PTSD and Addiction Disorder Screening and Treatment for Incarcerated Men

描述（由申请人提供）：州立监狱内至少有五分之一的男性有心理健康问题，超过一半的人在他们的成长期和成年期经历过身体，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。很少有男性囚犯在监禁期间接受与人际创伤有关的行为健康障碍的治疗，尽管这些问题是释放后重返监狱的风险因素。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知情服务和护理系统的重要性，但被监禁男子中与创伤有关的行为健康问题很少受到关注。本申请涉及成年男性矫正环境中的创伤后应激障碍（PTSD）和物质使用障碍（SUD）的筛查和治疗。拟议的研究将在新泽西的一所成人中等安全监狱进行，该监狱关押了约1900名主要年龄在18至25岁之间的男性囚犯。我们提出了一个两阶段的研究：（1）测试的可靠性（重测）计算机管理的PTSD和SUD筛查与临床医生管理的筛查相比（目标：在监禁环境中开发一种具有成本效益的基于人群的PTSD和SUD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个循证，手动第一阶段创伤干预（寻求安全（SS）和创伤恢复和授权模式版本的男子与物质使用问题（M-TREM）（目标：确定有效的干预措施，创伤后应激障碍和SUD的监禁男子）。将从两个方面加强随机对照试验：（1）那些拒绝参加治疗的人将被展示一个10分钟的关于PTSD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）通过随机分配确定，三分之二的参与受试者（n=160）将被随机分配至治疗组，另外三分之一（n=80）将根据他们对一种干预措施的偏好来选择治疗。我们将测试筛查和治疗干预的总体有效性，以及教育增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具有成本效益的方法，用于筛查PTSD和SUD的监禁男子和有效的干预措施，治疗这些联合行为健康问题。关注创伤后应激障碍筛查和创伤知情治疗的重要性在外科医生报告、总统精神健康新自由委员会和医学研究所的各种报告中得到了强调。该应用程序是响应当前的NIMH战略计划，特别是目标#3（开发新的和更好的干预措施，纳入精神疾病患者的不同需求和情况）和#4（加强NIMH支持的研究的公共卫生影响）。

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).