Pathways of Risk and Resilience in Firefighter Recruits

消防员新兵的风险和复原力途径

• 批准号: 7590843
• 负责人: SUZY B GULLIVER
• 金额: $ 70.34万
• 依托单位: TEXAS A&M UNIVERSITY HEALTH SCIENCE CTR
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-02 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7590843
• 关键词: Acute; Address; Affect; Aggressive behavior; Alcohol or Other Drugs use; Anxiety; Birds; Blood specimen; Characteristics; Childhood; Chronic; Clinical; Compatible; Complex; Condition; Coping Behavior; Data; Data Reporting; Databases; Dependency; Development; Diagnosis; Diagnostic; Disease; Disease remission; Disease susceptibility; Dissociation; Distress; Emergency Situation; Employment; Environment; Equation; Equilibrium; Etiology; Evaluation; Event; Exposure to; Family; Family history of; Fire - disasters; Future; Genes; Genetic; Genetic Markers; Genetic Risk; Goals; Growth; Guidelines; Human Resources; Hurricane; Individual; Individual Differences; Interruption; Interview; Investigation; Lead; Life; Life Experience; Literature; Measurement; Measures; Mediating; Mediator of activation protein; Mental disorders; Modeling; Natural Disasters; Nature; Numbers; Occupations; Pathology; Pathway interactions; Patient Self-Report; Pattern; Personality; Persons; Population; Post-Traumatic Stress Disorders; Prevention; Principal Investigator; Psychopathology; Range; Rate; Recording of previous events; Recovery; Recruitment Activity; Relapse; Research; Research Personnel; Retirement; Risk; Risk Factors; Safety; Sampling; Self Medication; Services; Social support; Stress; Stress and Coping; Substance Use Disorder; Symptoms; Testing; Time; Training; Trauma; Traumatic Stress Disorders; base; biological adaptation to stress; biopsychosocial; career; coping; day; depressive symptoms; design; disorder risk; experience; family genetics; functional disability; functional status; interest; method development; programs; prospective; resilience; response; social; social cognitive theory; theories

DESCRIPTION (provided by applicant): Over half of all U.S. citizens will be exposed to a potentially traumatic event (PTE) during their lifetime. The recent, unprecedented man-made and natural disasters of 9/11 and Hurricane Katrina catastrophically illustrate that lifetime trauma exposure rates are rising. The psychiatric response associated with traumatic exposure involves post-traumatic stress disorder (PTSD), substance-use disorder (SUD), or co-occurring psychopathology (i.e., PTSD-SUD). However, not all individuals will develop psychiatric disorders in response to PTE exposure, underscoring the question: What are the factors that lead some individuals who are exposed to traumatic events down the path to resilience and other individuals down the path to risk for these disorders? This question can be examined effectively in a sample of firefighter (FF) recruits who will experience life-threatening events on a day-to-day basis as a result of their profession. FFs exposed to PTEs may follow a number of pathways towards pathology or wellness. Unfortunately, the variables and parameters that predict risk and resilience for PTSD, SUD, and PTSD-SUD symptoms and diagnostic caseness, as well as the patterns of recovery and relapse related to these disorders, are not well understood. In the proposed study, 400 urban, professional FF recruits will be followed from selection and training, through their early careers as FFs in a prospective, longitudinal evaluation. Resilience to, or development of, PTSD, SUD, or PTSD-SUD will be examined, as well as temporal patterns of symptom expression, recovery, and relapse. Biopsychosocial variables that influence post-exposure pathways and increase or decrease the likelihood of developing PTSD, SUD, or PTSD-SUD symptoms and/or caseness will be evaluated. Following a multi-dimensional pre-employment baseline assessment (i.e., genetic markers, family history, personality factors, prior PTE exposure and substance use), PTSD and SUD symptomatology plus empirically-derived predictor variables (i.e., trauma characteristics, acute peritraumatic responses, coping, and social support) will be measured at 3-month intervals for 3 successive years. Latent growth curve analyses, structural equation modeling, multigroup structural equation modeling, and cross-lag panel analytic approaches will test temporal dependency as well as postulated relationships between risk and resilience factors. This application is the next step in our research team's programmatic investigation of trauma-related disorders among FFs, with an emphasis on factors that may inform prevention and treatment guidelines for both FFs and other trauma-exposed populations. The long-term goal of this study is to build a FF database from recruitment through retirement in order to identify patterns of risk and resilience in this highly-exposed, essential public safety population.

描述(由申请人提供)：超过一半的美国公民在他们的一生中将接触到潜在的创伤性事件(PTE)。最近史无前例的9/11人为和自然灾害以及卡特里娜飓风灾难性地表明，终生创伤曝光率正在上升。与创伤暴露相关的精神反应包括创伤后应激障碍(PTSD)、物质使用障碍(SUD)或共生精神病理学(即PTSD-SUD)。然而，并不是所有的人都会因PTE暴露而出现精神障碍，这突出了一个问题：是什么因素导致一些暴露在创伤事件中的人沿着恢复能力的道路前进，而其他人则沿着这些障碍的风险道路前进？这个问题可以在消防员(FF)新兵的样本中得到有效的检验，这些新兵将因其职业而每天经历危及生命的事件。暴露在PTE下的FFS可能会沿着多种途径走向病理或健康。不幸的是，预测创伤后应激障碍、创伤后应激障碍和创伤后应激障碍症状和诊断干酪率的变量和参数，以及与这些疾病相关的康复和复发模式，还没有被很好地理解。在这项拟议的研究中，400名城市专业消防新兵将从选拔和培训开始，通过他们作为消防人员的早期职业生涯，进行前瞻性的纵向评估。本课程将研究创伤后应激障碍、创伤后应激障碍或创伤后应激障碍的恢复力或发展，以及症状表现、恢复和复发的时间模式。将评估影响暴露后途径并增加或降低发生PTSD、SUD或PTSD-SUD症状和/或干酪性的可能性的生物心理社会变量。在就业前的多维基线评估(即遗传标记、家族史、个性因素、既往PTE暴露和药物使用)之后，创伤后应激障碍和创伤后应激障碍症状学加上经验性的预测变量(即创伤特征、急性创伤周围反应、应对和社会支持)将连续3年每隔3个月进行一次测量。潜在增长曲线分析、结构方程模型、多组结构方程模型和交叉滞后面板分析方法将测试时间相关性以及风险和弹性因素之间的假设关系。这一应用是我们的研究团队对F中创伤相关疾病的程序性调查的下一步，重点是可能为F F和其他创伤暴露人群的预防和治疗指南提供信息的因素。这项研究的长期目标是建立一个从招募到退休的FF数据库，以便在这一高度暴露的、基本的公共安全人群中确定风险和弹性的模式。