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

针对受灾青少年的新型 PTSD 风险评估工具的评估

• 批准号: 7901551
• 负责人: CARLA KMETT DANIELSON
• 金额: $ 15.44万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-28 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7901551
• 关键词: Accounting; Administrative Supplement; Adult; Affect; Affective; Algorithms; Alleles; Anxiety; Arts; Attention; Auditory; Behavior; Behavior assessment; Behavioral; Biological; Candidate Disease Gene; Characteristics; Child; Clinical; Conflict (Psychology); Demographic Factors; Development; Diagnostic; Disasters; Disease; Distress; Early treatment; Equilibrium; Etiology; Evaluation; Event; Exposure to; Family; Family Characteristics; Fright; Funding; Genes; Genetic; Genetic Variation; Goals; High Prevalence; Impulsivity; Incidence; Individual; Inherited; Injury; Intervention Studies; Interview; Life; Limbic System; Link; Literature; Logistic Regressions; Measures; Mediating; Mental Health; Methodology; Methods; Modification; Neurobiology; Online Systems; Outcome; Parents; Participant; Patient Self-Report; Performance; Post-Traumatic Stress Disorders; Procedures; Psychopathology; Public Health; Punishment; RGS2 gene; Receiver Operating Characteristics; Recording of previous events; Recovery; Recruitment Activity; Reliance; Research; Rewards; Risk; Risk Assessment; Risk Factors; Risk Reduction; Risk-Taking; Sampling; Secure; Social support; Socioeconomic Status; Source; Specific qualifier value; Staging; Structure; Symptoms; Syndrome; System; Technology; Telephone; Testing; Translational Research; Trauma; Trees; Variant; Weight; Work; Youth; analog; base; clinical decision-making; clinically significant; computerized; cost; disorder risk; distress tolerance; endophenotype; experience; genetic variant; high risk; improved; indexing; innovation; locus ceruleus structure; noradrenergic; novel; population based; psychologic; resilience; response; stressor; therapy development; tool; trait

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.

描述（由申请人提供）：与成人样本相比，受灾青少年患创伤后应激障碍 (PTSD) 的风险明显更高，其症状通常在灾后持续数月甚至数年。然而，其他遭受灾害的青少年表现出了恢复力和快速恢复能力，而没有出现创伤后应激障碍。已开始努力确定特定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。尽管在许多情况下很有用，但仅依靠自我报告来确定 PTSD 风险和弹性因素可能会出现问题。因此，开发创新行为技术，利用转化研究和实验精神病理学方法，评估通过自我报告不容易或可靠测量的特定风险和保护因素，将对 PTSD 风险评估做出宝贵贡献。在当前的研究中，我们建议开发和评估最先进的综合工具，用于受灾青少年的 PTSD 风险评估，通过使用新颖的行为评估任务，针对理论上和经验上与 PTSD 相关的两个因素（痛苦承受力和冒险倾向），并结合使用其他经验确定的灾难、儿童和父母风险因素。如果成功，该工具将有助于增进对与灾难相关创伤以及可能与其他类型创伤相关的 PTSD 发展的更基本机制的理解，并且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 3,000 名受灾青少年及其父母作为人口样本，参与 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初步的基于电话的基线评估，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症状的信息。参与者还将被要求在基线访谈后完成额外的基于网络的评估，其中将涉及青少年和父母完成针对痛苦耐受性和冒险倾向的新颖的计算机化行为评估任务，以及额外的特质焦虑自我报告测量。基线后四个月和十二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，包括接受者操作特征树方法，将用于进一步检查评估因素与 PTSD 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具体的分数，并开发包括所有重要 PTSD 预测因素的决策算法。具体来说，我们寻求创建一种优化的、分阶段的 PTSD 风险评估方法，平衡准确性与可行性和成本，以提供实用的、功能性的评估电池，可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受灾青少年及其家庭造成的代价高昂且令人衰弱的影响，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且经济高效地识别 PTSD 风险最大的青少年。这种识别将有助于确定灾后风险降低工作的目标，并可能减少全面诊断创伤后应激障碍的发生率及其相关成本和痛苦。