Risk and Protective Factors for Adjustment of College Women After a Mass Shooting

描述（由申请人提供）：该研究的具体目的是前瞻性地研究2008年2月14日发生在伊利诺伊州迪卡尔布的北伊利诺伊大学（NIU）校园的大规模枪击事件后的即时和长期（长达2年）调整结果（即创伤后应激障碍症状，抑郁症状和焦虑症状）。在枪击事件发生时，一大批（N = 816） NIU女大学生正在参与一项关于性再受害的纵向研究。鉴于再受害研究以创伤为重点的性质，它提供了一个独特的机会来检查枪击后的调整结果，同时控制枪击前的调整水平。到目前为止，653名女性（80%符合条件）已经完成了一项在线调查，NIU创伤研究（NTS）：时间1，平均在大规模枪击事件发生后27天。调查包括对枪击后的调整、接触枪击的程度以及其他风险和保护因素（如社会支持、创伤后成长）的评估。建议在拍摄后3.5个月、7.5个月、1年和2年进行额外评估。假设有几个因素会影响创伤后调整的变化。这些包括枪击前的危险因素[例如，童年或其他创伤暴露，应激激素失调（例如，枪击前唾液皮质醇水平）和功能失调的影响调节策略]，与枪击相关的因素（例如，暴露的严重程度），以及对大规模枪击的即时反应（例如，创伤周围解离和应对枪击相关痛苦的影响调节策略）。除了拟议的风险和保护因素对六个时间点调整水平变化的直接影响外，还将测试一些相互作用的影响。在拍摄后1年的评估之后，将招募一部分参与者（N = 160）参加临床重新评估研究，以便将自我报告筛选措施校准为金标准的面对面结构化诊断访谈。此外，一项独特的基于实验室的研究[表达性写作研究（EWS）]也被提议用于参与者（N = 100）的子集（N = 100），他们在NTS: Time 1报告高和低暴露于射击。在EWS中，参与者将写一篇关于大规模枪击事件的文章，然后在收集生理数据的同时大声朗读他们的文章。EWS的目的之一是检验生理反应性、唾液皮质醇变化和情绪回避的自我报告在EWS期间是否可以预测长期适应结果，作为射击暴露严重程度的函数。表达性写作的具体内容也将被审查。国税厅调查的调整纵向追踪数据也将作为EWS的追踪数据。综合起来，这些拟议项目的数据将提供关于风险因素和保护因素在预测大规模枪击事件后的调整方面的作用的关键和独特的信息。如果成功，拟议的研究将(i)提供关于经历或目睹大规模枪击事件的心理后果的信息，同时控制枪击前的症状水平和调整；（ii）确定拍摄前调整（如创伤史、功能失调情绪调节、应激激素失调）对拍摄后调整结果的直接和调节作用；（iii）提供关于参与表达性写作和阅读任务的生理反应性（和恢复）的信息，作为暴露于大规模枪击事件的功能。拟议的研究旨在促进NIH的兴趣，从纵向的角度来理解导致创伤后应激障碍和其他创伤相关精神疾病发展的因素（风险和保护）。

DESCRIPTION (provided by applicant): The specific aim of the proposed set of studies is to prospectively examine immediate and long-term (up to 2 years) adjustment outcomes (i.e., posttraumatic stress disorder symptoms, depression symptoms, and anxiety symptoms) following the mass shooting that occurred on the Northern Illinois University (NIU) campus in DeKalb, Illinois, on February 14, 2008. At the time of the shooting, a large sample (N = 816) of female undergraduates at NIU were participating in a longitudinal study of sexual revictimization. Given the trauma- focused nature of the revictimization study, it provided a unique opportunity to examine post-shooting adjustment outcomes while controlling for pre-shooting adjustment levels. To date, 653 women (80% of eligibles) have completed an online survey, NIU Trauma Study (NTS): Time 1, an average of 27 days after the mass shooting. The survey contained assessments of post-shooting adjustment, degree of exposure to the shooting, and additional risk and protective factors (e.g., social support, posttraumatic growth). Additional assessments are proposed for 3.5 months, 7.5 months, 1 year, and 2 years post-shooting. Several factors are hypothesized to influence changes in adjustment in the aftermath of the trauma. These include pre-shooting risk factors [e.g., childhood or other trauma exposure, dysregulation of stress hormones (i.e., pre-shooting salivary cortisol levels), and dysfunctional affect regulation strategies], factors associated with the shooting (e.g., severity of exposure), and immediate reactions to the mass shooting (e.g., peritraumatic dissociation and affect regulation strategies for coping with shooting-related distress). In addition to direct effects of proposed risk and protective factors on changes in adjustment level across the six time points, a number of interactive effects will also be tested. Following the 1-year post-shooting assessment, a subset of participants (N = 160) will be recruited to participate in a clinical reappraisal study in order to calibrate the self-report screening measures to gold-standard face-to-face structured diagnostic interviews. In addition, a unique laboratory-based study [Expressive Writing Study (EWS)] is also proposed for a subset of participants (N = 100) who at NTS: Time 1 report high and low exposure to the shooting. In the EWS, participants will write about the mass shooting and then read their essay aloud to themselves while their physiological data are collected. One aim of the EWS is to examine whether physiological reactivity, salivary cortisol changes, and self-reports of emotional avoidance during the EWS are predictive of longer-term outcomes in adjustment as a function of severity of exposure to the shooting. The specific content of the expressive writing will also be examined. Longitudinal follow-up data on adjustment from the NTS survey will also serve as follow-up data for the EWS. In combination, data from these proposed projects will provide crucial and unique information about the role of risk factors and protective factors in predicting adjustment following a mass shooting. If successful, the proposed research will (i) provide information regarding the psychological consequences of experiencing or witnessing a mass shooting while controlling for pre-shooting levels of symptoms and adjustment; (ii) identify the direct and moderating effects of pre-shooting adjustment (e.g., trauma history, dysfunctional affect regulation, dysregulation of stress hormones) on post-shooting adjustment outcomes; and (iii) provide information regarding the physiological reactivity (and recovery) of engaging in an expressive writing and reading task as a function of exposure to the mass shooting. The proposed set of studies seeks to promote NIH's interests in understanding, from a longitudinal perspective, the factors (risk and protective) that contribute to the development of posttraumatic stress disorder and other trauma-related mental illnesses.