Risk and Resilience in Urban Black American Acute Trauma Survivors

项目摘要 创伤是常见的，并增加了一系列负面健康结果的风险，最明显的是创伤后 应激障碍（PTSD）。鉴于创伤暴露的潜在有害后遗症， 预测慢性创伤后应激障碍的创伤后风险因素。此外，城市种族/少数民族可能会经历 严重的环境压力使他们患创伤后应激障碍的风险特别高。在这个节骨眼上， 现有的数据有助于预测城市少数民族特有的风险，或者考虑到如何 劣势和少数压力可能在创伤后的几个月内影响神经生物学压力系统， 以及这如何影响长期困境的风险。因此，在社区咨询委员会的指导下， 研究小组将：1）确定城市黑人慢性创伤后应激障碍风险的急性创伤后神经行为预测因子 美国人，重点是在处理威胁过程中的前额叶皮层下功能，2）描述了 社会环境风险和恢复力因素与生物应激标志物的纵向相互作用， 创伤影响风险，以及3）使用机器学习来识别慢性PTSD的最强大的预测因素 从神经影像学、生物标志物、自我报告和地理编码风险的综合评估中得出， 弹性变量我们将招募190名成年人谁确定为黑人或非洲裔美国人从紧急情况下， 在密尔沃基的威斯康星州Froedtert医院/医学院， 在创伤暴露后2周和3、6和12个月进行评估。两周和12个月 评估将包括对处理威胁的神经系统的测量，包括对威胁的预测和 对威胁的反应所有的访问将包括创伤后应激障碍和其他症状的措施，神经生物学压力， 标记物，特别是内源性大麻素，以及社会环境风险和复原力因素，特别是那些 与美国城市黑人有关。我们将研究急性创伤后神经回路变量（2周） 预测12个月后的PTSD和其他结果，以及创伤前的环境变量（资源 剥夺、虐待儿童、暴力暴露）缓和了这种关系（目标1）。我们亦会评估 在创伤后的几个月里，社会环境风险和恢复力因素如何影响神经生物学 压力系统，以及这种相互作用如何影响创伤后应激障碍，身体健康状况差和情绪调节的风险 12个月时的神经回路（目标2）。我们将使用两种假设驱动的分析，重点放在先验 特定的预测器（目标1和2），以及全面的数据驱动的机器学习分析（目标3）。 这种方法将允许确定神经生物学标记物用于预测风险的额外效用 超过了以前确定的自我报告指标。我们希望这个项目能够识别预测因子 创伤后应激障碍后的城市黑人美国人在高风险，与潜在的过程 （对威胁的过度反应，异常的神经生物学应激反应）， 干预措施，最终提高城市黑人美国创伤幸存者的生活质量。

PROJECT ABSTRACT Trauma is common and increases risk for a host of negative health outcomes, most notably posttraumatic stress disorder (PTSD). Given the potential harmful sequelae of trauma exposure, it is crucial to identify acute post-trauma risk factors that predict chronic PTSD. Moreover, urban racial/ethnic minorities can experience significant environmental stress that puts them at particularly high risk for PTSD. At this juncture relatively little data exists to aid in prediction of risk specific to urban racial minorities, or that takes into account how disadvantage and minority stress may impact neurobiological stress systems in the months following trauma, and how that affects risk for long-term distress. Thus, under the guidance of a community advisory board our team will 1) identify acute post-trauma neurobehavioral predictors of risk for chronic PTSD among urban Black Americans, with a focus on prefrontal-subcortical function during processing of threat, 2) characterize how the longitudinal interaction of socioenvironmental risk and resilience factors and biological stress markers following trauma impacts risk, and 3) use machine learning to identify the most robust set of predictors of chronic PTSD drawn from a comprehensive assessment of neuroimaging, biomarkers, self-report and geocoded risk and resilience variables. We will recruit 190 adults who identify as Black or African American from the Emergency Department at Froedtert Hospital/Medical College of Wisconsin in Milwaukee, and conduct comprehensive assessments at 2 weeks, and 3, 6, and 12 months following trauma exposure. The two-week and 12-month assessments will include measures of neural systems for threat processing, including both anticipation of and reactivity to threat. All visits will include measures of PTSD and other symptoms, neurobiological stress markers, particularly endocannabinoids, and socioenvironmental risk and resilience factors, especially those relevant for urban Black Americans. We will examine how acute post-trauma neurocircuitry variables (2 week) predict PTSD and other outcomes twelve months later, and how pre-trauma environmental variables (resource deprivation, child maltreatment, violence exposure) moderate this relationship (Aim 1). We will also assess how, in the months following trauma, socio-environmental risk and resilience factors influence neurobiological stress systems, and how this interaction impacts risk for PTSD, poor physical health, and emotion regulation neurocircuitry at twelve months (Aim 2). We will use both hypothesis-driven analyses focusing on a priori specified predictors (Aims 1 and 2), as well as comprehensive data-driven machine learning analyses (Aim 3). This approach will allow for determination of the additional utility of neurobiological markers for predicting risk beyond previously identified self-report indicators. We expect this project to lead to identification of predictors of PTSD following trauma for urban Black Americans at high risk that are linked to underlying processes (hyper-responsivity to threat, aberrant neurobiological stress response) that can inform preventive interventions, ultimately improving the quality of life for urban Black American trauma survivors.