Predicting Classes of Functional Trajectories: Malleable Risk Factors

描述（由申请人提供）： 在常见的精神健康障碍（如创伤后应激障碍、抑郁症和酒精使用障碍）与不良功能结局之间存在明确的关系。然而，很少有人知道返回退伍军人的长期功能轨迹和具体因素，预测谁会遵循更好或更差的重新调整课程。在我们目前RR& D资助的MERIT奖的成功基础上，我们第二次提交的续签申请建议继续关注现有的300名退伍军人，他们曾担任持久行动和伊拉克自由与新黎明（OEF/OIF/OND）的一部分。样本量也将扩大到包括500名退伍军人。具体目标是确定临床相关的、可改变的心理社会因素，这些因素：1）前瞻性地预测长期功能和社区重返随时间的改善;（2）预测潜在功能类别轨迹的成员资格;（3）预测功能类别之间的过渡。退伍军人将在基线和24个月时完成最先进的诊断访谈和自我报告问卷。将在6个月、12个月和18个月时邮寄随访问卷。将评估多个功能领域，包括职业、家庭、社会和身体功能，以及重返社区。这一研究方案的长期目标是改善返回的持久自由行动/法语国家组织/海外民主组织退伍军人的功能成果和生活质量。为了与VHA在治疗计划中实施恢复和康复原则的目标保持一致，本研究将提供一个经验数据平台，以帮助指导有意义的治疗计划的改进和进一步发展，以帮助OEF/OIF/OND退伍军人随着时间的推移进行最佳的战后重新调整。完成研究后，该项目的数据将为退伍军人事务部资源的分配和临床干预的目标提供信息，这些资源和目标最有可能确保退伍军人在部署到战区后恢复。

DESCRIPTION (provided by applicant): There is a well-established relationship between commonly occurring mental health disorders, such as post-traumatic stress disorder, depression, and alcohol use disorders, and poor functional outcomes. However, less is known about long-term functional trajectories among returning Veterans and specific factors that predict who will follow better or worse courses of readjustment. Building upon the successful foundation of our currently RR&D-funded MERIT award, this second submission of our renewal application proposes to continue following the existing carefully-characterized cohort of 300 Veterans who served as part of Operations Enduring and Iraqi Freedom and New Dawn (OEF/OIF/OND) for an additional 2-year period. The sample size will also be expanded to include 500 Veterans. The Specific Aims are to identify clinically relevant, modifiable psychosocial factors that: 1) prospectively predict improvements in long-term functioning and community reintegration over time; (2) predict membership in latent class trajectories of functioning; and (3) predict transitions between classes of functional trajectories. Veterans will complete state-of-the-art diagnostic interviews and self-report questionnaires at baseline and 24-months. Follow-up questionnaires will be mailed at 6-, 12-, and 18-months. Multiple domains of functioning will be evaluated, including occupational, family, social, and physical functioning, as well as community reintegration. The long-term objective of this programmatic line of research is to improve functional outcomes and quality of life of returning OEF/OIF/OND Veterans. In keeping with the VHA's goal of operationalizing principles of recovery and rehabilitation in treatment planning, this research wil provide a platform of empirical data to help guide refinement and further development of meaningful treatment programs to assist OEF/OIF/OND Veterans with optimal post-war readjustment over time. Upon completing the study, data from this project will inform allocation of VA resources and targets for clinical interventions that have the highest probability of ensuring that Veterans recover following deployments to warzones.