Maria I. Medved

Continuity Amid Chaos: Neurotrauma, Loss of Memory, and Sense of Self

In serious illness or disability, individuals commonly say that their sense of self has dramatically changed. One might expect that the experience of a radically altered sense of self would be even more profound in individuals after neurotrauma because it is the brain itself that suddenly, and often literally, becomes “strange.” The aim of this study was to investigate how people left with autobiographical memory impairments—impairments that also affect the capacity to organize complex linguistic productions such as autobiographical narratives—experience themselves and, specifically, their sense of self. Seven adults who had primarily anterograde memory impairments for 1 year were interviewed. Regardless of the profound changes in their everyday functioning and lives, the stories the participants told evoke a surprising sense of a continuous self. Employing several narrative and discursive techniques, they emphasized sameness and an unbroken connection between their pre- and post-morbid lives. We believe that most individuals felt they did not have to recover their former sense of self because they subjectively seemed to have never lost it.

Stress and mental disorders in female military personnel: Comparisons between the sexes in a male dominated profession

The proportion of women in militaries is growing; however, many studies in the area of military mental health have been conducted with majority male samples. The present study examined sex differences in trauma exposure, work stress, and mental disorders in the Canadian Community Health Survey - Canadian Forces Supplement, a representative sample of 5155 regular force personnel and 3286 reservists ages 16-54. Past-year DSM-IV mental disorders (depression, generalized anxiety disorder, panic disorder, social phobia, PTSD, and alcohol dependence), lifetime exposure to 28 traumatic events, and work stress were assessed. Regular and reserve female personnel were less likely than males to experience deployment-related traumas, accidents, and several events involving violence (adjusted odds ratio [AOR] range 0.10-0.62). Women were more likely to endorse sexual trauma, partner abuse, and being stalked (AOR range 3.60-13.63). For work stress, regular force women reported higher levels of job demand and stress around social support than men, whereas regular and reserve force women reported less physical exertion. After adjusting for a range of covariates, regular female personnel were more likely than males to have PTSD (AOR 1.88, 99% CI 1.01-3.50), while reservist women were more likely than men to have depression, panic disorder, and any mood or anxiety disorder (AOR range 1.87-6.98). Both regular and reservist women had lower rates of alcohol dependence (AOR range 0.30-0.34). Clinicians working with female personnel should screen for trauma/stressors and mental disorders that are particularly common in this population.

Correlates of suicidality: investigation of a representative sample of Manitoba First Nations adolescents.

OBJECTIVES We examined individual, friend or family, and community or tribe correlates of suicidality in a representative on-reserve sample of First Nations adolescents. METHODS Data came from the 2002-2003 Manitoba First Nations Regional Longitudinal Health Survey of Youth. Interviews were conducted with adolescents aged 12 to 17 years (n=1125) from 23 First Nations communities in Manitoba. We used bivariate logistic regression analyses to examine the relationships between a range of factors and lifetime suicidality. We conducted sex-by-correlate interactions for each significant correlate at the bivariate level. A multivariate logistic regression analysis identified those correlates most strongly related to suicidality. RESULTS We found several variables to be associated with an increased likelihood of suicidality in the multivariate model, including being female, depressed mood, abuse or fear of abuse, a hospital stay, and substance use (adjusted odds ratio range=2.43-11.73). Perceived community caring was protective against suicidality (adjusted odds ratio=0.93; 95% confidence interval=0.88, 0.97) in the same model. CONCLUSIONS Results of this study may be important in informing First Nations and government policy related to the implementation of suicide prevention strategies in First Nations communities.

Making Sense of Traumatic Experiences: Telling Your Life With Fragile X Syndrome

The discourse of individuals with fragile X syndrome has been described as fragmented, tangential, and associatively connected, resulting in autobiographical narratives that are incoherent and difficult to understand. In this article, the authors discuss the case of an adolescent female with moderate mental retardation due to fragile X syndrome. The analysis of her autobiographical stories, rather than being primarily reflective of cognitive impoverishment, reveals a different—narrative—mode of thought. The authors present and examine some of her narratives in terms of their specific functions: communication, coherence, exploration, distancing, and evaluation. Their findings suggest that narrative analysis can be an important complement to traditional neuropsychological assessment.

Living with Parkinson’s disease - managing identity together

The specific aim of this paper is to discuss how individuals living with Parkinsons disease and their main family supports perceive communications with each other, with a focus on their roles related to care. The paper is based on individual interviews conducted with individuals and their main family support person. The transcripts were analyzed based on grounded theory and “managing identity together” emerged as the core category. This is discussed in terms of independence, a sense of self-sufficiency and an overall sense of personhood. Implications for other populations conclude the paper.

Mental health outcomes of burn: a longitudinal population-based study of adults hospitalized for burns

PURPOSE This study investigates the increased risk of mental health outcomes and health care utilization associated with burn with two year of follow-up using a longitudinal population-based matched cohort design. METHODS Adult burn survivors (n=157) were identified from a provincial burn registry and matched 1:5 with non-burn control subjects from the general population (matching variables age and gender). The prevalence of mental health outcomes and the rates of health care utilization between the groups were compared for the 2years pre and post index date using anonymously linked population-based administrative health care data. Rates were adjusted for age, gender and sociodemographic characteristics. RESULTS While the burn cohort had an increased prevalence of mental health problems after burn compared to the control cohort, the burn group also had an increased prevalence of pre-burn depression (16.6% vs 7.8%; p=0.0005) and substance use disorders (8.9% vs 3.2%; p=0.001) when compared to controls. Once the pre-existing prevalence of mental illness was taken into account there was no significant change in the prevalence of mental health problems when comparing the burn group to controls over time. CONCLUSIONS Although burns may not increase rates of mental health issues and health care utilization, burn survivors are a vulnerable group who already demonstrate increased rates of psychopathology and need for care. The present study highlights the importance of assessment and treatment of mental health outcomes in this population.

