PTSD, TBI, and Neuropsychological Factors in Partner Violence among Veterans

描述（由申请人提供）： 该延续申请提议延长一项受资助的 CRS&D 优异审查项目，该项目调查愤怒、认知缺陷和偏见在伊拉克自由行动 (OIF)/持久自由行动 (OEF) 退伍军人中 PTSD 症状严重程度与亲密伴侣暴力 (IPV) 实施之间的关系。在当前的应用中，我们建议检查创伤性脑损伤（TBI）和执行功能对这些关系的影响。本研究的主要目的是检验以下假设：(a) TBI 和执行功能缺陷与较高的身体和心理 IPV 严重程度呈正相关且独特的相关； (b) TBI 和执行功能缺陷将减轻 PTSD 症状和认知缺陷/偏差对 IPV 结果的影响。研究设计和方法：参与者将是 150 名 18 岁以上的男性 OEF/OIF 退伍军人，他们已结婚或与伴侣同居至少一年。如果出现以下情况，潜在参与者将被排除：(a) 阅读困难妨碍有效完成评估工具，(b) 参与者的精神状态妨碍完成研究程序，例如严重器质性、活动性精神病或简易精神状态检查表现受损 (c) 参与者服用了任何被认为对中枢神经系统有显着影响的药物，或 (d) 参与者符合当前酒精或药物依赖的标准，或曾因酒精或药物依赖而接受住院治疗或门诊治疗（例如，过去 60 天内接受过 AA、NA 或 Methodone 治疗）。参与者将从三个来源抽取：(a) 在波士顿地区张贴的传单； (b) 已经建立的国家创伤后应激障碍中心受试者招募数据库； (c) 大量邮寄给居住在马萨诸塞州的所有男性 OEF/OIF 退伍军人名册上的人员，该名册由国防人力数据中心 (DMDC) 保存，并根据 DMDC 和 VACO 签署的数据使用协议与 VA 共享。参与将包括电话筛选和三场实验室会议，间隔大约一周。对参与者的初步筛选将需要确定研究资格。第 1 节将涉及知情同意程序和简易精神状态检查的管理、自我报告问卷以及针对 PTSD 和其他 Axis I 疾病的诊断访谈。第 2 节将包括模拟情境中的清晰思维 (ATSS) 实验室程序，以评估认知缺陷和偏见。该方法评估愤怒唤起期间的想法，因为如果在愤怒情绪状态被激活且存在相关情境线索时进行评估，则与愤怒相关的想法更有可能被访问和报告。第 3 节将涉及 TBI 和感兴趣的神经心理学变量的评估。临床关系：研究结果可能会对项目修改和开发产生影响，特别是愤怒管理和 IPV 实施。研究结果可能强调需要考虑神经心理缺陷和创伤性脑损伤病史的认知行为愤怒管理策略。研究结果还可能阐明 IPV 的标记变量以及与理解和治疗该人群 IPV 特别相关的特定神经心理学因素的重要性。研究结果还将为首席研究员正在进行的研究计划提供信息，该计划的重点是制定预防和治疗 IPV 的干预措施。 公共卫生相关性： 与退伍军人健康的相关性 亲密伴侣暴力 (IPV) 使退伍军人与家庭成员疏远，并对支持网络产生负面影响，使退伍军人面临各种社会心理和身体健康问题以及社会和职业功能不良的风险增加。为了更好地预防和治疗此类家庭问题，我们必须更好地了解这一人群中 IPV 的性质和原因，这一点至关重要。目前的调查旨在研究创伤性脑损伤和执行功能缺陷在返回的退伍军人中 IPV 中的作用，以及它们与 PTSD 症状和认知缺陷/偏见在 IPV 中的相互作用。这项工作将为首席研究员目前资助的为患有 PTSD 的退伍军人开发和测试初级和二级 IPV 预防干预措施的工作提供信息。

DESCRIPTION (provided by applicant): This continuation application proposes to extend a funded CRS&D Merit Review project investigating the role of anger and cognitive deficits and biases with respect to the association between PTSD symptom severity and intimate partner violence (IPV) perpetration among Operation Iraqi Freedom (OIF)/ Operation Enduring Freedom (OEF) veterans. In the current application, we propose to examine the contribution of traumatic brain injury (TBI) and executive functioning with respect to these relationships. The primary objective of this study is to test the hypotheses that (a) TBI and executive functioning deficits will be positively and uniquely associated with higher physical and psychological IPV severity; and (b) TBI and executive functioning deficits will moderate the impacts of PTSD symptoms and cognitive deficits/biases on the IPV outcomes. Research Design and Methodology: Participants will be 150 male OEF/OIF veterans over the age of 18 who have been married or cohabitating with a partner for at least one year. Potential participants will be excluded if (a) reading difficulties prevent valid completion of the assessment instruments, (b) the mental status of a participant precludes the completion of study procedures, such as severe organicity, active psychosis, or impaired performance on the Mini-Mental Status Exam (c) the participant has taken any medication that is thought to have significant CNS effects, or (d) the participant meets criteria for current alcohol or drug dependence, OR has been in inpatient treatment or outpatient treatment for alcohol or drug dependence (e.g., AA, NA, or methodone treatment) within the past 60 days. Participants will be drawn from three sources: (a) flyers posted in the Boston area; (b) the already established National Center for PTSD subject recruitment database; and (c) a mass mailing to those on a roster of all male OEF/OIF veterans living in Massachusetts, held by the Defense Manpower Data Center (DMDC), and shared with the VA under a data use agreement signed by DMDC and the VACO. Participation will involve a phone screening and three laboratory sessions, spaced approximately one week apart. The initial screening with the participant will entail the determination of study eligibility. Session 1 will involve informed consent procedures and the administration of the Mini-Mental Status Examination, self-report questionnaires, and diagnostic interviews for PTSD and other Axis I disorders. Session 2 will include the Articulated Thoughts in Simulated Situations (ATSS) laboratory procedure to assess cognitive deficits and biases. This methodology assesses thoughts during anger arousal, since anger- related thoughts are more likely to be accessible and reportable if assessed when angry mood states are activated and relevant contextual cues present. Session 3 will involve the assessment of TBI and the neuropsychological variables of interest. Clinical Relationships: Study findings will potentially have consequences for program modification and development, specifically for anger management and IPV perpetration. Findings may highlight the need for cognitive-behavioral anger management strategies that take into account neuropsychological deficits and history of TBI. Study findings may also elucidate marker variables for IPV and the significance of specific neuropsychological factors that are particularly relevant for understanding and treating IPV in this population. Study findings will also inform the Principal Investigator's ongoing research program focused on developing interventions for the prevention and treatment of IPV. PUBLIC HEALTH RELEVANCE: Relevance to Veterans Health Intimate partner violence (IPV) alienates veterans from family members and negatively impacts support networks, placing the veteran at increased risk for various psychosocial and physical health problems and poor social and occupational functioning. It is critically important that we develop a better understanding of the nature and causes of IPV in this population in order to best prevent and treat such family problems. The current investigation proposes to examine the roles of traumatic brain injury and executive functioning deficits in IPV among returning veterans, as well as their interplay with symptoms of PTSD and cognitive deficits/biases in contributing to IPV. This work will inform the Principal Investigator's current funded efforts to develop and test primary and secondary IPV prevention interventions for veterans with PTSD.