TWENTYNINE PALMS, Calif. — Two days before shipping off to war, Marine Pfc. Jesse Sheets sat inside a trailer in the Mojave Desert, his gaze fixed on a computer that flashed a rhythmic pulse of contrasting images.
Smiling kids embracing a soldier. A dog sniffing blood oozing from a corpse. Movie star Cameron Diaz posing sideways in a midriff top. Troops cowering for safety during an ambush.
A doctor tracked his stress levels and counted the number of times he blinked. Electrode wires dangled from his left eye and right pinky finger.
Sheets is part of a military experiment to try to predict who is most at risk for post-traumatic stress disorder. Understanding underlying triggers might help reduce the burden of those who return psychologically wounded - if they can get early help.
PTSD is a crippling condition that can emerge after a terrifying event - car accident, sexual assault, terrorist attack or combat. It's thought to affect as many as one in five veterans returning from Afghanistan and Iraq.
Military doctors have been mystified as to why certain fighters exposed to bombings and bloodshed develop paralyzing stress symptoms while others who witness the same trauma shake it off.
Studies provide clues
Studies on veterans and civilians offer clues. Childhood abuse, history of mental illness and heightened severity of trauma seem to raise a person's risk. Having a social net and a coping strategy appear to offer some protection.
However, none of the factors explored so far are reliable predictors.
"Right now, we can't determine with certainty who will and who won't develop PTSD," said Paula Schnurr, deputy executive director of the Department of Veterans Affairs' National Center for Posttraumatic Stress Disorder. "Perhaps with better measures, we can get closer."
Earlier this year, a quarterly publication from the national PTSD center found that studies to date have looked at only "a narrow band of the potential risk and resilience predictors" and that more work beyond surveys was needed.
New PTSD studies are using technology to try to get at the answer. Select Marine and Army units are undergoing a battery of physical and mental tests before deployment, including genetic testing, brain imaging and stress exams. They are followed in war zones and upon return.
Research assembly line
One autumn morning, a throng of Marines squeezed into a trailer at the Marine Corps Air Ground Combat Center in Southern California before deploying to Afghanistan.
"We're doing this not to make you better prepared to go do what you have to do in Afghanistan. We're not doing this to make your health any better," said Dr. William Nash, a retired Navy psychiatrist and study co-investigator. "We're doing this so that we can learn more about how to protect Marines from stress injuries like PTSD."
The trailer soon buzzed like a factory, with Marines rotating from one station to another. They gave blood, urine and saliva samples so researchers can look for genetic markers that might play a role.
Groundbreaking research published last year on adult survivors of child abuse suggests that specific variations of a gene increased their chances of developing PTSD. Scientists think there may be many other gene variants that contribute to PTSD risk.
Marines also underwent a blink test to gauge their startle response and neuropsychological screening. They filled out questionnaires and were interviewed by psychiatrists.
The work is funded by the Marine Corps, Veterans Affairs and Navy Medicine. Last year, about 1,000 Marines were recruited before leaving for Iraq.
This latest batch of 673 Marines who were tested during a two-week period in the fall headed to Afghanistan, where they're sure to see more intense fighting. They will be followed up in the field by Navy corpsmen with special "stress first-aid" training to read early signals.