PTSD, Cortisol, Immune Function with Battering Over Time

描述（由申请人提供）：与亲密伴侣暴力 (IPV) 相关的毁灭性身体和情感影响每年影响近 120 万美国女性。第一次袭击只是恐惧、伤害和绝望的开始，这些恐惧、伤害和绝望可能会持续一个女人的一生。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，特别是因为它与反复的创伤经历有关。大多数创伤幸存者群体的研究都是横断面进行的，产生了大量信息，但这种方法只能及时提供单一观察。在护理或其他学科中，人们对 IPV 随着时间的推移如何影响健康知之甚少。本研究的目的是调查 IPV、儿童期虐待、复原力和创伤后应激障碍 (PTSD) 之间的关系对健康结果的影响，包括 156 名来自庇护所和社区的受虐妇女在 24 个月内自我报告的身体健康状况、昼间肾上腺皮质激素和免疫功能。将采用预测解释设计来测试这些关系的模型并实现三个研究目标：1）测试模型的横截面拟合并确定可能的中介和调节路径，2）纵向检查昼间肾上腺皮质激素、免疫功能和 PTSD 之间的关系模式，3）纵向测试整个模型的拟合度。结构方程模型 (SEM) 将用于模拟模型构造之间的横截面和纵向关系，生长曲线模型将用于检查 24 个月内 PTSD、昼间肾上腺皮质激素和免疫功能的变化轨迹。探索性分析将用于确定个体变化模式的预测因素。这项研究将增加人们对创伤的社会心理和生理反应之间的关系及其对女性健康长期影响的认识。研究结果将为制定护理干预措施提供理论基础，旨在预防和减少 IPV 对身心健康的长期影响。

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.