Protective factors for mental disorders and psychological distress in female, compared with male, service members in a representative sample.

Objective: Although military interest in promoting psychological resilience is growing, resources protective against psychopathology have been understudied in female service members. Using a representative sample of Canadian Forces personnel, we investigated whether religious attendance, spirituality, coping, and social support were related to mental disorders and psychological distress in female service members, and whether sex differences occurred in these associations. Method: Religious attendance and spirituality were self-reported. Coping items were taken from 3 scales and produced 3 factors (active, avoidance, and self-medication). Social support was assessed with the Medical Outcomes Study Social Support Survey. Past-year mental disorders were diagnosed with the World Mental Health Composite International Diagnostic Interview. The Kessler Psychological Distress Scale assessed distress. Multivariate regression models investigated links between correlates and psychological outcomes within each sex. For associations that were statistically significant in only one sex, sex by correlate interactions were computed. Results: In female service members, inverse relations were found between social support and MDD, any MDD or anxiety disorder, suicidal ideation, and distress. No associations were found between religious attendance and outcomes, and spirituality was associated with an increased likelihood of some outcomes. Active coping was related to less psychological distress, while avoidance coping and self-medication were linked to a higher likelihood of most outcomes. Although several statistically significant associations were found in only one sex, only one sex by correlate interaction was statistically significant. Conclusions: Social support was found to be inversely related to several negative mental health outcomes in female service members. Few differences between men and women reached statistical significance. Future research should identify additional helpful resources for female service members.

Remembering without a past: Individuals with anterograde memory impairment talk about their lives

Abstract This paper describes the linguistic resources people with anterograde amnesia draw on in conversational narratives. Because of their problems in recollecting post-morbid memories, it is particularly challenging for such individuals to refer to personal experiences. Seven patients with anterograde memory impairments due to neurotrauma were interviewed one year post-event. Among other topics, they were asked to talk about their new lives and selves, which was expected to be a precarious affair given that they did not have many or any autobiographical memories. Microanalyses of their narratives identified three readily available linguistic resources that participants used to facilitate their storytelling. These were categorized as “memory importation” (transplanting a past memory into the present), “memory appropriation” (taking anothers memory as ones own), and “memory compensation” (searching for memories). It is argued that although these resources were not always efficiently used by participants and their use often violated conversational expectations, these linguistic techniques provided a helpful means to sustain the production of personal narratives, even in the absence of autobiographical memory.

Increased suicidal activity following major trauma: a population-based study.

BACKGROUND Nonfatal injuries are a leading cause of morbidity and mortality. In 2008, 14,065 patients with major trauma were hospitalized across Canada. With individuals surviving trauma, the psychosocial sequelae of severe physical injury have become an important area of research. No previous studies have used a population-based sample to estimate the incidence of suicidality (suicide or suicide attempt) following physical injury. This study aimed to assess the odds ratio (OR) of suicidality among adults with major trauma compared with a matched cohort. METHODS This retrospective study included persons older than 18 years who experienced an unintentional major traumatic injury (Injury Severity Score [ISS] > 12) at a regional academic trauma center between April 1, 2001, and March 31, 2011. Individuals who had no suicide attempts in the previous 5 years were identified from the trauma registry. These individuals were matched with data from provincial administrative databases. A cohort matched in terms of age, sex, and date of indexed injury was created from the general population with five controls for each trauma case, and the rate of suicidality was compared between groups. RESULTS A total of 2,198 adults with major were matched to 10,990 individuals. Suicidality was increased in the trauma cohort (OR, 4.31). This increase persisted even if adjusted for anxiety/mood disorders and substance abuse (adjusted OR1, 3.65) as well as residence, physical comorbidities, income quintile and those factors in adjusted OR1 (adjusted OR2, 3.30). All ORs were significant with p < 0.05 CONCLUSION Individuals who experience major traumatic injuries are at a greater risk for postinjury suicidality compared with those in a matched cohort. LEVEL OF EVIDENCE Epidemiologic study, level IV

Broken Heart Stories: Understanding Aboriginal Women’s Cardiac Problems

Many Aboriginal communities call heart problems, and in particular cardiovascular disease, “White man’s sickness.” At the same time, Aboriginal women present with some of the highest rates of this disease. Against this backdrop, we explored how women with cardiac problems understand their heart health and used narrative-discursive methods to analyze interviews conducted with women from two First Nations in North America. The women told stories that were riddled with contradictions, unfolding a complicated personal and cultural reality of living with cardiovascular disease. In many stories, heart disease was described as resulting from a “community imbalance” in the wake of colonialism whereby the women had to take over the traditional roles of men. Their ideas of heart disease risk and healing flowed from this understanding. They derived a sense of strength, however, from their ability to undertake both gender roles. Based on our findings, we provide some recommendations for cardiac care.