma, there is an “excruciating sense” of being outside normal life, alone with feelings that no one else can understand.

Stolorow’s contribution to the field is his articulation of these feelings in a way that becomes an invaluable resource for validation.

“Trauma defies language; it resists being communicated”

Central to healing in the aftermath of a traumatic event is the transformation of trauma’s unspeakable imprint to a story that can be told without reliving it.

Understanding how trauma leaves us without words may make it easier to consider ways that can help unlock the story hidden in visual images, painful feelings, flashbacks, bodily symptoms or silent avoidance. Both are important steps toward finding your words and continuing your story.

What is a Traumatic Event?

A potentially traumatic event is most often one that is threatening to the life or bodily integrity of self or a loved one. It may include combat, sexual and physical assault, death of a child, suicide of a loved one, accidents, being held hostage, imprisoned, or tortured, natural and man-made disasters, as well the diagnosis of a life threatening illness.

Suicide ranks as the eleventh leading cause of death in the United States. We have lost loved ones across the generations.

• Older Americans are disproportionately likely to die by suicide. Although they comprise only 12 percent of the U.S. population, people age 65 and older accounted for 16 percent of suicide deaths in 2004.
• Suicide is the second leading cause of death in college students and the third leading cause of death in adolescents.  Every day 14 teens take their own lives.
•  According to the Centers for Disease Control and Prevention, for the second year in a row, middle -aged adults have the highest suicide rate in the country, surpassing even older Americans.

While there are many factors that contribute to suicide, an important new study identifies two factors that have been associated with increased risk for suicidal thought and behavior across the lifespan – hopelessness and lack of connectedness to others.

It was some time after spending weeks in ICU with our youngest son, that I realized – If we had lost him, we would have also lost his brother.

In times of crisis, we too often overlook the bond between siblings and the unique but unrecognized grief suffered when a brother or sister dies.

Karen Hickman, founder of Gold Star Siblings shares that when her brother was killed serving in Vietnam, she felt like an outsider at the funeral,

“I had to grieve alone and where my parents couldn’t see me because I had to be strong for them and my younger brother.”

Author, T.J. Wray describes that the year her adult brother died she forgot how to breathe –  but no one noticed. People tried to console her with comments like,

“Thank goodness, it wasn’t your husband or one of your children.”

Last week the media reported the sad and unanticipated deaths of two men. Derek Boogaard of the Rangers died from an accidental overdose of the drug oxycodone mixed with alcohol and retired lieutenant, John A. Garcia, a 23-year veteran of FDNY who not only responded to 9/11 but responded and lost two of his men in the Deutsche Bank Fire. died by suicide.

One can’t help but wonder if the tragic deaths reflect the danger of hidden depression in men.  Increasingly we have become aware that although women are twice as likely to be diagnosed with depression, many men, beyond the 10-17% diagnosed, may also be suffering with depression.

Depression May Be More Deadly for Men

What makes depression in men so dangerous? It too often goes unrecognized and untreated because it is masked by physical complaints, substance abuse, anger and other stealth symptoms.

Today a concerned parent commented to my blog “Could My Teen Commit Suicide?” by describing his 14 year old daughter who had begun cutting herself.

He asked “Could this be a warning sign?”

Also today two colleagues raised concerns about young people engaged in cutting – one a female college student and one a 15 year old male.

Whether parent or professional, this is a topic that concerns and confuses us. It is one that we cannot ignore. It is one worth considering.