Pathways of Risk and Resilience in Firefighter Recruits

描述（由申请人提供）：超过一半的美国公民将在其一生中暴露于潜在创伤事件（PTE）。最近，9/11和卡特里娜飓风等前所未有的人为和自然灾害灾难性地表明，终身创伤暴露率正在上升。与创伤暴露相关的精神反应涉及创伤后应激障碍（PTSD）、物质使用障碍（SUD）或共同发生的精神病理学（即，PTSD-SUD）。然而，并不是所有的人都会在PTE暴露后发展出精神疾病，这就强调了一个问题：是什么因素导致一些暴露于创伤事件的人走上了恢复力的道路，而其他人则走上了这些疾病的风险之路？这个问题可以有效地检查在消防员（FF）新兵谁会经历危及生命的事件，每天的基础上，由于他们的职业的样本。暴露于PTE的FF可能遵循许多通向病理或健康的途径。不幸的是，预测PTSD，SUD和PTSD-SUD症状和诊断病例的风险和恢复力的变量和参数，以及与这些疾病相关的恢复和复发模式，还没有得到很好的理解。在这项拟议的研究中，400名城市专业FF新兵将从选拔和培训开始，通过前瞻性的纵向评估，跟踪他们作为FF的早期职业生涯。将检查对PTSD、SUD或PTSD-SUD的恢复力或发展，以及症状表达、恢复和复发的时间模式。将评估影响暴露后途径并增加或减少发生PTSD、SUD或PTSD-SUD症状和/或病例的可能性的生物心理社会变量。在进行多方面的就业前基线评估（即，遗传标记、家族史、个性因素、先前的PTE暴露和物质使用），PTSD和SUD精神病学加上精神病学衍生的预测变量（即，创伤特征、急性创伤周围反应、应对和社会支持）将连续3年每3个月进行测量。潜在增长曲线分析，结构方程模型，多组结构方程模型，交叉滞后面板分析方法将测试时间依赖性以及假设的风险和弹性因素之间的关系。该应用程序是我们研究团队对FF中创伤相关疾病的计划性调查的下一步，重点是可能为FF和其他创伤暴露人群提供预防和治疗指南的因素。这项研究的长期目标是建立一个从招募到退休的FF数据库，以确定这个高度暴露的基本公共安全人群的风险和弹性模式。

DESCRIPTION (provided by applicant): Over half of all U.S. citizens will be exposed to a potentially traumatic event (PTE) during their lifetime. The recent, unprecedented man-made and natural disasters of 9/11 and Hurricane Katrina catastrophically illustrate that lifetime trauma exposure rates are rising. The psychiatric response associated with traumatic exposure involves post-traumatic stress disorder (PTSD), substance-use disorder (SUD), or co-occurring psychopathology (i.e., PTSD-SUD). However, not all individuals will develop psychiatric disorders in response to PTE exposure, underscoring the question: What are the factors that lead some individuals who are exposed to traumatic events down the path to resilience and other individuals down the path to risk for these disorders? This question can be examined effectively in a sample of firefighter (FF) recruits who will experience life-threatening events on a day-to-day basis as a result of their profession. FFs exposed to PTEs may follow a number of pathways towards pathology or wellness. Unfortunately, the variables and parameters that predict risk and resilience for PTSD, SUD, and PTSD-SUD symptoms and diagnostic caseness, as well as the patterns of recovery and relapse related to these disorders, are not well understood. In the proposed study, 400 urban, professional FF recruits will be followed from selection and training, through their early careers as FFs in a prospective, longitudinal evaluation. Resilience to, or development of, PTSD, SUD, or PTSD-SUD will be examined, as well as temporal patterns of symptom expression, recovery, and relapse. Biopsychosocial variables that influence post-exposure pathways and increase or decrease the likelihood of developing PTSD, SUD, or PTSD-SUD symptoms and/or caseness will be evaluated. Following a multi-dimensional pre-employment baseline assessment (i.e., genetic markers, family history, personality factors, prior PTE exposure and substance use), PTSD and SUD symptomatology plus empirically-derived predictor variables (i.e., trauma characteristics, acute peritraumatic responses, coping, and social support) will be measured at 3-month intervals for 3 successive years. Latent growth curve analyses, structural equation modeling, multigroup structural equation modeling, and cross-lag panel analytic approaches will test temporal dependency as well as postulated relationships between risk and resilience factors. This application is the next step in our research team's programmatic investigation of trauma-related disorders among FFs, with an emphasis on factors that may inform prevention and treatment guidelines for both FFs and other trauma-exposed populations. The long-term goal of this study is to build a FF database from recruitment through retirement in order to identify patterns of risk and resilience in this highly-exposed, essential public safety population.