This Week in JAMA FREE

Edited by Annette Flanagin, RN, MA, and Thomas B. Cole, MD, MPH

Three research articles in this theme issue address posttraumatic stress disorder (PTSD). The first, by Krakow and colleaguesArticle, is a randomized trial of the effectiveness of imagery rehearsal therapy for the treatment of nightmares among women with PTSD who had experienced sexual assault. Disturbing dreams, sleep quality, and posttraumatic stress symptoms all improved at study end point (3- or 6-month follow-up) in women who received imagery rehearsal therapy. The other 2 studies assessed PTSD in populations that have survived war-related trauma or mass violence. Mollica and colleaguesArticle, in a 3-year follow-up study of Bosnian refugees who had been living in a refugee camp in Croatia in 1996, report that 45% of respondents who had met DSM-IV criteria for depression, PTSD, or both in the original study continued to have these disorders; 16% of initially asymptomatic individuals became symptomatic for psychiatric disorders. In a study of PTSD in postconflict, low-income countries, de Jong and colleaguesArticle found that the prevalence of PTSD was 37.4% in Algeria, 28.4% in Cambodia, 15.8% in Ethiopia, and 17.8% in Gaza. In a commentary, DavidsonArticle emphasizes that PTSD is a worldwide health problem associated with serious morbidity and reviews the presentation and treatment of this disorder.

Humanitarian organizations are not regulated or monitored by professional bodies and may fail to provide timely or adequate interventions during public health emergencies. In this epidemiologic survey in the Gode district of Ethiopia, the center of the famine in the Somali region that began in 1999, Salama and colleaguesArticle found that most of the 293 deaths during the famine were due to wasting and communicable diseases, including 47 potentially preventable measles-related deaths among children aged 14 years or younger. Approximately 77% of the deaths occurred before the major humanitarian relief interventions began in April/May 2000. In another study, Gustafson and colleaguesArticle report that among patients with tuberculosis, interruption of regular tuberculosis treatment during the civil war in Guinea-Bissau was associated with a significant increase in mortality compared with that among patients with tuberculosis in treatment 12 months before the conflict. In a commentary, WaldmanArticle stresses the importance of establishing humanitarian and technical guidelines for emergency relief to correct deficiencies in humanitarian assistance, such as reported from the Somali region of Ethiopia and from Guinea-Bissau.

Research among adults has shown that younger age is a risk factor for intimate partner violence. In this analysis of data from the 1997 and 1999 Massachusetts Youth Risk Behavior Surveys, Silverman and colleagues found that approximately 1 in 5 female students in the 9th through 12th grades reported being physically and/or sexually abused by a dating partner. Health risk behaviors among adolescent girls that were associated with reported abuse by dating partners included substance use, unhealthy weight control behaviors, high-risk sexual behavior, prior pregnancy, and suicidality.

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Individuals who are stalked, including physicians, who are overrepresented among those who are stalked, may experience long-lasting adverse effects. Some stalkers may benefit from psychiatric help.

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Results of a survey of attitudes of female emergency department patients toward mandatory reporting of domestic violence injuries to police.

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Content analysis of 55 home video games rated E (for "everyone") found that 35 games involved intentional violence.

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For your patients: Information about posttraumatic stress disorder.

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