PTSD, TBI, and Neuropsychological Factors in Partner Violence among Veterans

描述(由申请人提供)： 这一延续申请建议延长一个由CRS&D功绩审查资助的项目，该项目调查愤怒和认知缺陷以及偏见在创伤后应激障碍症状严重程度与伊拉克自由行动(OIF)/持久自由行动(OEF)退伍军人中亲密伴侣暴力(IPV)行为之间的关联方面的作用。在目前的应用中，我们建议研究创伤性脑损伤(TBI)和执行功能在这些关系中的贡献。这项研究的主要目的是检验以下假设：(A)脑创伤和执行功能缺陷将与较高的生理和心理IPV严重程度正相关；以及(B)脑创伤和执行功能缺陷将缓和创伤后应激障碍症状和认知缺陷/偏见对IPV结果的影响。研究设计和方法：参与者将是150名18岁以上的男性OEF/OIF退伍军人，他们已经结婚或与伴侣同居至少一年。在下列情况下，可能的参与者将被排除在外：(A)阅读困难阻碍有效完成评估工具，(B)参与者的精神状况使其无法完成研究程序，例如严重的器质性、积极的精神病，或在小型智力状态考试中表现受损(C)参与者曾服用任何被认为对中枢神经系统有显著影响的药物，或(D)参与者符合目前酒精或药物依赖的标准，或在过去60天内曾因酒精或药物依赖而住院治疗或门诊治疗(例如，AA、NA或方法酮治疗)。参与者将来自三个来源：(A)张贴在波士顿地区的传单；(B)已经建立的创伤后应激障碍主题招募数据库；(C)向居住在马萨诸塞州的所有男性OEF/OIF退伍军人名册上的人发送大量邮件，由国防人力数据中心(DMDC)持有，并根据DMDC和VACO签署的数据使用协议与退伍军人管理局共享。参与将包括一次电话筛选和三次实验室会议，间隔约一周。与参与者一起进行的初步筛选将需要确定学习资格。第一次会议将涉及知情同意程序和管理的微型精神状态检查，自我报告问卷，以及创伤后应激障碍和其他轴心I障碍的诊断性访谈。第二堂课将包括评估认知缺陷和偏见的模拟情境(ATS)实验程序。这种方法评估愤怒唤醒期间的想法，因为如果在愤怒情绪状态被激活和相关背景线索存在时进行评估，与愤怒相关的想法更有可能被访问和报告。第三堂课将涉及脑损伤的评估和感兴趣的神经心理学变量。临床关系：研究结果可能会对程序的修改和开发产生影响，特别是对于愤怒管理和IPV实施。研究结果可能突出了认知-行为愤怒管理策略的必要性，这些策略考虑到了神经心理缺陷和脑外伤病史。研究结果还可能阐明IPV的标记变量和特定神经心理因素的意义，这些因素对理解和治疗IPV在这一人群中特别相关。研究结果还将为首席调查员正在进行的研究计划提供信息，该计划的重点是开发预防和治疗IPV的干预措施。 公共卫生相关性： 与退伍军人健康的相关性亲密伴侣暴力(IPV)使退伍军人与家庭成员疏远，并对支持网络产生负面影响，使退伍军人面临各种心理和身体健康问题以及社会和职业功能不良的风险增加。至关重要的是，我们必须更好地了解这一人群中IPV的性质和原因，以便最好地预防和治疗此类家庭问题。目前的调查建议研究退伍军人中创伤性脑损伤和执行功能缺陷在IPV中的作用，以及它们与创伤后应激障碍症状和导致IPV的认知缺陷/偏见的相互作用。这项工作将为首席调查员目前资助的为患有创伤后应激障碍的退伍军人开发和测试初级和二级IPV预防干预措施的工作提供信息。

DESCRIPTION (provided by applicant): This continuation application proposes to extend a funded CRS&D Merit Review project investigating the role of anger and cognitive deficits and biases with respect to the association between PTSD symptom severity and intimate partner violence (IPV) perpetration among Operation Iraqi Freedom (OIF)/ Operation Enduring Freedom (OEF) veterans. In the current application, we propose to examine the contribution of traumatic brain injury (TBI) and executive functioning with respect to these relationships. The primary objective of this study is to test the hypotheses that (a) TBI and executive functioning deficits will be positively and uniquely associated with higher physical and psychological IPV severity; and (b) TBI and executive functioning deficits will moderate the impacts of PTSD symptoms and cognitive deficits/biases on the IPV outcomes. Research Design and Methodology: Participants will be 150 male OEF/OIF veterans over the age of 18 who have been married or cohabitating with a partner for at least one year. Potential participants will be excluded if (a) reading difficulties prevent valid completion of the assessment instruments, (b) the mental status of a participant precludes the completion of study procedures, such as severe organicity, active psychosis, or impaired performance on the Mini-Mental Status Exam (c) the participant has taken any medication that is thought to have significant CNS effects, or (d) the participant meets criteria for current alcohol or drug dependence, OR has been in inpatient treatment or outpatient treatment for alcohol or drug dependence (e.g., AA, NA, or methodone treatment) within the past 60 days. Participants will be drawn from three sources: (a) flyers posted in the Boston area; (b) the already established National Center for PTSD subject recruitment database; and (c) a mass mailing to those on a roster of all male OEF/OIF veterans living in Massachusetts, held by the Defense Manpower Data Center (DMDC), and shared with the VA under a data use agreement signed by DMDC and the VACO. Participation will involve a phone screening and three laboratory sessions, spaced approximately one week apart. The initial screening with the participant will entail the determination of study eligibility. Session 1 will involve informed consent procedures and the administration of the Mini-Mental Status Examination, self-report questionnaires, and diagnostic interviews for PTSD and other Axis I disorders. Session 2 will include the Articulated Thoughts in Simulated Situations (ATSS) laboratory procedure to assess cognitive deficits and biases. This methodology assesses thoughts during anger arousal, since anger- related thoughts are more likely to be accessible and reportable if assessed when angry mood states are activated and relevant contextual cues present. Session 3 will involve the assessment of TBI and the neuropsychological variables of interest. Clinical Relationships: Study findings will potentially have consequences for program modification and development, specifically for anger management and IPV perpetration. Findings may highlight the need for cognitive-behavioral anger management strategies that take into account neuropsychological deficits and history of TBI. Study findings may also elucidate marker variables for IPV and the significance of specific neuropsychological factors that are particularly relevant for understanding and treating IPV in this population. Study findings will also inform the Principal Investigator's ongoing research program focused on developing interventions for the prevention and treatment of IPV. PUBLIC HEALTH RELEVANCE: Relevance to Veterans Health Intimate partner violence (IPV) alienates veterans from family members and negatively impacts support networks, placing the veteran at increased risk for various psychosocial and physical health problems and poor social and occupational functioning. It is critically important that we develop a better understanding of the nature and causes of IPV in this population in order to best prevent and treat such family problems. The current investigation proposes to examine the roles of traumatic brain injury and executive functioning deficits in IPV among returning veterans, as well as their interplay with symptoms of PTSD and cognitive deficits/biases in contributing to IPV. This work will inform the Principal Investigator's current funded efforts to develop and test primary and secondary IPV prevention interventions for veterans with PTSD.