Predicting PTSD Risk in Children After Acute Traumatic Events

描述（由申请人提供）：急性单一事件创伤是儿童和青少年不幸的共同经历。伤害、灾难和其他急性创伤每年影响数百万儿童。在单一事件中，伤害在流行率和公共卫生影响方面都很突出。许多遭受创伤的青少年恢复得很好，但相当多的人出现了严重的创伤后应激障碍（PTSD）症状，损害了心理功能、学业和社会发展。临床医生和研究人员都非常需要创伤后早期经过验证的筛查策略，以可靠地识别创伤暴露儿童发展持续性PTSD症状的最高风险。为儿童创伤后早期的多个时间点设计的简短筛查工具，适合各种从业人员使用，将对公共卫生产生最大影响。这些工具可以将筛查和预防工作的范围扩大到儿科医疗机构，从而吸引不太可能寻求正式心理健康服务的创伤暴露儿童。这项研究的广泛和长期目标是开发和测试风险评估工具，用于在急性创伤暴露后的多个时间点筛查儿童。拟议的项目将对来自前瞻性评估急性儿童创伤（主要是儿童伤害）后创伤后应激症状和创伤后应激障碍的研究的现有数据进行二次分析。这个探索性/发展性项目的具体目标是：1)建立数据共享和协作的工作基础设施；2)确定结合现有数据制定预测变量和结果变量以及预测分析的最佳方法；3)进行分析，初步形成一套儿童风险评估工具。项目团队结合了专家内容知识和方法学专业知识，并将提供现有数据集，其中包括2500多名经历过急性创伤（主要是伤害）的儿童的前瞻性数据。这些数据是在多个时间点收集的，包括创伤前的回顾性特征、创伤周围的人和事件特征、住院生物学数据以及早期和后期的创伤后反应。作为当前项目的一部分，研究小组将开发一个丰富的儿童创伤前瞻性数据档案，以及一个协作和数据共享基础设施，这些基础设施将在初始项目期间之后产生影响。在开发风险评估工具时，计划的方法是设计一个多点筛查过程（早期筛查适合创伤后立即进行，后期筛查则在创伤后的最初几周到几个月内进行）。该小组将检查跨时间的筛查结果组合和单一筛查点的疗效。该项目的结果将为在不同的临床和研究环境中以及在经历过不同类型急性创伤的儿童中进行前瞻性测试和验证测序风险评估工具奠定基础。该项目旨在推动开发可在儿童创伤后早期使用的简短风险评估工具。通过将筛查和预防工作的范围扩大到儿科医疗机构，以吸引不太可能寻求正式心理健康服务的创伤暴露儿童，这些工具将对公共卫生产生巨大影响。这促进了2010年健康人目标的实现，即增加在卫生保健机构接受心理健康检查和评估的人数（目标18-6）。

DESCRIPTION (provided by applicant): Acute single-incident trauma is an unfortunately common experience for children and adolescents. Injury, disasters, and other acute traumas affect many millions of children each year. Among single-incident events, injury stands out in both prevalence and public health impact. Many trauma-exposed youth recover well, but a considerable number develop significant symptoms of posttraumatic stress disorder (PTSD) that impair psychological functioning and academic and social development. Well-validated screening strategies in the early post-trauma period are greatly needed by both clinicians and researchers, to reliably identify trauma-exposed children at highest risk of developing persistent PTSD symptoms. Brief screening tools designed for multiple time points in the early aftermath of child trauma, and suitable for use by a range of practitioners, would have the greatest public health impact. Such tools could expand the reach of screening and prevention efforts to pediatric medical settings, thus engaging trauma- exposed children unlikely to seek formal mental health services. The broad, long-term goal of this research is to develop and test risk assessment tools for screening children at multiple time points after acute trauma exposure. The proposed project will employ secondary analysis of existing data from studies that have prospectively assessed posttraumatic stress symptoms and PTSD following acute child trauma, primarily child injury. The specific aims of this exploratory / developmental project are to: 1) Establish a working infrastructure for data sharing and collaboration; 2) Determine best ways to combine available data to formulate predictor and outcome variables and predictive analyses; 3) Conduct analyses to develop a preliminary set of risk assessment tools for children. The project team combines expert content knowledge and methodological expertise, and will make available existing datasets with prospective data regarding more than 2500 children who have experienced acute trauma, primarily injury. These data were collected at numerous time points and include retrospective pre-trauma characteristics, peri-traumatic person and event characteristics, in-hospital biological data, and early and later post-traumatic responses. As part of the current project, the research team will develop a rich archive of prospective data on child trauma, and an infrastructure for collaboration and data-sharing that will have impact beyond the initial project period. In developing risk assessment tools, the planned approach is to design a multi-point screening process (an early screen suitable for the immediate post-trauma period, and later screen(s) within the first weeks to months post-trauma). The team will examine the efficacy of combinations of screening results across time and of single screening points. The results of this project will lay the groundwork for prospective testing and validation of sequenced risk assessment tools in different clinical and research settings and with children who have experienced distinct types of acute trauma. This project aims to advance the development of brief risk assessment tools that are feasible for use in the early aftermath of child trauma. Such tools would have great public health impact by expanding the reach of screening and prevention efforts to pediatric medical settings to engage trauma-exposed children unlikely to seek formal mental health services. This advances Healthy People 2010 goals to increase the number of persons seen in health care settings who receive mental health screening and assessment (Objective 18-6).