Child Trajectories of Postraumatic Stress after Natural Disasters

项目摘要/摘要 自然灾害，包括飓风、洪水、地震、龙卷风和野火，呈现出一种 这对儿童的健康和福祉构成重大威胁。灾害管理专家主张 需要采取阶梯式干预模式来解决儿童的心理健康需求 在灾难之后。分级护理模式的目标是对儿童进行分类，以便那些处于最高风险的儿童 对于持续的痛苦(例如，临床上升高的创伤后应激症状，PTSS (超过灾后3-6个月)得到最大程度的干预。然而，a 实施分级护理模式的关键障碍是缺乏关于以下方面的信息 灾难发生后，儿童的PTSS模式(即轨迹)如何以及为什么会不同。因此，它不是 明确如何根据儿童患持续性PTSS的风险对其进行分层。这项提案将利用 新的方法论方法，综合数据分析(IDA)，以克服 从无数关注儿童心理健康的个人研究中得出结论 灾难过后的结果。个人研究，虽然对指导未来的方向是有价值的 研究，在样本量、被检查的儿童发展时期、灾后 评估时间框架、评估频率、所研究的风险因素以及样本多样性。 IDA方法集成了来自多个研究的个体水平数据，创建了一个汇集的数据源 这比任何一项单独的研究都更强大和多样化。拟议的研究将综合 来自具有里程碑意义的研究的数据，这些研究是关于儿童对美国四场代价最高的灾难的反应。 历史(安德鲁飓风、查利飓风、卡特里娜飓风和艾克飓风)，使用1,653名儿童的3245次观测 6至16岁，灾后3至25个月评估。这项提议的目标是 使用IDA建立数据的经验知识库，以了解哪些因素具有特征 PTSS的轨迹各不相同。具体目标包括目标1：开发一种IDA方法 框架，综合四项关于儿童心理健康结果的研究 毁灭性飓风；和目标2：确定临时避难所的轨迹和相关风险因素 在飓风过后。这项研究的长期目标是开发更多的风险模型 在分级护理模式中有效利用稀缺的灾后资源。结果将直接 适用于临床实践，为高中生早期识别提供指导 持续性PTSS的风险。

Project Summary/Abstract Natural disasters, including hurricanes, floods, earthquakes, tornadoes, and wildfires, present a significant threat to the health and wellbeing of children. Disaster management experts advocate that stepped care models of intervention are needed to address children’s mental health needs after disasters. The goal of stepped care models is to triage children so that those at highest risk for persistent distress (e.g., clinically elevated posttraumatic stress symptoms, PTSS, that endure beyond 3 – 6 months postdisaster) receive the most intense levels of intervention. However, a critical barrier to implementing stepped care models is that there is a paucity of information on how and why children differ in the PTSS patterns (i.e., trajectories) after disasters. Thus, it is not clear how to stratify children based on their risk for persistent PTSS. This proposal will utilize a novel methodological approach, Integrative Data Analysis (IDA), to overcome the limitations of drawing conclusions from the myriad of individual studies focused on children’s mental health outcomes after disasters. Individual studies, while valuable in informing future directions for research, are limited in terms of sample size, period of child development examined, postdisaster assessment time frame, frequency of assessments, risk factors studied, and sample diversity. IDA methods integrate individual level data from multiple studies, creating a pooled source of data that is more powerful and diverse than any individual study. The proposed study will integrate data from landmark studies of children’s reactions to four of the most costly disasters in U.S. history (Hurricanes Andrew, Charley, Katrina, and Ike), using 3,245 observations of 1,653 children aged 6 to 16 years, assessed from 3 to 25 months postdisaster. The objective of this proposal is to use IDA to build an empirical knowledge base of data to understand which factors characterize varying trajectories of PTSS. The Specific Aims include Aim 1: Develop an IDA methods framework to synthesize data across four studies of children’s mental health outcomes after devastating hurricanes; and Aim 2: Determine trajectories and associated risk factors of PTSS following the hurricanes. The long-term goal of this study is to develop risk models to more effectively use scarce postdisaster resources in stepped care models. Results will be directly applicable to clinical practice by providing guidance for early identification of children at higher risk of persistent PTSS.