A prospective study of posttraumatic stress symptom development and cannabis use among trauma exposed injured emerging adults following Emergency Department discharge

项目摘要 经历创伤性身体伤害的个人面临着一系列负面后果的高风险 例如创伤后应激障碍和药物滥用。创伤后早期（即，的 暴露后的几天、几周和几个月）代表了恢复的关键时期， 重要的是了解症状的发展新兴成人（18-25岁），谁是 其特征是物质使用行为的发展高峰和创伤暴露风险的增加 和伤害。随着区域法律，文化和对大麻使用的信仰（CU）继续转变，人们担心 创伤性损伤可能会导致大麻使用升级，因为许多人报告使用大麻来 减轻痛苦、过度兴奋和其他创伤后症状。此外，虽然美国大多数州 大麻合法化的医疗用途包括压力和创伤（如创伤后应激障碍）的结果， 资格条件的国家颁发的医用大麻许可证，很少有人知道如何CU可能会影响 早期创伤后过程，包括PTSD的发展和其他与压力相关的结果，如 抑郁焦虑和药物滥用尽管已知内源性大麻素系统在 调节应激反应，有限的（和矛盾的）证据存在的安全性和有效性 大麻排除了关于其在急性创伤后恢复期间的作用的强有力的结论， 前瞻性研究表明CU对PTSD症状有不利影响或无长期影响。的 该研究的首要目标是将CU描述为与创伤后症状相关， 在创伤暴露后立即滥用大麻的样本受伤 新兴的成年人。我们将招募N=100名创伤暴露的大麻使用者（18-25岁）， 急诊科用于急性损伤后的评估（例如，人身攻击、严重车祸）。 出院后，参与者将完成为期4周的生态瞬时评估（EMA），以记录CU 行为和创伤后应激障碍症状的发展，与被动收集生理输出（心率）配对 通过可穿戴生物传感器（智能手表）来监测生理。受试者将返回完成临床试验 在出院后4周和6个月进行访谈和症状自我报告。其主要目标是 研究的目的是：（a）描述PTSD症状发展、生理学和大麻使用的过程 和（B）评估急性创伤后反应对长期的影响 6个月时发生PTSD和其他压力敏感性结局（抑郁、焦虑、大麻滥用） 随访

PROJECT SUMMARY Individuals who experience traumatic physical injury are at a heightened risk for a range of negative outcomes such as posttraumatic stress disorder (PTSD) and substance misuse. The early post-trauma period (i.e., the days, weeks, and months following exposure) represents a critical period of recovery and may be especially important for understanding symptom development among emerging adults (aged 18-25), who are characterized by a developmental peak in substance use behaviors and an increased risk for trauma exposure and injury. As regional laws, cultures, and beliefs about cannabis use (CU) continue to shift, there is concern that traumatic injury may result in escalations in cannabis use, as many individuals report using cannabis to relieve distress, hyperarousal, and other post-trauma symptoms. Furthermore, while the majority of US states that have legalized cannabis for medical use include outcomes of stress and trauma (such as PTSD) as qualifying conditions for a state-issued medical marijuana license, little is known about how CU may impact the early post-trauma course, including development of PTSD and other stress-related outcomes such as depression, anxiety, and substance misuse. Despite the known role of the endocannabinoid system in regulating the stress response, limited (and contradicting) evidence exists regarding safety and efficacy of cannabis precludes strong conclusions about its role during acute post-trauma recovery, with some prospective studies demonstrating detrimental or no long-term effects of CU on PTSD symptoms. The overarching goals of the proposed study are to characterize CU as related to post-trauma symptoms and cannabis misuse during the period immediately following trauma exposure among a sample of injured emerging adults. We will recruit N=100 trauma-exposed cannabis users (aged 18-25) presenting to the Emergency Department for evaluation after acute injury (e.g., physical assault, serious vehicular crashes). Upon discharge, participants will complete 4-weeks of ecological momentary assessment (EMA) to record CU behavior and PTSD symptom development, paired with passive collection of physiological output (heart rate) via wearable biosensors (smartwatch) to monitor physiology. Participants will return for completion of clinical interview and self-report of symptoms at 4-weeks and 6-months post-discharge. The main objectives of this research are to: (a) characterize the course of PTSD symptom development, physiology, and cannabis use during the acute post-trauma period and (b) evaluate effects of the acute post-trauma response on long term development of PTSD and other stress sensitive outcomes (depression, anxiety, cannabis misuse) at 6-month follow-up.