Constructing a Danish Reaction to Severe Stress Cohort

描述（由申请人提供）：创伤在美国和世界各地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，在美国不存在经历过创伤性事件或因这些事件而接受过精神诊断的人的大型纵向队列，也不容易建立。确实存在的一般人群队列通常由于调查长度的考虑，可以收集的数据量有限，并且容易出现偏差和随访损失。丹麦是研究创伤经历造成的疾病的纵向后遗症的理想地点，因为该国的医疗保健和社会记录已经编目了几十年。目前的应用程序旨在创建丹麦的ICD-10严重压力反应（RSS）队列（包括诊断为急性压力反应，创伤后应激障碍，适应障碍和其他严重压力反应的人），然后可以将其与丹麦其他国家医疗保健和社会数据联系起来，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该队列所有成员所经历的创伤性事件的数据。鉴于目前的研究建议使用现有的国家卫生保健数据，RSS队列将最终提供一个有效的资源来检查RSS疾病的短期和长期后遗症，以及这些关联的修饰因子。因此，这个项目非常适合进一步实现NIMH目前的战略目标，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，由于该队列将包含丹麦所有曾经接受过ICD-10 RSS诊断的人的前瞻性收集数据，因此从拟议队列中产生的研究将不会受到依赖于人群子集内回顾性报告的研究中常见的回忆和选择偏倚问题的影响。作为新队列应用的初步证明，我们将研究ICD-10 RSS障碍与全因死亡率和自杀死亡率之间的关系。

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.