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性事件（PTE）。最近，前所未有的9/11和卡特里娜飓风的人为和自然灾害灾难性地说明了终身创伤暴露率正在上升。与创伤性暴露相关的精神反应包括创伤后应激障碍（PTSD）、物质使用障碍（SUD）或同时发生的精神病理（即PTSD-SUD）。然而，并不是所有的人都会因接触创伤性事件而患上精神疾病，这就强调了一个问题：是什么因素导致一些经历过创伤性事件的人走上恢复之路，而另一些人走上患这些疾病的风险之路？这个问题可以在消防员（FF）新兵的样本中有效地检验，因为他们的职业每天都会经历危及生命的事件。暴露于pte的FFs可能遵循多种病理或健康途径。不幸的是，预测PTSD、SUD、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。在拟议的研究中，将对400名城市专业FF新兵进行前瞻性的纵向评估，从选拔到培训，一直到他们作为FF的早期职业生涯。对PTSD、PTSD-SUD或PTSD-SUD的恢复力或发展将被检查，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和增加或减少发生PTSD、SUD或PTSD-SUD症状和/或病例的可能性的生物心理社会变量。在进行多维就业前基线评估（即遗传标记、家族史、人格因素、先前PTE暴露和物质使用）之后，PTSD和SUD症状学以及经验衍生的预测变量（即创伤特征、急性创伤周围反应、应对和社会支持）将连续3年每隔3个月进行一次测量。潜在增长曲线分析、结构方程模型、多组结构方程模型和交叉滞后面板分析方法将检验风险和恢复力因素之间的时间依赖性以及假设关系。该应用程序是我们研究小组对FFs中创伤相关疾病的程序性调查的下一步，重点是可能为FFs和其他创伤暴露人群提供预防和治疗指南的因素。本研究的长期目标是建立一个从招募到退休的FF数据库，以确定这一高度暴露的重要公共安全人群的风险和恢复能力模式。

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.