Models of Risk for PTSD

创伤后应激障碍 (PTSD) 风险模型

• 批准号: 9301034
• 负责人: Matthew C. Morris
• 金额: $ 17.44万
• 依托单位: MEHARRY MEDICAL COLLEGE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-09 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9301034
• 关键词: Accounting; Acute; Address; Adrenal Glands; Area; Chronic stress; Clinical; Cognitive; Consultations; Control Groups; Coping Skills; Cross-Sectional Studies; Data Collection; Depressive disorder; Early Intervention; Early treatment; Emotional; Exposure to; Fright; Goals; Healthcare; Hydrocortisone; Hypothalamic structure; Individual; Individual Differences; Interpersonal Violence; Intervention; Laboratories; Life Stress; Link; Literature; Maintenance; Major Depressive Disorder; Measures; Mental Health; Mentors; Methods; Modeling; Mood Disorders; Neurobiology; Neuropsychological Tests; Neurosecretory Systems; Outcome; Output; Pathway interactions; Patient Self-Report; Pattern; Performance; Peripheral; Pharmacology; Physiological; Pituitary Gland; Pituitary-Adrenal System; Play; Post-Traumatic Stress Disorders; Problem behavior; Process; Psychosocial Factor; Psychosocial Stress; Public Health; Reading; Research; Research Training; Risk; Risk Factors; Risk Marker; Role; Safety; Saliva; Salivary; Sampling; Schools; Social Problems; Stress; Sympathetic Nervous System; Symptoms; System; Time; Training; Training Programs; Trauma; United States; Woman; Work; alpha-amylase; base; biological adaptation to stress; coping; depressive symptoms; disorder risk; executive function; experience; habituation; high risk; hypothalamic-pituitary-adrenal axis; indexing; innovation; intervention program; longitudinal design; meetings; men; neurobiological mechanism; pediatric trauma; physical assault; programs; psychosocial; public health relevance; response; sexual assault; skills; stress reactivity; traumatic event; treatment program; violence against women; webinar

DESCRIPTION (provided by applicant): This application seeks to identify cognitive and neurobiological markers of risk for posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD) in the acute aftermath of trauma. In addition, a plan is outlined for the candidate to acquire the necessary training to develop an independent program of research focused on understanding markers and mechanisms of risk for PTSD and MDD. The candidate's prior training in life stress, mood disorders and PTSD research has allowed him to hone many skills necessary for achieving this goal. However, he requires additional training, mentoring and experience in five key areas: (1) diurnal sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) activity; (2) SNS and HPA reactivity to stress; (3) neurobiological risk markers for PTSD; (4) cognitive risk factors for PTSD and MDD; and (5) longitudinal designs to study coping and neuroendocrine trajectories for the onset and course of PTSD and/or MDD. A comprehensive training plain has been developed that includes hands-on didactic experiences, formal coursework, independent readings, seminars, webinars, mentoring meetings and consultation with experts in these five key areas. The proposed study will investigate longitudinal pathways leading from interpersonal violence (IPV) exposure to PTSD and/or MDD in a sample of 60 women recently exposed to IPV and 40 non-exposed women using four waves of data collection (within 1 month after exposure to IPV, and at 1, 3, and 6 months following the initial assessment). Although women are twice as likely as men to develop PTSD and/or MDD after exposure to trauma, the mechanisms underlying this increased risk remain unclear. Identifying individuals at elevated risk for these disorders is critical for developing effective early intervention programs. The HPA and SNS systems serve as main lines of defense in responding to stress or trauma. Individuals who develop PTSD have reduced activity in the HPA system and increased activity in the SNS following trauma. Cross-sectional studies suggest that a progressive divergence of HPA and SNS activity following trauma may contribute to the maintenance of PTSD, but there is scant longitudinal research to support this hypothesis. Although PTSD and MDD frequently co-occur, the role of MDD symptoms in the patterns of HPA and SNS function following trauma-exposure has not yet been described. The primary aims of the proposed study are to (a) examine whether a progressive divergence in SNS and HPA daily output is associated with higher levels of PTSD symptoms over time, and (b) to determine whether women at greater risk for PTSD fail to habituate in terms of their cortisol responses to a psychosocial stress task. Secondary goals will examine the role of co-occurring MDD symptoms on diurnal secretion and reactivity of HPA/SNS systems. Psychosocial factors such as coping strategies may also determine the risk for PTSD and/or MDD and may influence SNS/HPA function. Results will identify cognitive and neurobiological factors associated with risk for PTSD and/or MDD that could be used to develop more "personalized" early intervention programs.

描述(申请人提供)：这项申请寻求确定创伤后应激障碍(PTSD)和/或严重抑郁障碍(MDD)在创伤后急性发作的风险的认知和神经生物学标记。此外，还概述了候选人获得必要培训的计划，以开发一项独立的研究计划，重点了解创伤后应激障碍和MDD的风险标记和机制。应聘者之前在生活压力、情绪障碍和创伤后应激障碍研究方面的培训使他磨练了许多实现这一目标所必需的技能。然而，他需要在五个关键领域进行额外的培训、指导和经验：(1)日常交感神经系统(SNS)和下丘脑-垂体-肾上腺(HPA)活动；(2)SNS和HPA对压力的反应性；(3)创伤后应激障碍的神经生物学风险标记物；(4)创伤后应激障碍和MDD的认知风险因素；以及(5)研究应对和神经内分泌轨迹与PTSD和/或MDD发病和病程的纵向设计。已经开发了一个全面的培训平台，其中包括实践教学经验、正式课程作业、独立阅读、研讨会、网络研讨会、辅导会议和咨询这五个关键领域的专家。这项拟议的研究将在最近接触过创伤后应激障碍和/或MDD的60名女性和40名非接触者中，使用四波数据收集(在接触IPV后的1个月内，以及最初评估后的1、3和6个月)，调查由人际暴力(IPV)暴露于创伤后应激障碍和/或MDD的纵向途径。尽管女性在受到创伤后患上创伤后应激障碍和/或MDD的可能性是男性的两倍，但这种风险增加的潜在机制仍不清楚。确定这些疾病的高风险个体对于制定有效的早期干预计划至关重要。HPA和SNS系统是应对压力或创伤的主要防线。患有创伤后应激障碍的人在创伤后HPA系统中的活动减少，而在SNS中的活动增加。横断面研究表明，创伤后HPA和SNS活动的渐进性分化可能有助于PTSD的维持，但缺乏纵向研究支持这一假说。尽管创伤后应激障碍和MDD经常同时发生，但MDD症状在创伤暴露后HPA和SNS功能模式中的作用尚未被描述。这项拟议的研究的主要目的是(A)检查SNS和HPA每日输出的渐进性差异是否与随着时间的推移而出现更高水平的创伤后应激障碍症状有关，以及(B)确定患创伤后应激障碍风险更高的女性是否无法根据她们对心理社会压力任务的皮质醇反应来适应。次要目标将研究共同出现的MDD症状对HPA/SNS系统的每日分泌和反应性的作用。心理社会因素，如应对策略，也可能决定患创伤后应激障碍和/或MDD的风险，并可能影响SNS/HPA功能。结果将确定与创伤后应激障碍和/或MDD风险相关的认知和神经生物学因素，这些因素可用于开发更“个性化”的早期干预计划。