Understanding predictors of post-traumatic stress after pediatric medical events

描述(申请人提供)：背景：儿童创伤是儿童最常见的心理创伤经历之一。每年有2000万美国儿童遭受意外伤害。虽然这些儿童中的大多数都表现出短暂的情绪困扰，但大约19%(即380万)的儿童出现了严重的、持续的创伤后应激障碍(PTSD)症状。创伤后应激障碍症状是功能结果的关键预测因素，可能会干扰对药物治疗方案的最佳坚持，并与较差的一般健康结果和受损的生活质量有关。确定导致创伤后应激障碍发展的变量是最大限度地发挥二级预防计划的有效性，以减少青少年在医疗事件后发生创伤后应激障碍的关键一步。有证据表明，父母和孩子的创伤后应激障碍之间存在联系，但父母的症状如何影响孩子的症状还没有确定。先前的研究已经报道了对创伤事件的认知评估、应对行为和受伤后心理恢复之间的关系。父母如何影响孩子的评估和随后的应对，以及这如何影响创伤后应激障碍的结果，目前还没有明确的说法。虽然创伤事件的最初生理反应与随后的创伤后应激障碍之间的关系已经建立，但很少有研究检查这些反应在与儿童创伤周围认知评估有关时的作用，以及这些反应的评估如何有助于筛选创伤后应激障碍的风险。拟议的项目将大大加深我们对生物因素(心血管水平)、心理因素(儿童的评估和应对)和环境因素(父母如何影响他们的孩子的评估和应对)之间的相互作用，以及这些因素如何导致儿科损伤后的创伤后应激障碍的理解。本研究的具体目的是：1)研究创伤前后儿童的认知评估和应对在预测创伤后儿童创伤后应激障碍症状中的作用；2)阐明创伤后认知评估相关的创伤周围生物学因素(即心血管水平)对创伤后创伤后应激障碍的影响；3)通过研究创伤前后亲子互动，确定父母对子女的认知评估和应对的影响，以及这如何预测创伤后儿童创伤后创伤后应激障碍症状。方法：在研究一中，我们将对现有的三组儿科创伤样本进行二次分析，以考察父母和儿童早期创伤症状、儿童应对和父母应对协助在儿童创伤后应激障碍发展中的影响。我们将使用结构方程建模技术来检验交叉滞后回归模型、潜在增长曲线模型和潜在差异得分模型。在研究2中，我们将结合1)创新的实验设计(改编自焦虑症文献)，其中儿童(7-13岁)和父母参与一项互动任务，以评估模棱两可的情景并选择应对策略，2)儿童和父母对创伤期间的评估、应对和创伤后应激障碍症状的自我报告，以及3)病历回顾，以获得关于儿童心率和伤害严重程度的数据。职业目标：这个K23奖项将为候选人提供必要的培训和指导，使其成为一名独立的儿科心理学研究人员和创伤后应激障碍预防领域的领导者，方法是：1)获得研究设计和研究分析方面的专业知识，评估经历过医疗事件的儿童中创伤后应激障碍的生物、心理和环境风险因素之间的相互作用，并使用先进的统计技术(结构方程建模)检查创伤后应激障碍的预测因素；2)发展新的方法学技能，用于研究和预防创伤后应激障碍(亲子相互作用的观察编码)，3)获得在急性医疗应激期间为儿童和父母制定和测试创伤后应激障碍预防干预措施的专门知识(二级预防)，以及4)在同行评议的科学期刊上发表研究成果和提高科学技能。重要性：我未来研究计划的目标是开发预防性干预措施，以减少急性儿科医疗事件后儿童创伤后应激障碍的发生率。这一拟议的项目推进了NIMH的战略目标，即绘制精神疾病的轨迹图，以确定何时、何地以及如何进行干预，确定可延展性和健壮的风险因素，以及拟议的健康人2020目标，通过测试促进适应性应对和预防PTSD发展的战略来提高生活质量。

DESCRIPTION (provided by applicant): Background: Pediatric injuries are among the most common psychologically traumatic experiences for children. Twenty million American children suffer from unintentional injuries annually. While the majority of these children display transient emotional distress, approximately 19% (i.e., 3.8 million) develop significant, persistent symptoms of posttraumatic stress disorder (PTSD). PTSD symptoms are key predictors of functional outcomes, may interfere with optimal adherence to medical regimens, and have been linked to poorer general health outcomes and impaired quality of life. Identification of variables that contribute to the development of PTSD is an essential step in maximizing the effectiveness of secondary prevention programs to reduce the incidence of PTSD in youth following medical events. Evidence suggests an association between parent and child PTSD but how parents' symptoms influence children's symptoms has not yet been established. Prior research has reported associations among cognitive appraisals about the traumatic event, coping behavior, and psychological recovery following injury. The ways in which parents influence children's appraisals and subsequent coping and how this affects PTSD outcomes is not articulated. While the relation of initial physiological reactions to the traumatic event with subsequent PTSD has been established, little research has examined the role of these reactions as they relate to peri-trauma cognitive appraisals in children and how assessment of these reactions could help in screening for PTSD risk. The proposed project will significantly deepen our understanding of the interplay among biological (cardiovascular levels), psychological (child's appraisals and coping), and environmental factors (how parents influence their child's appraisals and coping) and how these factors contribute to PTSD following pediatric injury. The specific aims are to 1) examine the roles of children's cognitive appraisals and coping during the peri-trauma injury period in predicting post- trauma child PTSD symptoms 2) elucidate the contribution of peri-trauma biological factors (i.e.,cardiovascular levels) as associated with peri-trauma cognitive appraisals to the development of PTSD post-trauma, and 3) determine parents' influence on their child's cognitive appraisals and coping by examining parent-child interactions during the peri-trauma period and how this predicts post-trauma child PTSD symptoms. Methods: In study 1, we will conduct secondary analyses of three existing data sets of pediatric injury samples to examine the influence of parent and child early trauma symptoms, child coping, and parent coping assistance in the development of child PTSD. We will use structural equation modeling techniques to examine cross-lagged regression models, latent growth curve models, and latent difference score models. In Study 2, we will combine 1) an innovative experimental design (adapted from the anxiety disorder literature), in which children (ages 7-13 years) and parents engage in an interaction task to appraise an ambiguous scenario and choose a coping strategy, 2) child and parent self-report of appraisals, coping, and PTSD symptoms during the peri-trauma period, and 3) medical chart review to obtain data on the child's heart rate and injury severity. Career Goals: This K23 Award will provide necessary training and mentorship for the candidate to become an independent pediatric psychology researcher and leader in the field of PTSD prevention by allowing the candidate to 1) gain expertise in research design and analyses of studies evaluating the interplay between biological, psychological, and environmental risk factors for PTSD among children who experience medical events and use of advanced statistical techniques (structural equation modeling) to examine predictors of PTSD, 2) develop new methodological skills as applied to the study and prevention of PTSD (observational coding for parent-child interactions), 3) gain expertise in development and testing of PTSD preventive interventions for children and parents during a period of acute medical stress (secondary prevention), and 4) advance scientific skills in publication of research in peer-reviewed scientific journals and grantsmanship. Importance: The goal of my future research program is to develop preventive interventions to reduce the incidence of PTSD in children following acute pediatric medical events. This proposed project advances The NIMH's Strategic Objectives to chart mental illness trajectories to determine when, where, and how to intervene by identifying malleable and robust risk factors and the proposed Healthy People 2020 goals to promote quality of life by testing strategies to promote adaptive coping and prevent the development of PTSD.