Explaining the Attenuation Effect in Epidemiological Studies

描述（由申请人提供）：虽然流行病学家和临床研究人员依靠纵向评估来研究过程和变化，但几十年来，人们已经知道，健康问题的调查报告显示出一种偏见，即从第一次访谈到随后的访谈，健康问题的频率和严重程度都莫名其妙地下降。这种下降被称为衰减效应，在精神疾病中比在酒精使用障碍中有更好的记录，但这种差异可能是由于对后者研究的缺乏。酒精滥用和精神疾病调查中衰减偏差的存在可能导致对这些疾病的病程及其前体的错误结论。对衰减效应的几种解释已被提出，包括重复评估的治疗益处，参与者对这些评估的解释变化，或参与者反应的学习/优化过程，但这些解释尚未经过测试。此外，在衰减效应已得到充分确定的精神疾病和尚未确定的酒精疾病的对比背景下，这些解释还没有被联合考虑。我们提出两个具体目标。1)仔细描述两项针对大学生的密集纵向研究中的衰减效应，通过估算其在a)四个月期间反复评估的酒精问题和心理健康调查以及b)面对急性压力事件的学生的酒精使用和心理状态的每日日记研究中的量级。2)在实验研究中重现效果，并检验部分原因是a)重复评估的治疗效果，b)参与者对评估工具的理解增加，或c)参与者倾向于使用对话规范来判断他们应该报告什么以及他们认为调查人员希望听到什么。这些目标将通过四个研究来实现，其中三个是随机实验，一个是心理生理学实验室研究。公共卫生相关性：这项研究将帮助研究人员在纵向调查中收集更准确的关于酒精和精神疾病的数据。反过来，这将有助于了解这些疾病的原因和过程，从而能够设计预防和干预方案。

DESCRIPTION (provided by applicant): Although epidemiologists and clinical researchers depend on longitudinal assessments to study process and change, for decades it has been known that survey reports of health problems show a bias where they decline inexplicably in frequency and severity from first to subsequent interviews. This decline, called the attenuation effect, is better documented in psychiatric than in alcohol use disorders, but this difference could be due to the paucity of research on the latter. The presence of attenuation biases in surveys of alcohol abuse and psychiatric disorders can lead to erroneous conclusions about the course of these diseases and of their precursors. Several explanations for the attenuation effect have been proposed, including a therapeutic benefit of repeated assessments, participants' changing interpretations of those assessments, or a process of learning/optimization of participant responses, but these explanations have not been tested. Moreover, the explanations have not been jointly considered in contrasting contexts of psychiatric disorders where the attenuation effect is well established, and alcohol disorders, where it is not yet established. We propose two specific aims. 1) To carefully delineate the attenuation effect in two intensive longitudinal studies of college students, by estimating its magnitude in a) surveys of alcohol problems and mental health assessed repeatedly over a four month period, and b) daily diary studies of alcohol use and mental state among students facing an acutely stressful event. 2) To reproduce the effect in experimental studies and to test hypotheses that it is due in part to a) a therapeutic effect of the repeated assessments, b) participants' increased understanding of the assessment instrument, or c) a tendency for participants use conversation norms to judge what they should report and what they think investigators expect to hear. These aims will be approached with four studies, three of which are randomized experiments and one a psychophysiology lab study. PUBLIC HEALTH RELEVANCE: This study will help researchers gather more accurate data on alcohol and psychiatric disorders assessed in longitudinal surveys. This, in turn, will facilitate understanding of causes and courses of these disorders, enabling prevention and intervention programs to be designed.