Trauma and the Psychological and Physiological Health of Children and Young People in Low- and Middle-Income Countries upd 02/23

低收入和中等收入国家儿童和青少年的创伤与心理和生理健康 upd 02/23

• 批准号: 2686123
• 金额: --
• 依托单位: University of Bath
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2686123
• 关键词: Trauma; Psychological; Physiological; Health; Children

AbstractChildren and young people who experience a traumatic event (e.g., physical or sexual assault, disasters, serious accidents) are vulnerable to developing a range of psychological and psychosocial difficulties in the aftermath, including post-traumatic stress disorder (PTSD). PTSD can be extremely distressing and can significantly influence children's social, educational, and physical health outcomes in the long-term. Research investigating potential PTSD biomarkers has indicated that heart rate (HR) and heart rate variability (HRV; the variation in time intervals between heartbeats) are particularly robust biomarkers of PTSD in adults. However, the limited research with children and young people has yielded mixed results and primarily draws on small samples in high income countries (HIC) where risk of child trauma and subsequent rates of PTSD are relatively low. PTSD in children in low- and middle-income countries (LMIC) has been critically understudied, and HR has not been studied as a PTSD biomarker in such populations, despite high rates of exposure to traumatic events and of mental health disorders, including PTSD. Additionally, longitudinal studies that track HR changes in trauma-exposed children are entirely lacking in the literature despite their ability to provide crucial insight into the link between HR indices and PTSD.The overall aim of this PhD project is to provide systematic investigation of HR indices as short- and long-term biomarkers of PTSD among children from LMICs, wherein children are at greater risk of exposure to severe and recurrent traumas. Two existing datasets will be utilised to achieve this overarching aim. Firstly, data from 250 trauma-exposed children, aged 8 to 16 years, from Cape Town, South Africa recruited through a prospective ESRC-funded longitudinal study will allow examination of: a) whether HR indices shortly following trauma are predictive of later PTSD; and b) whether physiological changes emerge over time as a consequence of persistent PTSD. Secondly, data from the 2004 Pelotas birth cohort study (n=4231), which recruited all children born in Pelotas, South Brazil in 2004 and has conducted follow-ups at ages 6, 11, 15 and 18 years, will allow examination of: a) whether associations between HR indices and PTSD change during development (e.g., are stronger in adolescence versus childhood); b) whether pre-existing HR/HRV characteristics lead to vulnerability to PTSD given trauma exposure; and c) whether there are cardiac biomarkers that become established in the context of chronic PTSD. Overseas institutional visits to both Stellenbosch University, South Africa and the University of São Paulo, Brazil are planned to facilitate collaboration with co-researchers regarding data collection, analysis, and dissemination of findings.Potential Applications & BenefitsChildren and young people from LMICs comprise the majority of the world's children and are disproportionally likely to be affected by trauma. However, they are profoundly underrepresented in the PTSD evidence base. This project has the potential to make a crucial contribution to our understanding of the psychobiological underpinnings of PTSD among LMIC children. Moreover, the use of longitudinal methods that have yet to be applied in this field will enable novel and important questions to be addressed regarding temporality of associations between trauma, PTSD, and autonomic factors. This project will thus provide major new insights into the psychological and physiological consequences of childhood trauma, a key social determinant of health and wellbeing.

摘要经历创伤性事件的儿童和青少年（例如，（如人身或性攻击、灾难、严重事故）受害者在事后很容易产生一系列心理和社会心理问题，包括创伤后应激障碍。创伤后应激障碍可能是非常令人痛苦的，可以显着影响儿童的社会，教育和身体健康的结果在长期。调查潜在创伤后应激障碍生物标志物的研究表明，心率（HR）和心率变异性（HRV;心跳之间的时间间隔变化）是成年人创伤后应激障碍的特别可靠的生物标志物。然而，对儿童和年轻人的有限研究产生了混合的结果，主要是在高收入国家（HIC）的小样本中进行的，这些国家的儿童创伤风险和随后的PTSD发病率相对较低。低收入和中等收入国家（LMIC）儿童的创伤后应激障碍（PTSD）研究严重不足，HR尚未作为此类人群的PTSD生物标志物进行研究，尽管暴露于创伤性事件和精神健康障碍（包括PTSD）的比例很高。此外，纵向研究，跟踪人力资源的变化在创伤暴露的儿童是完全缺乏的文献，尽管他们的能力，提供关键的洞察力之间的联系人力资源指数和PTSD.The博士项目的总体目标是提供系统的调查人力资源指数作为短期和长期的生物标志物PTSD的儿童从LMICs，其中儿童有更大的风险暴露于严重和经常性的创伤。将利用两个现有的数据集来实现这一总体目标。首先，来自南非开普敦的250名8 - 16岁创伤暴露儿童的数据，通过ESRC资助的前瞻性纵向研究招募，将允许检查：a）创伤后不久的HR指数是否可预测后期的PTSD;和B）是否随着时间的推移出现生理变化作为持续性PTSD的结果。其次，来自2004年佩尔松出生队列研究（n=4231）的数据将允许检查：a）HR指数和PTSD之间的关联是否在发育期间改变（例如，在青春期比儿童期更强）; B）预先存在的HR/HRV特征是否导致创伤暴露时易患PTSD;以及c）是否存在在慢性PTSD背景下建立的心脏生物标志物。计划对南非斯泰伦博斯大学和巴西圣保罗大学进行海外机构访问，以促进与合作研究人员在数据收集、分析和传播研究结果方面的合作。潜在应用和益处来自中低收入国家的儿童和青少年占世界儿童的大多数，他们很可能受到创伤的影响。然而，他们在PTSD证据库中的代表性严重不足。这个项目有可能对我们理解LMIC儿童PTSD的心理生物学基础做出至关重要的贡献。此外，使用纵向的方法，还没有被应用在这一领域将使新的和重要的问题得到解决创伤，创伤后应激障碍和自主因素之间的关联的时间性。因此，该项目将为儿童创伤的心理和生理后果提供重要的新见解，这是健康和福祉的关键社会决定因素。