Follow-up of Vietnam Veterans At Risk for Suicide

描述（由申请人提供）：这是对现有R 01的竞争性补充（CS）申请，标题为“有自杀风险的越南退伍军人的后续行动”（MH 060961），以下简称为父母补助金（PG）。要求为父母补助金的剩余17个月提供额外支助，以便对慢性创伤后应激障碍进行详细检查。自从PTSD被正式纳入诊断和统计手册（DSM）以来，已经过去了二十多年。然而，由于PTSD作为一种精神病诊断相对“新颖”，慢性PTSD的研究传统上使用原始创伤多年后获得的少数幸存者的回顾性信息。这一领域在美国正处于黄金时期，因为越南退伍军人是最大的明确定义的慢性创伤后应激障碍风险幸存人群，目前占美国成年男性的8.5%，创伤后应激障碍的历史可以追溯到30年前。虽然PG的目标涉及应对机制和减轻自杀风险的其他保护因素，但CS通过利用已经实施的对PTSD症状的现象学、触发因素和事件联系的评估以及自1972年以来该队列积累的纵向数据，重点关注慢性PTSD。PTSD评估在2001年9月11日之后被添加到PG中。这一两次修订的应用程序的具体目标包括：1）效度：检查以特定单一创伤为条件的PTSD症状标准评估与区别归因于多种创伤的PTSD症状的一致性; 2）定性：检查慢性PTSD的现象学，包括创伤事件的类型，症状的描述和触发因素，以及症状对创伤事件的归因; 3）定量：使用基于个人和基于创伤事件的数据，解开慢性PTSD的多种途径，包括脆弱性和共病，创伤事件的“点燃”或“点燃”效应，以及症状“汇编”; 4）定性-定量整合：检查慢性PTSD的多种途径与当前PTSD病理学和创伤归因的关联; 5）通过将9月11日事件作为一个“自然实验”，检验创伤性事件对慢性PTSD影响的“接种”与“加重”假说。估计420名越战老兵将构成有效分析样本，包括三组“自杀高风险”（n = 135）、“自杀低风险”（n = 215）和“自杀中等风险伴PTSD”（最少n=66），这些人将被新添加到CS中，以纳入DSMITJR PTSD阳性者在PG中未被选择。总CS样本中DSM-FV PTSD的终生患病率为33.4%（三组分别为62.2%、0.8%和66.7%）; 89%的阳性者在1996-7年最后一次评估之前的过去5年中患有活动性PTSD。我们希望新的发现将增加对慢性创伤后应激障碍复杂性的理解，并为改善这位越南老兵和其他创伤后应激障碍患者的治疗提供见解。

DESCRIPTION (provided by applicant): This is a competitive supplement (CS) application to the existing R01, titled "Follow-Up of Vietnam Veterans at Risk for Suicide"(MH060961), hereafter referred to as the Parent Grant (PG). Additional support is requested for the remaining 17 months of the Parent Grant to conduct detailed examination of chronic post-traumatic stress disorder (PTSD). More than two decades have passed since PTSD was officially incorporated into the Diagnostic and Statistical Manual (DSM)-in. However, given the relative "newness" of PTSD as a psychiatric diagnosis, research on chronic PTSD has traditionally used retrospective information from small numbers of survivors obtained many years after the original trauma. The field is reaching a prime time in the U.S. because Vietnam veterans are the largest clearly-definable surviving population at risk for chronic PTSD, currently representing 8.5% of U.S. adult males, for whom the history of PTSD dates back as long as 30 years. While the PG aims relate to the mechanisms of coping and other protective factors mitigating suicidal risk, the CS focuses on chronic PTSD by utilizing an already implemented assessment of phenomenology, triggers and event linking of PTSD symptoms, and the longitudinal data accumulated from this cohort since 1972. The PTSD assessment was added to the PG after September 11, 2001. The specific aims of this twice-revised application include: 1) Validity: examine the consistency of the standard assessment of PTSD symptoms conditioned on a specific single trauma with the PTSD symptoms that are differentially attributed to multiple traumas; 2) Qualitative: examine the phenomenology of chronic PTSD, including types of traumatic events, description and triggers of symptoms, and attribution of symptoms to traumatic events; 3) Quantitative: disentangle multiple pathways to chronic PTSD, including vulnerability and comorbidity, "kindling" or "stoking" effects of traumatic events, and symptom "compilation," using both person-based and traumatic event-based data; 4) Qualitative-quantitative integration: examine the association of multiple pathways to chronic PTSD with the current PTSD symptomatology and trauma attribution; and 5) Examine the "inoculation" vs. "exacerbation" hypothesis for the effect of traumatic events on chronic PTSD by utilizing September 11 as a "natural experiment." An estimated 420 Vietnam veterans will comprise the effective analysis sample, including three groups of "suicide high-risk" (n~135), "suicide low risk" (n" 215) and "suicide medium-risk with PTSD" (minimum n=66) who will be newly added to the CS to include DSMITJR PTSD positives not selected in the PG. Lifetime prevalence of DSM-FV PTSD in the total CS sample is 33.4% (62.2%, 0.8%, and 66.7% for the three groups, respectively); 89% of the positives had active PTSD during the past 5 years prior to the last assessment in 1996-7. We hope the new findings will increase the understanding of the complexity involved in chronic PTSD and provide insights to improve treatment for this Vietnam veteran and other populations of PTSD sufferers.