Risk and Resilience in Urban Black American Acute Trauma Survivors

项目摘要 创伤很常见，会增加一系列负面健康后果的风险，尤其是创伤后 应激障碍(PTSD)。鉴于创伤暴露的潜在有害后遗症，至关重要的是识别急性 创伤后预测慢性创伤后应激障碍的危险因素。此外，城市种族/少数民族可能会经历 严重的环境压力，使他们处于患创伤后应激障碍的特别高风险。在这一关头，相对较少 数据的存在是为了帮助预测特定于城市少数民族的风险，或者考虑到 在创伤后的几个月里，劣势和少数族裔压力可能会影响神经生物应激系统， 以及这如何影响长期困扰的风险。因此，在社区咨询委员会的指导下，我们的 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素 美国人关注的是威胁处理过程中的前额叶-皮质下功能，2)描述了 社会环境风险和复原力因素与生物应激标志物的纵向交互作用 创伤对风险的影响，以及3)使用机器学习来确定慢性创伤后应激障碍最可靠的预测因素集 来自对神经成像、生物标记物、自我报告和地理编码风险的全面评估 恢复力变量。我们将招募190名来自紧急情况组织的黑人或非裔美国人 密尔沃基弗罗德特医院/威斯康星医学院的科室，并进行全面的 在创伤暴露后2周、3、6和12个月进行评估。两周和12个月 评估将包括对神经系统进行威胁处理的测量，包括对 对威胁的反应能力。所有检查将包括创伤后应激障碍和其他症状、神经生物应激的测量。 标志物，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 与美国城市黑人相关。我们将研究创伤后急性神经回路变量(2周) 预测12个月后的创伤后应激障碍和其他结果，以及创伤前环境变量(资源 剥夺、虐待儿童、暴力暴露)缓和了这种关系(目标1)。我们还将评估 在创伤后的几个月里，社会环境风险和复原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、身体健康不良和情绪调节的风险 12个月时的神经回路(目标2)。我们将使用这两种假设驱动的分析，重点放在先验 具体的预测指标(目标1和目标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对预测风险的额外效用。 超出先前确定的自我报告指标。我们希望这个项目能帮助我们确定预测因素。 与潜在过程相关的美国城市黑人高风险创伤后的创伤后应激障碍 (对威胁的高反应性，异常的神经生物应激反应)，可以为预防 干预，最终改善美国城市黑人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.