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，遭受灾难的青年患创伤后应激障碍(PTSD)的风险明显更大，其症状通常会在灾难后持续数月和数年。然而，其他遭受灾害的青年在没有创伤后应激障碍的情况下表现出韧性和快速恢复。已经开始努力确定具体的创伤后应激障碍风险和复原力因素；然而，这项工作主要依赖于自我报告战略。尽管在许多情况下有用，但仅仅依靠自我报告来确定创伤后应激障碍的风险和复原力因素可能是有问题的。因此，创新行为技术的发展将是对创伤后应激障碍风险评估的宝贵贡献，这些技术借鉴了转化研究和实验精神病理学的方法，并评估了通过自我报告不易或可靠地衡量的特定风险和保护因素。在目前的研究中，我们建议开发和评估一个最先进的综合工具，通过使用新的行为评估任务，针对与创伤后应激障碍理论上和经验上相关的两个因素(痛苦容忍度和冒险倾向)，并结合其他经验性识别的灾难、儿童和父母风险因素，来评估受灾青少年中的创伤后应激障碍风险评估。如果成功，这一工具将有助于提高对创伤后应激障碍发展的更基本机制的理解，这些机制涉及与灾害相关的创伤，可能还涉及其他类型的创伤，还可能有助于有针对性的早期干预措施的制定、修改和实施工作。为了实现这些目标，该项目将招募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基线评估，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。参与者还将被要求在基线面试后完成一项额外的基于网络的评估，这将包括青少年和父母完成针对痛苦容忍度和冒险倾向的新颖的计算机化行为评估任务，以及一项额外的特质焦虑自我报告测量。电话访谈将在基线后4个月和12个月重新实施，以重新评估创伤后应激障碍症状。复杂的统计程序，包括接受者操作特征树方法，将被用来进一步检查评估的因素和创伤后应激障碍症状之间的关系，以确定上述任务、措施和变量的敏感和具体的截止分数，用于临床决策，并开发包括所有重要的创伤后应激障碍预测因素的决策算法。具体地说，我们寻求创建一种优化的、分阶段的创伤后应激障碍风险评估方法，在准确性、可行性和成本之间取得平衡，以提供实用的、适用于多种临床环境的功能评估单元。鉴于全世界灾害的高流行率，以及创伤后应激障碍对遭受灾害的青年及其家庭造成的代价高昂、令人衰弱的影响，拟议的工作与公共卫生需求高度相关。具体地说，如果成功地实现了为本研究提出的目标，复杂的创伤后应激障碍风险评估临床工具的开发将有助于准确和具有成本效益地识别哪些青少年处于创伤后应激障碍的最大风险。这种确认将有助于针对灾后减少风险的努力，并可能减少全面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.