War is a preeminent public health problem with significant medical consequences, of which mental health effects are a principal component. Exposure to the horrors of war has profound psychological effects on both military and civilian populations.  The course will examine a range of effects, with an emphasis on posttraumatic stress disorder (PTSD), a psychiatric condition that commonly results from war trauma. Assessment and treatment of PTSD presents significant clinical challenges at both individual and population levels. Current research activity in PTSD is substantial and relates to a variety of brain functions. The course will help students better understand and effectively work with the many individuals that are affected by war, including military veterans and refugee populations.

Kanter ED. The Impact of War on Mental Health. In: Levy BS, Sidel VW (eds.), War and Public Health. New York: Oxford University Press, 2007 (distributed in class)

Prigerson HG, Maciejewski PK, Rosenheck RA. Population Attributable Fractions of Psychiatric Disorders and Behavioral Outcomes Associated With Combat Exposure Among US Men. Am J Public Health 2002;92:59-63 (PDF)

Medeiros, E. Integrating Mental Health into Rehabilitation: The Case of Sierra Leonean and Liberian ‘Child Soldiers.' J Health Psychol 2007;12:498-504 (PDF)

Corbin, J. Returning home: resettlement of formerly abducted children in Northern Uganda. Disasters 2008;32:316-35 (PDF)

Optional

RAND Corporation, Invisible Wounds of War, 2008 (PDF)

Ravindran LN, Stein, MB. Pharmacotherapy of PTSD: Premises, principles, and priorities. Brain Res 2009 (PDF)

Cloitre M. Effective Psychotherapies for Posttraumatic Stress Disorder: A Review and Critique. CNS Spectrums 2009 (PDF)

Coalition to Stop the Use of Child Soldiers (especially psychosocial section) http://www.child-soldiers.org/home

The Role of Public Health Practitioners, Academics, and Advocates in Relation to Armed Conflict and War, APHA Position Paper 2009 (PDF)

De Jong J. A public health framework to translate risk factors related to political violence and war into multi-level preventive interventions. Social Science & Medicine 2010;70:71-79 (PDF)

 1) PTSD: assessment and epidemiology (Jan 14) (PPT)

• History and evolution of the diagnosis
• Diagnostic assessment
• Reexperiencing, avoidance, and hyperarousal
• Associated features
• Risk factors: nature of the trauma, pretrauma and posttrauma environments

2) PTSD: neurobiology and treatment (Jan 21)(PPT)

• Alteration of stress hormone systems
• Neurocircuitry of fear response
• "Battlemind"
• Relaxation and stress reduction
• Psychotherapies
• Medication treatment

3) Other psychiatric disorders, substance abuse, and brain injury (Jan 28)(PPT)

• Depression and suicide
• Other anxiety disorders
• Substance dependence and abuse
• Traumatic brain injury

4) Psychosocial effects of combat exposure and PTSD (Feb 4)(PPT)

• Unemployment and divorce
• Family violence and generational effects
• Readjustment and reintegration of veterans
• Discussion of Prigerson paper (student presentation)

5) Civilian populations (Feb 11)(PPT)

• Providing mental health services to war-affected populations
• Impact of war on women
• Impact of war on children
• PTSD and the perpetuation of conflict

6) Refugees and torture (Feb 18)(PPT)

• Mental health of refugees and internally displaced
• Mental health of asylum seekers
• Torture: epidemiology, assessment, treatment
• Discussion of child soldier papers(student presentation 1)(student presentation 2)

7) Prevention of war (Feb 25)(PPT)

• Primary, secondary, and tertiary strategies
• Role of health professionals