Understanding predictors of post-traumatic stress after pediatric medical events

了解儿科医疗事件后创伤后应激的预测因素

• 批准号: 8454410
• 负责人: Meghan L. Marsac
• 金额: $ 13.87万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-05 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8454410
• 关键词: Accidental Injury; Acute; Adherence; Affect; Age; American; Anxiety Disorders; Biological; Biological Factors; Cardiovascular system; Child; Child Development; Child Psychology; Childhood; Code; Cognitive; Coping Behavior; Data; Data Set; Development; Diagnosis; Early-life trauma; Effectiveness; Environmental Risk Factor; Equation; Event; Experimental Designs; Goals; Growth; Health; Healthy People 2020; Heart Injuries; Heart Rate; Impairment; Incidence; Injury; Journals; Link; Literature; Mediation; Medical; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Mentorship; Methods; Modeling; Outcome; Parent-Child Relations; Parents; Patient Self-Report; Peer Review; Physiological; Post-Traumatic Stress Disorders; Prevention; Prevention program; Preventive Intervention; Public Health; Publications; Quality of life; Reaction; Recording of previous events; Recovery; Regimen; Reporting; Research; Research Design; Research Personnel; Risk; Risk Factors; Role; Sampling; Scientific Advances and Accomplishments; Secondary Prevention; Severities; Stress; Symptoms; Techniques; Testing; Theoretical model; Time; Training; Trauma; Youth; career; coping; disorder prevention; disorder risk; emotional distress; experience; functional outcomes; innovation; model development; parental influence; post-traumatic stress; prevent; programs; psychologic; psychological distress; screening; skills

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.

描述（由申请人提供）：背景：儿童伤害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表现出短暂的情绪困扰，但大约19%（即，3.8 2000万人）发展出显著的、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，可能会干扰对医疗方案的最佳遵守，并且与较差的总体健康结果和受损的生活质量有关。识别有助于PTSD发展的变量是最大限度地提高二级预防计划有效性的重要步骤，以减少医疗事件后青年PTSD的发病率。有证据表明父母和孩子PTSD之间存在联系，但父母的症状如何影响孩子的症状尚未确定。先前的研究已经报道了关于创伤事件的认知评估，应对行为和受伤后的心理恢复之间的关联。父母如何影响孩子的评价和随后的应对方式，以及这如何影响PTSD的结果没有阐明。虽然创伤事件与随后的PTSD的初始生理反应的关系已经建立，很少有研究探讨这些反应的作用，因为它们涉及到创伤周围的认知评估在儿童和如何评估这些反应可以帮助筛选PTSD的风险。拟议的项目将大大加深我们对生物（心血管水平），心理（儿童的评价和应对）和环境因素（父母如何影响他们的孩子的评价和应对）之间的相互作用的理解，以及这些因素如何有助于创伤后应激障碍儿童受伤。具体目的是：1）检查儿童在创伤前后的认知评估和应对在预测创伤后儿童PTSD症状中的作用; 2）阐明创伤前后生物学因素（即，心血管水平）与创伤前后认知评估对创伤后PTSD发展的相关性，以及3）通过检查创伤前后亲子互动以及这如何预测创伤后儿童PTSD症状来确定父母对其子女认知评估和应对的影响。研究方法：在研究1中，我们将对现有的三组儿童创伤样本数据进行二次分析，以研究父母和儿童早期创伤症状、儿童应对和父母应对援助对儿童创伤后应激障碍发展的影响。我们将使用结构方程建模技术来研究交叉滞后回归模型，潜在增长曲线模型和潜在差异得分模型。在研究2中，我们将结合联合收割机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，以评估一个模糊的场景，并选择应对策略，2）儿童和父母自我报告的评估，应对，和创伤后应激障碍症状在围创伤期，以及3）医疗图表审查以获得关于儿童的心率和损伤严重性的数据。职业目标：该K23奖将为候选人提供必要的培训和指导，使其成为独立的儿科心理学研究人员和PTSD预防领域的领导者，允许候选人1）获得研究设计和研究分析方面的专业知识，评估生物，心理，在经历医疗事件和使用先进统计技术的儿童中，（结构方程模型）来检验PTSD的预测因子，2）发展新的方法学技能应用于PTSD的研究和预防（亲子互动的观察编码），3）在急性医疗压力期间，为儿童和父母开发和测试PTSD预防干预措施方面获得专业知识（二级预防），以及4）在同行评审的科学期刊和期刊上发表研究成果方面提高科学技能。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PTSD的发生率。这个拟议的项目推进了NIMH的战略目标，以绘制精神疾病轨迹，以确定何时，何地以及如何通过识别可塑性和强大的风险因素进行干预，以及拟议的健康人2020年目标，通过测试策略来促进适应性应对和预防PTSD的发展，以提高生活质量。