Evaluation of Novel PTSD Risk Assessment Tools for Disaster-Exposed Youth

描述（由申请人提供）：与成人样本相比，灾难暴露的年轻人患创伤后应激障碍（PTSD）的风险要大得多，症状往往在灾难发生后持续数月和数年。然而，其他遭受灾害的年轻人表现出弹性和快速恢复，而没有PTSD的发展。已经开始努力确定特定的创伤后应激障碍风险和弹性因素;然而，这项工作在很大程度上依赖于自我报告策略。虽然在许多情况下是有用的，但仅仅依靠自我报告来确定PTSD风险和弹性因素可能是有问题的。因此，开发创新的行为技术，借鉴转化研究和实验精神病理学的方法，并评估特定的风险和保护因素，不容易或可靠地通过自我报告测量，将是一个有价值的贡献创伤后应激障碍的风险评估。在目前的研究中，我们建议开发和评估一种最先进的综合工具，通过使用新的行为评估任务，针对两个因素的理论和经验与创伤后应激障碍（痛苦容忍度和冒险倾向），结合使用其他经验确定的灾难，儿童和父母的风险因素，在灾害暴露的青年创伤后应激障碍风险评估。如果成功，该工具将有助于提高对创伤后应激障碍发展的基本机制的理解，这些机制与灾难相关的创伤有关，可能与其他类型的创伤有关，也可能有助于有针对性的早期干预开发，修改和实施工作。为了实现这些目标，该项目将招募3,000名灾害暴露青年及其父母参加NIH资助的纵向网络干预研究（R 01 MH 081056）。青少年和家长参与者将完成初步的电话基线评估，其中将收集有关灾难暴露，其他创伤事件经历和事件特征，家庭相关变量以及创伤后应激障碍和其他心理健康问题的信息。参与者还将被要求在基线访谈后完成一项额外的基于网络的评估，这将涉及青少年和父母完成新的计算机化行为评估任务，目标是痛苦容忍度和冒险倾向，以及额外的特质焦虑自我报告措施。在基线后4个月和12个月，将重新进行电话访谈，以重新评估PTSD症状。复杂的统计程序，包括受试者操作特征树方法，将用于进一步检查评估的因素和PTSD症状之间的关系，以确定上述任务，措施和临床决策变量的敏感性和特异性分数，并开发一个决策算法，包括所有重要的PTSD预测因子。具体来说，我们试图创建一个优化的，分阶段的方法来进行PTSD风险评估，平衡准确性与可行性和成本，以提供一个实用的，功能性的评估电池，将推广到多个临床环境。考虑到世界范围内灾害的高发率以及创伤后应激障碍对灾害暴露青年及其家庭造成的代价高昂、破坏性影响，拟议的工作与公共卫生需求高度相关。具体来说，如果成功地实现了目前研究提出的目标，复杂的创伤后应激障碍风险评估临床工具的发展将有助于准确和具有成本效益的确定谁是创伤后应激障碍的风险最大的青年。这种识别将有助于有针对性地开展灾后减少风险的工作，并有可能减少完全诊断性创伤后应激障碍的发生率及其相关费用和痛苦。

DESCRIPTION (provided by applicant): Disaster-exposed youth, in comparison to adult samples, are at significantly greater risk for Posttraumatic Stress Disorder (PTSD), with symptoms often persisting for many months and years post-disaster. However, other disaster-exposed youth show resilience and rapid recovery without PTSD development. Efforts have been initiated to identify specific PTSD risk and resiliency factors; however, this work has relied largely on self- report strategies. Although useful in many circumstances, the sole reliance on self-report for identified PTSD risk and resiliency factors can be problematic. Thus, the development of innovative behavioral technologies that draw upon the methods of translational research and experimental psychopathology, and that assess specific risk and protective factors not easily or reliably measured through self-report, would be a valuable contribution to PTSD risk assessment. In the current study, we propose to develop and evaluate a state of the art comprehensive tool for PTSD risk assessment among disaster-exposed youth through the use of novel behavioral assessment tasks targeting two factors theoretically and empirically linked with PTSD (distress tolerance and risk-taking propensity), in combination with the use of other empirically identified disaster, child, and parent risk factors. If successful, this tool will help improve the understanding of more basic mechanisms underlying the development of PTSD in relation to disaster-related trauma, and potentially to other types of trauma, and also will likely aid in targeted early intervention development, modification, and implementation efforts. To accomplish these goals, this 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, baseline 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. Participants also will be asked to complete an additional web-based assessment following the baseline interview, which will involve both youth and parents completing novel computerized behavioral assessment tasks targeting distress tolerance and risk-taking propensity, as well as an additional self-report measure of trait anxiety. Phone-based interviews will be readministered at four- and twelve-months post-baseline to reassess PTSD symptoms. Sophisticated statistical procedures, including Receiver Operating Characteristics Tree methods, will be used to further examine the relation between the factors assessed and PTSD symptoms, to determine sensitive and specific cut-scores on the aforementioned tasks, measures, and variables for clinical decision-making, and to develop a decision algorithm that includes all significant PTSD predictors. Specifically, we seek to create an optimized, staged approach to PTSD risk assessment that balances accuracy against feasibility and costs to provide a practical, functional assessment battery that will generalize to multiple clinical settings. Given the high prevalence of disasters world-wide and the costly, debilitating impact of PTSD on disaster- exposed youth and their families, the proposed work is highly relevant to public health needs. Specifically, if successful in attaining the aims proposed for the current study, the sophisticated development of a PTSD risk assessment clinical tool would aid in the accurate and cost-effective identification of youth who are at greatest risk for PTSD. Such identification would help target post-disaster risk-reduction efforts and would likely reduce the incidence of full diagnostic PTSD and its associated costs and suffering.