Multiple Levels of Analysis: Trauma, Violence and PTSD Among Youths'

描述（由申请人提供）：尽管全国暴力犯罪呈下降趋势，但研究表明，在一些社区、家庭、学校和媒体中，暴力仍然高得惊人。这一拟议的R21项目的目标是双重的：发展一种多信息来源、多方法的青年在社会环境中遭受暴力的评估，以青年的心理健康为基础；并为开展新的研究奠定基础，以减少和预防青少年接触暴力对心理健康的有害影响。我们的新评估方法是由基于特定暴力行为的背景（环境）、内容（影响）、渠道（暴露模式）和慢性（暴露频率）的暴力暴露的四维概念驱动的。我们的测量与心理健康的综合评估（外化、内化和创伤性应激障碍）联系在一起，以发展精神病理学的当前理论为基础，提供对暴力暴露负担的全面评估。这项调查将在社会经济困难的城市社区进行，包括东北部一个主要大都市地区一系列预计暴露于暴力的风险。我们的研究对象是有11至14岁儿童的家庭；我们将对照顾者-青年对（二元N = 200）进行抽样，以获得一份综合协议，该协议将直接从对中获取的信息与来自社会生态各个层面的数据源的信息整合在一起。我们的调查以五个目标为指导：1)制定和实施一项跨信息来源、混合方法的协议，以评估青少年在社会环境中接触暴力的情况；2)利用我们提出的暴力暴露的四维概念来评估新的个性化方案的心理测量特性，并建立内部效度；3)应用暴露于暴力如何影响心理健康结果的双途径模型来评估新方案的标准效度；4)采用多变量模型分析有意义的亚群（例如，低风险和高风险暴露）的暴露模式和相关结果，以评估新方案的可推广性；5)分析报告的各种组合，以便最终确定临床研究环境中的现场测试方案。我们的调查将提供对了解暴力暴露如何导致负面健康结果至关重要的信息。最终，这方面的知识对于减少遭受暴力的负面影响的努力至关重要。我们测量青少年接触暴力的方法对于制定个性化评估和干预策略以改善儿童和青少年接触暴力的负面后遗症至关重要。此外，拟议的调查是扩大我们关于社会生态中的暴力如何通过生物心理社会机制影响个人心理健康的知识的必要步骤。公共卫生相关性：尽管大量研究证实，青少年在多种社会环境中遭受暴力对其心理健康状况有不利影响，但没有系统的努力来制定一种理论上知情的跨环境遭受暴力的衡量标准。正确评估暴露于暴力的关键方面，包括环境以及暴露的严重程度、频率和方式，是增进我们对暴力如何影响青少年心理健康结果的理解的重要一步。更好的暴露测量也将转化为更精确、最终更有效的干预策略。拟议的项目旨在制定一项新的协议，以评估青少年对暴力的接触，并探索不同的接触概况如何解释不同的精神病理学模式。

DESCRIPTION (provided by applicant): Despite national trends showing declines in violent crime, studies show that violence remains alarmingly high in some communities as well as in homes, schools, and the media. The goal of this proposed R21 project is twofold: To develop a multi-informant, multi-method assessment of youths' exposure to violence in the social environment, anchored to youths' mental health; and to set a foundation for launching new research into the reduction and prevention of the deleterious mental health consequences of youth violence exposure. Our novel approach to assessment is driven by a four-dimensional conception of violence exposure based on the context (setting), content (impact), channel (mode of exposure), and chronicity (frequency of exposure) of specific acts of violence. Our measurement is tied to a comprehensive assessment of mental health (externalizing, internalizing, and traumatic stress disorders) to provide an overall assessment of the burden of violence exposure based on current theory in developmental psychopathology. This investigation will be conducted in socio-economically distressed urban neighborhoods comprising a range of projected risk for exposure to violence in a major metropolitan area of the Northeast. Our study population will be families with children between the ages of 11 and 14 inclusive; we will sample caregiver-youth pairs (dyadic N = 200) for a comprehensive protocol integrating information from the pairs directly with information from data sources across all levels of the social ecology. Our investigation is guided by five aims: 1) Develop and implement a cross-informant, mixed-method protocol for assessing youths' exposure to violence in the social environment; 2) Utilize our novel four-dimensional conception of violence exposure to evaluate the psychometric properties of the new individualized protocol and establish internal validity; 3) Apply a dual pathway model of how exposure to violence affects mental health outcomes to evaluate the criterion validity of the new protocol; 4) Employ multivariate modeling to analyze patterns of exposure and associated outcomes across meaningful subpopulations (e.g., low and high risk for exposure) to assess the generalizability of the new protocol; and 5) Analyze various combinations of reports in order to finalize a protocol for field testing in clinical research settings. Our investigation will provide information critical to understanding how violence exposure leads to negative health outcomes. Ultimately this knowledge will be essential to efforts at reducing the negative impact of exposure to violence. Our approach to measuring youths' exposure to violence is essential for formulating individualized assessment and intervention strategies for ameliorating the negative sequelae of exposure among children and adolescents. Further, the proposed investigation represents a necessary step in expanding our knowledge of how violence in the social ecology impacts individual mental health via biopsychosocial mechanisms. PUBLIC HEALTH RELEVANCE: Although a large body of research confirms detrimental effects of youths' exposure to violence in multiple social contexts on their mental health status, there have been no systematic efforts to develop a theoretically informed measure of exposure to violence across settings. Properly assessing exposure to violence along key dimensions including context as well as severity, frequency, and mode of exposure is an essential step in advancing our understanding of how violence affects youths' mental health outcomes. Better measurement of exposure also will translate into more precise and ultimately more effective intervention strategies. The proposed project aims to develop a new protocol for assessing youths' exposure to violence and exploring how different profiles of exposure account for different patterns of psychopathology.