Web-Based Intervention for Disaster-Affected Adolescents and Families

描述(由申请人提供)：创伤后应激障碍(PTSD)在遭受灾难的青少年中很普遍，并增加了健康发病率和死亡率。尽管创伤后应激障碍在暴露于创伤应激源的青年中很常见，但并不是在所有暴露于创伤应激源的青年中都存在。与成年人相比，暴露在灾难中的青年患创伤后应激障碍的风险要大得多，症状往往在灾后数月和数年持续；然而，青年在灾后研究中的比例严重偏低。主要是在成人文献中，已经做出了相当大的努力来确定与创伤后应激障碍风险相关的变量，但只有大约20%的变异可以用心理社会变量来解释；因此，人们对将遗传决定因素纳入创伤后应激障碍的研究感兴趣。尽管创伤后应激障碍的遗传力估计中等(30%)，但关于创伤后应激障碍遗传风险因素的现代研究数量相对较少，精神遗传学调查在确定基因类型对障碍表型的直接影响方面的能力参差不齐。值得注意的是，目前还没有关于青春期创伤后应激障碍的遗传知情研究，这是一个关键的发展阶段。因此，迫切需要新的方法来检查遗传和环境调节因素，以便为暴露在灾难中的青年的风险和复原力模型提供信息。因此，我们回应的是通知编号(NOT-OD-10-032)标题：NIH宣布通过NIH基本行为和社会科学机会网络(OppNet)为竞争性修订申请(R01、R03、R15、R21、R21/R33和R37)提供恢复法案资金。该项目的主要目标是直接按照美国国立卫生研究院OppNet(NOT-OD-10-032)的研究重点，在一项由R01资助的受灾青年调查中增加基因抽样。母项目将招募3000名受灾青年及其父母的人口样本，参加由NIH资助的纵向、基于网络的干预研究(R01MH081056)。青少年和家长参与者将完成基于电话的初步评估，收集有关灾难暴露、其他创伤事件经历和事件特征、与家庭相关的变量以及创伤后应激障碍和其他精神健康症状的信息。OppNet的资金将用于扩大采访范围，包括更大范围的可能的环境调节剂。在基线访谈期间，青少年将被要求提供唾液样本用于DNA分析，这也将通过使用OppNet基金进行。参与者将收到一个收集工具包，他们将通过美国邮件退还，这是我们在之前的一项以灾难为重点的研究中成功实施的方法。DNA将从唾液样本中提取，候选基因将通过标签SNP方法和现有文献中报告的与创伤后应激障碍相关的特定可变数目串联重复序列进行检查。通过研究GxE的相互作用，这个项目将评估候选基因和创伤后应激障碍之间的关系是否受到环境因素的调节。这个项目通过利用来自R01的行为和社会数据以及来自OppNet基金的生物数据，将提供对创伤应激源后环境和生物之间相互作用的更深层次的理解。此外，该项目具有潜在的公共卫生效益，告知创伤后应激障碍的病理生理学知识，这可能导致改善药物治疗目标。 公共卫生相关性：许多青年暴露在灾难和其他可能产生创伤后应激障碍(PTSD)的潜在创伤性事件中；然而，并不是所有受影响的人都会患上创伤后应激障碍，因此需要关于生物和环境因素如何相互作用来增加或降低灾后PTSD风险的信息。该项目通过收集暴露在灾难中的青少年的DNA来解决这个问题，从而能够检查青少年创伤后应激障碍的基因与环境的相互作用。通过测试相关候选基因和环境特征是否会改变暴露在创伤事件中的影响，我们将推进基础科学知识，加深我们对儿童创伤后应激障碍病因的理解，从而为青少年创伤后应激障碍的二级预防或干预提供信息。

DESCRIPTION (provided by applicant): Posttraumatic Stress Disorder (PTSD) among adolescents exposed to disasters is prevalent and increases health morbidity and mortality. Although PTSD is common among youth exposed to traumatic stressors, is not present among all exposed youth. Disaster-exposed youth, in comparison to adults, are at significantly greater risk for PTSD, with symptoms often persisting for many months and years post-disaster; however, youth are drastically under-represented in post-disaster studies. Considerable effort, primarily in the adult literature, has been given to identify variables related to PTSD risk, but only about 20 percent of variance has been explained by psychosocial variables; thus, there has been interest in including genetic determinants into studies of PTSD. Despite moderate heritability estimates (30 percent) for PTSD, modern studies of genetic risk factors for PTSD are relatively few in number and psychiatric genetic investigations have been mixed in their ability to identify direct effects of genotypes on disorder phenotypes. Notably, there are no existant genetically informed studies of adolescent PTSD, a critical developmental phase. Therefore, the need is high for novel approaches to examining genetic and environmental moderators to inform models of risk and resilience in disaster exposed youth. Therefore, we are responding to Notice Number (NOT-OD-10-032) Title: NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications (R01, R03, R15, R21, R21/R33, and R37) through the NIH Basic Behavioral and Social Science Opportunity Network (OppNet). The primary objective of this project, directly in accordance with the research priorities of the NIH OppNet (NOT-OD-10- 032), is to add genetic sampling to a funded R01 investigation of disaster-exposed youth. The parent project will recruit a population-based sample of 3,000 disaster exposed youth and their parents participating in an NIH-funded longitudinal, web-based intervention study (R01MH081056). Youth and parent participants will complete an initial phone-based assessment, where information regarding disaster exposure, other traumatic event experiences and incident characteristics, family-related variables, and PTSD and other mental health symptomatology will be gathered. OppNet funding will be used to expand the interview to include a larger range of possible environmental modifiers. During the baseline interview, adolescents will be asked to provide saliva samples for DNA analysis, which will also be conducted through use of OppNet funding. Participants will be sent a collection kit that they return via U.S. mail, methods we have successfully executed in a previous disaster-focused study. DNA will be extracted from saliva samples and candidate genes will be examined via the tagging SNP method and by assying specific variable number tandem repeats of genes reported in the extant literature to be relevant for PTSD. By examining GxE interactions this project will assess whether relations between candidate genes and PTSD are moderated by aspects of the environment. This project, by harnessing the behavioral and social data from the R01 with the biologic data from the OppNet funding, will afford a deeper understanding of the interplay between the environment and biology in the aftermath of a traumatic stressor. Additionally, this project has potential public health benefits of informing the knowledge of pathophysiology of PTSD which may lead to improved pharmacologic treatment targets. PUBLIC HEALTH RELEVANCE: Many youth are exposed to disasters and other potentially traumatic events that can produce posttraumatic stress disorder (PTSD); however, not all exposed individuals develop PTSD, so information is needed about how biologic and environmental factors interact to increase or decrease risk of PTSD post-disaster. This project addresses this issue by collecting DNA from adolescents who were exposed to a disaster, allowing for examination of gene by environment interactions for adolescent PTSD. By testing whether relevant candidate genes and features of the environment modify the impact of exposure to traumatic events, we will advance basic science knowledge that will deepen our understanding of the causes of pediatric PTSD, which may inform secondary prevention or intervention of PTSD in youth.