"Testing a Video and Text Messaging Intervention to reduce PTSD and Opioid Misuse Among Sexual Violence Survivors"

“测试视频和短信干预措施以减少性暴力幸存者的创伤后应激障碍和阿片类药物滥用”

• 批准号: 10812062
• 负责人: Katie L Walsh
• 金额: $ 40.75万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812062
• 关键词: Accident and Emergency department; Acute; Address; Alcohol consumption; Caring; Clip; Communities; Data; Disease; Distress; Early Intervention; Elements; Emergency department visit; Feedback; Forcible intercourse; Forensic Medicine; Health; Helping to End Addiction Long-term; Individual; Intervention; Medical; Memory impairment; Mental Depression; Mental Health; Opiate Addiction; Opioid; Outcome; Participant; Pathway interactions; Personal Satisfaction; Post-Traumatic Stress Disorders; Prevention; Public Health; Randomized; Randomized, Controlled Trials; Recording of previous events; Recovery; Reporting; Research; Risk; Sampling; Sequential Multiple Assignment Randomized Trial; Site; Stress; Subgroup; Survivors; Testing; Text Messaging; Time; Training and Education; United States; United States National Institutes of Health; Woman; active control; acute stress; acute traumatic stress disorder; adaptive intervention; assault; care systems; chronic pain; comorbidity; coping; cost; empowerment; evidence base; experience; marijuana use; meetings; memory encoding; men; mindfulness; nicotine use; novel; opioid epidemic; opioid misuse; opioid mortality; opioid use; opioid use disorder; pilot test; prescription opioid; prescription opioid misuse; prevent; programs; recruit; reduce symptoms; response; sexual assault; sexual violence; skills; skills training; substance misuse; suicidal; text messaging intervention; tool; treatment as usual; trial comparing; trial design; usability; violence exposure

Responding to NIH’s Helping to End Addiction Long-term (HEAL) initiative NOSI titled “Opioid Use Disorder Care Pathways for Individuals with Histories of Exposure to Violence,” this R61/R33 project seeks to develop and evaluate a brief video and text messaging intervention delivered in the emergency department (ED) to prevent the onset or escalation of opioid use, misuse, or disorder among recent sexual assault (SA) survivors. More than 1 in 4 women will experience an attempted or completed rape in her lifetime. PTSD and opioid misuse are prevalent in the wake of sexual violence, and the opioid epidemic is having a unique impact on women, with sharper increases in prescription opioid deaths, a greater likelihood of meeting criteria for opioid use disorder (OUD), and increased likelihood of comorbid mental health conditions compared to men. ED visits for sexual assault medical forensic exams (SAMFEs) have increased more than 1500% in the last two decades and may provide an important opportunity to intervene to prevent the onset or escalation of PTSD and opioid misuse and disorder. Our team developed and tested a brief video intervention delivered in the ED to women presenting for a SAMFE in two randomized controlled trials. Compared to treatment as usual (TAU), the video was associated with reductions in PTSD, depression, suicidality, alcohol, marijuana, and nicotine use for subgroups of survivors when followed over 6 months. However, in our second RCT, an active control mindfulness video better reduced post-SA opioid use compared to TAU for survivors with pre-SA opioid misuse. Thus, we propose to develop a new video, Skills Training in Active Recovery (STAR) based on the evidence-based principles of both videos to better address PTSD and opioid misuse. In the previous RCTs, survivors reported substantial distress at the SAMFE; given that distress can impair memory encoding, we propose to develop a 3-week daily text messaging program called TextSTAR that will reinforce content presented in the video but give opportunities for survivors to engage with the material in a different setting and over a longer period of time. During the R61, we propose to develop the STAR video and TextSTAR and get feedback from a community advisory board of sexual assault survivors about the wording and presentation of the content to maximize acceptability and utility. We will pilot test STAR and TextSTAR with a separate sample of survivors (N = 50) recruited from 5 ED sites within the Better Tomorrow Network, a research network of SAMFE programs throughout the US, to gather preliminary data about our recruitment approach, acceptability of the intervention, and efficacy. In the R33, we will conduct a SMART trial where survivors will be randomized to receive STAR or no video at the ED, assessed at 1 week, and those above threshold for acute stress/PTSD or opioid use, misuse or disorder will be randomized to receive TextSTAR or no text intervention for 3 weeks. We will re-assess PTSD and opioid misuse and disorder at 1, 3, and 6 months. If efficacious, this intervention is a low-cost and easy-to-disseminate approach to reduce PTSD and opioid outcomes among SA survivors.

回应NIH的帮助长期（治愈）倡议NOSI的题为“阿片类药物使用障碍） 对暴露历史暴露历史的个人的护理途径，“这个R61/R33项目旨在发展 并评估急诊科（ED）提供的简短视频和文本消息干预措施 在最近的性侵犯（SA）生存中，防止阿片类药物使用，失误或混乱的发作或升级。 超过四分之一的妇女将在她的一生中经历或完成强奸。 PTSD和阿片类药物 滥用性暴力后普遍存在，阿片类药物流行对 妇女的处方阿片类药物死亡人数增加，符合阿片类药物标准的可能性更大 与男性相比，使用障碍（OUD）和合并性心理健康状况的可能性增加。埃德访问 在过去的二十年中，用于性侵犯医学法医检查（SAMFES）已增加了1500％以上 并可能提供一个重要的机会，以防止PTSD和OOID的发作或升级 滥用和混乱。我们的团队开发并测试了在ED中提供的简短视频干预措施 在两个随机对照试验中为SAMFE展示。与往常一样（tau）相比，视频 与PTSD，抑郁，自杀，酒精，大麻和尼古丁的减少有关 在6个月以上的伴随时，表面的亚组。但是，在我们的第二个RCT中，主动控制 与tau相比，正念视频可以更好地减少Sa opioid的使用后使用Pre-Sa Opioid的生存 滥用。这是，我们建议制定一个新的视频，主动恢复中的技能培训（Star） 这两个视频的基于证据的原则，以更好地解决PTSD和阿片类药物滥用。在以前的RCT中 幸存者报告说在萨姆夫（Samfe）遇到了很大的困扰。鉴于困扰会损害记忆编码，我们 提出制定一个为3周的每日文本消息传递计划，称为Textstar，该计划将加强内容 在视频中呈现，但为生存提供了在不同环境中与材料互动的机会 在更长的时间内。在R61期间，我们建议开发Star Video和Textstar并获得 关于性侵犯社区顾问委员会的反馈，关于措辞和介绍的措辞 最大化可接受性和效用的内容。我们将带有单独样本的测试明星和文本明星 从更好的明天网络中的5个ED网站招募的表面（n = 50），一个研究网络 美国各地的SAMFE计划，以收集有关我们招聘方法的初步数据，可接受性 干预和有效性。在R33中，我们将进行一项智能试验，其中生存将随机分配 在ED上接收星星或没有视频，在1周评估，急性压力/PTSD的阈值高于阈值 或使用OPIOED，MISSUSE或混乱将被随机分配以在3周内接受文本明星或没有文本干预。 我们将在1、3和6个月重新评估PTSD和OIOID MISSUSE和混乱。如果有效，此干预措施 是一种低成本且易于降低的方法，可减少SA生存中的PTSD和阿片类药物结局。