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，遭受灾难的青少年患创伤后应激障碍（PTSD）的风险明显更高，其症状通常在灾难后持续数月或数年。然而，其他遭受灾难的年轻人表现出弹性和快速恢复，没有PTSD的发展。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风险和恢复因素可能是有问题的。因此，利用转化研究和实验精神病理学方法的创新行为技术的发展，以及评估不容易或可靠地通过自我报告测量的特定风险和保护因素，将对PTSD风险评估做出有价值的贡献。在目前的研究中，我们建议通过使用新的行为评估任务，针对与PTSD相关的两个理论和经验因素（痛苦耐受和冒险倾向），并结合其他经验确定的灾难、儿童和父母风险因素，开发和评估一种最先进的综合工具，用于灾害暴露青少年的PTSD风险评估。如果成功，这个工具将有助于提高对创伤后应激障碍与灾难相关的创伤以及潜在的其他类型创伤的发展的更基本机制的理解，也可能有助于有针对性的早期干预发展，修改和实施工作。为了实现这些目标，该项目将招募一个以人口为基础的样本，包括3000名受灾害影响的青少年及其父母，他们将参加美国国立卫生研究院资助的一项基于网络的纵向干预研究（R01MH081056）。青年和家长参与者将完成基于电话的初步基线评估，收集有关灾害暴露、其他创伤性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精神健康症状的信息。在基线访谈之后，参与者还将被要求完成一项额外的基于网络的评估，其中包括青少年和父母完成针对痛苦承受能力和冒险倾向的新型计算机行为评估任务，以及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个月重新进行，以重新评估PTSD症状。复杂的统计程序，包括接受者操作特征树方法，将用于进一步检查评估因素与创伤后应激障碍症状之间的关系，以确定上述任务、测量和临床决策变量的敏感和特定的分值，并开发一个决策算法，包括所有重要的创伤后应激障碍预测因子。具体来说，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，以平衡准确性、可行性和成本，提供一种实用的、功能性的评估方法，将推广到多种临床环境。鉴于灾害在世界范围内的高发率以及创伤后应激障碍对暴露在灾害中的青年及其家庭造成的昂贵和衰弱影响，拟议的工作与公共卫生需求高度相关。具体来说，如果成功实现当前研究提出的目标，PTSD风险评估临床工具的复杂开发将有助于准确和经济地识别具有最大PTSD风险的青少年。这种识别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.