PTSD, Cortisol, Immune Function with Battering Over Time

描述（由申请人提供）：与亲密伴侣暴力（IPV）相关的破坏性身体和情感影响每年影响近120万美国妇女。第一次袭击只是恐惧、伤害和绝望的开始，而这些会持续一个女人的一生。关于影响遭受暴力和创伤的妇女健康的生理和心理因素之间动态相互作用的知识有限，特别是涉及到反复的创伤经历。大多数创伤幸存者群体的研究是横断面进行的，产生了很多信息，但这种方法只提供了一个单一的观察时间。在护理或其他学科中，人们对IPV的影响如何随着时间的推移影响健康知之甚少。本研究的目的是检查IPV、童年虐待、复原力和创伤后应激障碍（PTSD）对健康结果的关系，包括自我报告的身体健康、每日肾上腺皮质激素和免疫功能，研究对象为来自收容所和社区的156名受虐妇女，时间超过24个月。预测解释设计将用于测试这些关系的模型，并解决三个研究目标：1)测试模型的横截面拟合并确定可能的中介和调节路径，2)纵向检查昼夜肾上腺皮质激素，免疫功能和创伤后应激障碍之间的关系模式，以及3)纵向测试整个模型的拟合。结构方程模型（SEM）将用于模拟模型构建之间的横断面和纵向关系，生长曲线模型将用于检查24个月内PTSD、肾上腺皮质激素和免疫功能的变化轨迹。探索性分析将用于确定个体变化模式的预测因素。这项研究将增加对创伤的心理社会和生理反应之间的关系及其对妇女健康的长期影响的认识。研究结果将为制定针对预防和减少IPV长期身心健康后果的护理干预措施提供理论基础。

DESCRIPTION (provided by applicant): The devastating physical and emotional effects associated with intimate partner violence (IPV) affect nearly 1.2 million women in the United States yearly. The first assault is only the beginning of the terror, injuries, and desperation that can continue through a woman's life. Knowledge regarding the dynamic interplay among the physiological and psychological factors affecting the health of women who have experienced violence and trauma is limited, particularly as it relates to repeated traumatic experiences. Most studies of trauma survivor groups are conducted cross-sectionally, yielding much information, but this methodology provides only a single observation in time. Little is known in nursing or other disciplines about how the impact of IPV might affect health over time. The purpose of this study is to examine relationships among IPV, childhood maltreatment, resilience, and posttraumatic stress disorder (PTSD) on health outcomes, including self-report physical health, diurnal adrenocortical hormones, and immune function in 156 battered women from shelters and the community over 24-months. A predictive-explanatory design will be employed to test a model of these relationships and address three research objectives: 1) to test the cross-sectional fit of the model and identify possible mediating and moderating paths, 2) to longitudinally examine patterns of relationships among diurnal adrenocortical hormones, immune function and PTSD, and 3) to longitudinally test the fit of the full model. Structural equation modeling (SEM) will be used to model the cross-sectional and longitudinal relationships between model constructs and growth curve modeling will be used to examine trajectories of change in PTSD, diurnal adrenocortical hormones, and immune function over 24-months. Exploratory analyses will be used to identify predictors of individual patterns of change. This study will increase knowledge regarding the relationships between psychosocial and physiologic responses to trauma and their impact on women's health over time. Findings will provide a theoretical foundation upon which to develop nursing interventions directed towards the prevention and reduction of long-term physical and mental health consequences of IPV.