PTSD and Addiction Disorder Screening and Treatment for Incarcerated Men

描述(由申请人提供)：在州立监狱中，至少五分之一的男性有精神健康问题，超过一半的人在成长期间和成年后经历过身体、性或情感虐待(称为“人际创伤”)，大多数人有酒精或药物使用问题。人际关系创伤与健康和行为健康问题以及犯罪行为高度相关。很少有男性囚犯在服刑期间接受与人际创伤有关的行为健康障碍的治疗，尽管这些问题是获释后返回监狱的风险因素。虽然卫生局局长的报告和总统的新自由委员会报告强调了创伤信息服务和护理系统的重要性，但被监禁男子中与创伤相关的行为健康问题几乎没有受到关注。这个应用程序解决了成年男性教养环境中创伤后应激障碍(PTSD)和物质使用障碍(SUD)的筛查和治疗。这项拟议的研究将在新泽西州一所成人中等安全级别的监狱进行，该监狱关押了约1900名男性囚犯，主要年龄在18岁至25岁之间。我们提出了一项分两个阶段进行的研究：(1)测试计算机管理的PTSD和SUD筛查的可靠性(重测)与临床医生管理的筛查的可靠性(目标：开发一种成本效益高的基于人群的PTSD和SUD在监禁环境中的筛查程序)和(2)进行随机对照试验(RCT)，其中240名男性囚犯被分配到两组基于证据的手动第一阶段创伤干预措施(寻求安全(SS)和有物质使用问题的男性创伤恢复和赋权模型版本(M-TREM)(目标：在被监禁男性中确定针对PTSD和SUD的有效干预措施)。RCT将通过两种方式得到加强：(1)将向拒绝接受治疗的人播放一段10分钟的关于创伤后应激障碍和SUD的教育视频，并在观看视频后第二次被邀请参加RCT，以及(2)随机分配，三分之二的参与者(n=160)将被随机分配到治疗组，另外三分之一(n=80)将根据他们对一种干预措施的偏好选择治疗。我们将测试筛查和治疗干预措施的总体有效性，以及教育加强和偏好对结果的边际影响。 公共卫生相关性：这项研究有可能确定在被监禁男性中筛查PTSD和SUD的经济有效的方法，以及有效的干预措施来治疗这些联合的行为健康问题。卫生局局长的报告、总统关于精神卫生的新自由委员会和医学研究所的各种报告强调了重点关注创伤后应激障碍筛查和创伤知情治疗的重要性。这一应用响应了当前的NIMH战略计划，特别是目标3(开发新的更好的干预措施，纳入精神疾病患者的不同需求和情况)和#4(加强NIMH支持的研究对公共卫生的影响)。

DESCRIPTION (provided by applicant): At least one-fifth of men inside state prisons have mental health problems, over half have experienced physical, sexual, or emotional abuse (referred to as "interpersonal trauma") during their formative years and often in adulthood, and the majority has alcohol or drug use problems. Interpersonal trauma is highly correlated with health and behavioral health problems and criminality. Few male inmates receive treatment for behavioral health disorders related to interpersonal trauma while incarcerated even though these problems are risk factors for returning to prison after release. While the Surgeon General's Report and the President's New Freedom Commission Report highlighted the importance of trauma-informed services and systems of care, trauma- related behavioral health problems among incarcerated men have received little attention. This application addresses both screening for and treatment of Post-Traumatic Stress Disorder (PTSD) and substance use disorders (SUD) within an adult male correctional setting. The proposed study will be conducted at an adult medium security prison in New Jersey that houses ~1900 male inmates primarily aged 18 to 25. We propose a two-phase study that: (1) tests the reliability (test-retest) of computer-administered screening for PTSD and SUD compared to clinician-administered screening (goal: to develop a cost-effective population- based screening procedure for PTSD and SUD within incarcerated settings) and (2) conduct a randomized controlled trial (RCT) in which 240 male inmates are assigned to two evidence-based, manualized first stage trauma interventions (Seeking Safety (SS) and Trauma Recovery and Empowerment Model version for men with substance use problems (M-TREM) (goal: to identify effective interventions for PTSD and SUD among incarcerated men). The RCT will be enhanced in two ways: (1) those who decline treatment participation will be shown a 10-minute educational video on PTSD and SUD and after viewing the video invited a second time to participate in the RCT and (2) determined by random assignment, two-thirds of participating subjects (n=160) will be randomly assigned to treatment and the other one-third (n=80) will choose treatment based on their preference for one intervention over the other. We will be testing overall effectiveness of screening and treatment interventions and the marginal impact of educational-enhancement and preferences on outcomes. PUBLIC HEALTH RELEVANCE: This study has the potential to identify cost-effective methods for screening PTSD and SUD among incarcerated men and effective interventions for treating these conjoint behavioral health problems. The importance of focusing on PTSD screening and trauma-informed treatment was highlighted in the Surgeon General's Report, the President's New Freedom Commission on Mental Health and a variety of reports by The Institute of Medicine. This application is responsive to the current NIMH Strategic Plan, specifically Objectives #3 (Develop New and Better Interventions that Incorporate the Diverse Needs and Circumstances of People with Mental Illnesses) and #4 (Strengthen the Public Health Impact of NIMH-Supported Research).