PTSD, Cortisol, Immune Function with Battering Over Time

描述(由申请人提供)：与亲密伴侣暴力(IPV)相关的毁灭性的身体和情感影响每年影响到美国近120万女性。第一次袭击只是恐怖、伤害和绝望的开始，这种恐惧、伤害和绝望可能会持续到女人的一生。关于影响经历过暴力和创伤的妇女健康的生理和心理因素之间的动态相互作用的知识有限，特别是因为它涉及反复的创伤经历。大多数创伤幸存者群体的研究都是横断面进行的，产生了很多信息，但这种方法只提供了一次及时的观察。在护理或其他学科中，关于IPV的影响随着时间的推移可能会如何影响健康，人们知之甚少。本研究的目的是检验IPV、儿童期虐待、恢复力和创伤后应激障碍(PTSD)对156名来自庇护所和社区的受虐妇女24个月的健康结果的关系，包括自我报告的身体健康、白天的肾上腺皮质激素和免疫功能。预测-解释性设计将被用来测试这些关系的模型，并解决三个研究目标：1)测试模型的横截面适配性，并确定可能的中介和调节路径；2)纵向检查每日肾上腺皮质激素、免疫功能和创伤后应激障碍之间的关系模式；3)纵向测试完整模型的适合性。结构方程模型(SEM)将被用来模拟模型结构之间的横截面和纵向关系，生长曲线模型将被用来检查创伤后应激障碍(PTSD)、昼夜皮质激素和免疫功能在24个月内的变化轨迹。探索性分析将用于确定个别变化模式的预测因素。这项研究将增加关于创伤的心理社会和生理反应之间的关系的知识，以及随着时间的推移它们对妇女健康的影响。研究结果将为制定旨在预防和减少IPV对身心健康造成的长期后果的护理干预措施提供理论基础。

DESCRIPTION (provided by applicant): The devastating physical and emotional effects associated with intimate partner violence (IPV) affect nearly 1.2 million women in the United States yearly. The first assault is only the beginning of the terror, injuries, and desperation that can continue through a woman's life. Knowledge regarding the dynamic interplay among the physiological and psychological factors affecting the health of women who have experienced violence and trauma is limited, particularly as it relates to repeated traumatic experiences. Most studies of trauma survivor groups are conducted cross-sectionally, yielding much information, but this methodology provides only a single observation in time. Little is known in nursing or other disciplines about how the impact of IPV might affect health over time. The purpose of this study is to examine relationships among IPV, childhood maltreatment, resilience, and posttraumatic stress disorder (PTSD) on health outcomes, including self-report physical health, diurnal adrenocortical hormones, and immune function in 156 battered women from shelters and the community over 24-months. A predictive-explanatory design will be employed to test a model of these relationships and address three research objectives: 1) to test the cross-sectional fit of the model and identify possible mediating and moderating paths, 2) to longitudinally examine patterns of relationships among diurnal adrenocortical hormones, immune function and PTSD, and 3) to longitudinally test the fit of the full model. Structural equation modeling (SEM) will be used to model the cross-sectional and longitudinal relationships between model constructs and growth curve modeling will be used to examine trajectories of change in PTSD, diurnal adrenocortical hormones, and immune function over 24-months. Exploratory analyses will be used to identify predictors of individual patterns of change. This study will increase knowledge regarding the relationships between psychosocial and physiologic responses to trauma and their impact on women's health over time. Findings will provide a theoretical foundation upon which to develop nursing interventions directed towards the prevention and reduction of long-term physical and mental health consequences of IPV.