Constructing a Danish Reaction to Severe Stress Cohort

描述（由申请人提供）：美国和世界各地创伤的高患病率使得对压力和创伤经历后遗症的流行病学研究变得至关重要。不幸的是，经历过创伤事件或因这些事件而接受精神病诊断的人的大型纵向队列在美国并不存在，并且不容易构建。由于考虑到调查的时间长度，确实存在的一般人口群组往往在可收集的数据量方面受到限制，并且容易受到偏见和失去后续行动的影响。丹麦是研究创伤性经历所致精神障碍的纵向后遗症的理想地点，因为国家医疗保健和社会记录已经编目了几十年。本申请旨在创建丹麦的ICD-10严重应激反应（RSS）队列（包括诊断为急性应激反应、创伤后应激障碍、适应障碍和其他严重应激反应的人群），然后将其与其他丹麦国家医疗保健和社会数据相关联，以研究这些疾病的各种长期影响。在可能的情况下，还将使用丹麦国家数据库收集队列所有成员经历的创伤事件的数据。鉴于目前的研究建议使用现有的国家医疗保健数据，RSS队列将最终提供一个有效的资源，以检查RSS障碍的短期和长期后遗症，以及这些协会的修饰符。[因此，该项目非常适合推进NIMH当前的战略目标，即“绘制精神疾病轨迹以确定何时、何地以及如何干预”（#2）。]此外，拟议的开放队列将是一个持久的资源，可以不断更新，以检查关联。最后，由于该队列将包含前瞻性收集的所有在丹麦接受过ICD-10 RSS诊断的人的数据，因此从拟议队列产生的研究将不会受到依赖于人群亚组内回顾性报告的研究中常见的召回和选择偏倚问题的影响。作为新队列效用的初步证明，我们将检查ICD-10 RSS疾病与全因死亡率和自杀死亡率之间的关系。 公共卫生相关性：目前的项目与公共卫生有很大的关系，因为它将建立一个资源，可以在国家一级审查对严重应激障碍的反应。这包括检查严重应激障碍反应的后遗症，这些协会的修饰符，并确定公共卫生干预和预防工作可以瞄准的因素。

DESCRIPTION (provided by applicant): The high prevalence of trauma in the US and around the world has made epidemiologic research on the sequelae of stressful and traumatic experiences of paramount importance. Unfortunately, large longitudinal cohorts of people who have experienced traumatic events, or received a psychiatric diagnosis as a result of these events, do not exist in the United States and cannot be easily constructed. General population cohorts that do exist are often limited in the amount of data that can be collected due to considerations about survey length, and are vulnerable to bias and loss to follow up. Denmark is the ideal location in which to study the longitudinal sequelae of disorders resulting from traumatic experiences, as national healthcare and social records have been catalogued for decades. The current application aims to create an ICD-10 reaction to severe stress (RSS) cohort in Denmark (including people with the diagnoses of acute stress reaction, posttraumatic stress disorder, adjustment disorder, and other reactions to severe stress), which can then be linked to other national Danish healthcare and social data to study various long term effects of these disorders. National Danish databases will also be used to collect data about traumatic events that have been experienced by all members of the cohort, where possible. Given that the current study proposes to use existing national healthcare data, the RSS cohort will ultimately provide an efficient resource to examine the short and long-term sequelae of RSS disorders, as well as modifiers of these associations. [Therefore, this project is well-suited to further the current NIMH strategic objective of "charting mental illness trajectories to determine when, where and how to intervene" (#2).] Further, the proposed open cohort will be an enduring resource, which can be continually updated to examine associations. Finally, because the cohort will contain prospectively collected data on all people who have ever received an ICD-10 RSS diagnosis in Denmark, the research produced from the proposed cohort will not be subject to the recall and selection bias issues common in studies that rely on retrospective reporting within subsets of populations. As an initial demonstration of the utility of the new cohort, we wil examine the associations between ICD-10 RSS disorders and all-cause mortality and mortality due to suicide. PUBLIC HEALTH RELEVANCE: The current project is of great public health relevance because it will establish a resource in which reaction to severe stress disorders can be examined at a national level. This includes examining the sequelae of reaction to severe stress disorders, modifiers of these associations, and identifying factors toward which public health intervention and prevention efforts can be aimed.