Using EMA to Assess the PTSD-HIV Risk Behavior Relationship in OEF/OIF Veterans

 描述：最近的研究报告说，退伍军人中艾滋病毒、性传播感染和物质使用率升高。从阿富汗和伊拉克返回的190万新退伍军人（持久自由行动和伊拉克自由行动; OEF/OIF）中的许多人，特别是那些经历过战斗的退伍军人，将从事高风险的性行为。冒险和战斗暴露之间的关系可能与创伤后应激障碍有关，因为患有创伤后应激障碍的退伍军人支持更高的冒险率。有一些精心设计但缺乏支持的理论认为，性冒险可能代表着科普创伤后应激障碍症状的努力，与物质相关的冒险的后果，和/或与其他合并症如冲动的关联（1）。一项使用生态瞬时评估（EMA）的研究，提出了澄清这些前因。由于OEF/OIF退伍军人PTSD是复杂的重叠合并症，如冲动和物质使用，标准的回顾性总结数据不能澄清与从事艾滋病毒相关的性风险行为（HSRB）相关的先前的精神状态和行为。标准的回顾性估计也是不精确的，因为它们是由可能依赖于非代表性事件或时间段来整合28天信息的统计学得出的。EMA可以用来了解PTSD和HSRB之间的关联的性质，通过测量它们实时发生的关联。使用EMA，本项目将估计在这些行为和状态的回顾性测量中发生的任何系统性偏差，并确定现场收集的数据是否澄清了HSRB的更具决定性的模型。在拟议的研究中，在四人预试验阶段之后，36名OEF/OIF退伍军人报告最近的PTSD症状和最近的HSRB将在多个领域完成基线评估，然后在接下来的28天内每天三次被呼叫，以完成简短的交互式语音应答（IVR）评估特定时间的PTSD症状，物质使用，情绪，冲动性（使用最近开发的专为瞬时采样设计的瞬时冲动性评估）和HSRB。退伍军人将完成随访亲自评估，与基线评估一样，将包括EMA测量的相同领域的28天回顾性测量，以及对其28天EMA数据的简要回顾，以确定他们自己对症状随时间变化的解释，以及与HSRB发生相关的因素。总之，生态瞬时评估将被用来澄清直接的，潜在的因果关系，影响HSRB在高危退伍军人的参与HSRB是不是很好地理解。

 DESCRIPTION: Recent studies report elevated rates of HIV, sexually transmitted infections, and substance use among veterans. Many of the 1.9 million new veterans returning from Afghanistan and Iraq (Operations Enduring Freedom and Iraqi Freedom; OEF/OIF), especially those veterans who have been exposed to combat, will engage in high risk sexual behaviors. The relationship between risk-taking and combat exposure may be related to PTSD, as veterans with PTSD endorse even higher rates of risk-taking. There are elaborate but poorly-supported theories that sexual risk-taking may represent either an effort to cope with PTSD symptoms, a consequence of substance-related risk-taking, and/or an association with other comorbidities such as impulsivity (1). A study using ecological momentary assessment (EMA) is proposed to clarify these antecedents. Because OEF/OIF veterans PTSD is complicated by overlapping comorbidities, such as impulsivity and substance use, standard retrospective summary data cannot clarify the antecedent mental states and behaviors that are associated with engaging in HIV-related sexual risk behavior (HSRB). Standard retrospective estimates are also imprecise because they are derived by heuristics that may rely on non- representative events or time periods to integrate 28 days of information. EMA can be used to understand the nature of the association between PTSD and HSRB by measuring the associations as they occur in real-time. Using EMA, this project will estimate any systematic biases that occur in retrospective measurement of these behaviors and states, and determine if data collected in situ clarify more determinative models of HSRB. In the proposed study, after a four-person pre-pilot stage, 36 OEF/OIF veterans reporting recent PTSD symptoms and recent HSRB will complete baseline assessments in multiple domains, and then will be called three times daily for the next 28 days to complete brief, interactive voice response (IVR)-delivered assessments of time- specific PTSD symptoms, substance use, mood, impulsivity (using a recently-developed assessment of momentary impulsivity designed specifically for momentary sampling), and HSRB. Veterans will complete a follow-up in-person assessment that, like the baseline assessment, will include 28-day retrospective measures of the same domains that were measured by EMA, and a brief review of their 28-day EMA data to determine their own interpretations about changes in symptoms over time, and factors associated with HSRB occurrence. In summary, ecological momentary assessment will be used to clarify immediate, and potentially causal, influences on HSRB in at-risk veterans whose engagement in HSRB is not well understood.