Collaborative care intervention targeting violence risk behaviors, substance use, and posttraumatic stress and depressive symptoms in injured adolescents: a randomized clinical trial.
Collaborative care intervention targeting violence risk behaviors, substance use, and posttraumatic stress and depressive symptoms in injured adolescents: a randomized clinical trial.
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DOI：
10.1001/jamapediatrics.2013.4784
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发表时间：
2014-06
期刊：
影响因子：
26.1
通讯作者：
D. Zatzick;J. Russo;S. P. Lord;C. Varley;Jin Wang;L. Berliner;G. Jurkovich;L. Whiteside;Stephen S. O’Connor;F. Rivara
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文献类型：
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作者：
D. Zatzick;J. Russo;S. P. Lord;C. Varley;Jin Wang;L. Berliner;G. Jurkovich;L. Whiteside;Stephen S. O’Connor;F. Rivara
重要性 暴力和伤害风险行为、酗酒和吸毒问题以及创伤后应激障碍 (PTSD) 和抑郁症状在遭受创伤性身体伤害后前往急诊医疗机构就诊的青少年中经常发生。目的 测试针对随机抽样的患有或不患有创伤性脑损伤的住院青少年的一系列危险行为和症状的阶梯式协作护理干预措施的有效性。设计、环境和参与者 一项实用的随机临床试验是在美国的一个一级创伤中心进行的。参与者包括 120 名 12 至 18 岁的青少年，随机分为干预组 (n = 59) 和对照组 (n = 61)。干预措施 逐步协作护理干预措施包括针对危险行为和药物使用的动机访谈要素，以及针对 PTSD 和抑郁症状的药物和认知行为治疗要素。主要结果和措施 在随机分组前以及受伤住院后 2、5 和 12 个月时对青少年进行基线评估。使用标准化工具来评估暴力风险行为、酗酒和吸毒以及创伤后应激障碍和抑郁症状。结果 调查在每个评估点都实现了 95% 以上的青少年随访。在基线时，大约三分之一的参与者认可携带武器的暴力风险行为。回归分析表明，受伤后一年内，与对照组相比，干预患者携带武器的情况显着减少（组×时间效应，F3,344 = 3.0；P = .03）。受伤后 12 个月时，4 名干预患者 (7.3%) 与 13 名对照患者 (21.3%) 报告目前携带武器（相对风险，0.31；95% CI，0.11-0.90）。该干预措施在降低有或没有脑外伤的受伤青少年携带武器的风险方面同样有效。其他治疗目标，包括酗酒和吸毒问题以及高水平的创伤后应激障碍和抑郁症状，相对于携带武器而言，在队列中出现的频率较低，并且没有受到干预的显着影响。结论和相关性 协作护理干预降低了青少年受伤住院后一年内携带武器的风险。未来的调查应该复制这一初步观察结果。如果这一发现得到重复，精心策划的调查和政策工作可以系统地实施和评估针对美国创伤中心青少年暴力预防的筛查和干预程序。试验注册 ClinicalTrials.gov 标识符：NCT00619255。
IMPORTANCE Violence and injury risk behaviors, alcohol and drug use problems, and posttraumatic stress disorder (PTSD) and depressive symptoms occur frequently among adolescents presenting to acute care medical settings after traumatic physical injury. OBJECTIVE To test the effectiveness of a stepped collaborative care intervention targeting this constellation of risk behaviors and symptoms in randomly sampled hospitalized adolescents with and without traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTS A pragmatic randomized clinical trial was conducted at a single US level I trauma center. Participants included 120 adolescents aged 12 to 18 years randomized to intervention (n = 59) and control (n = 61) conditions. INTERVENTIONS Stepped collaborative care intervention included motivational interviewing elements targeting risk behaviors and substance use as well as medication and cognitive behavioral therapy elements targeting PTSD and depressive symptoms. MAIN OUTCOMES AND MEASURES Adolescents were assessed at baseline before randomization and 2, 5, and 12 months after injury hospitalization. Standardized instruments were used to assess violence risk behaviors, alcohol and drug use, and PTSD and depressive symptoms. RESULTS The investigation attained more than 95% adolescent follow-up at each assessment point. At baseline, approximately one-third of the participants endorsed the violence risk behavior of carrying a weapon. Regression analyses demonstrated that intervention patients experienced significant reductions in weapon carrying compared with controls during the year after injury (group × time effect, F3,344 = 3.0; P = .03). At 12 months after the injury, 4 (7.3%) intervention patients vs 13 (21.3%) control patients reported currently carrying a weapon (relative risk, 0.31; 95% CI, 0.11-0.90). The intervention was equally effective in reducing the risk of weapon carrying among injured adolescents with and without traumatic brain injury. Other treatment targets, including alcohol and drug use problems and high levels of PTSD and depressive symptoms, occurred less frequently in the cohort relative to weapon carrying and were not significantly affected by the intervention. CONCLUSIONS AND RELEVANCE Collaborative care intervention reduced the risk of adolescent weapon carrying during the year after the injury hospitalization. Future investigation should replicate this preliminary observation. If the finding is replicated, orchestrated investigative and policy efforts could systematically implement and evaluate screening and intervention procedures targeting youth violence prevention at US trauma centers. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT00619255.