Models of Risk for PTSD

描述（由申请人提供）：本申请寻求鉴定创伤后应激障碍（PTSD）和/或重度抑郁症（MDD）急性创伤后风险的认知和神经生物学标志物。此外，还概述了候选人获得必要培训的计划，以制定一项独立的研究计划，重点是了解PTSD和MDD的风险标志物和机制。候选人之前在生活压力，情绪障碍和创伤后应激障碍研究方面的培训使他能够磨练实现这一目标所需的许多技能。然而，他需要额外的培训，指导和经验，在五个关键领域：（1）昼夜交感神经系统（SNS）和下丘脑-垂体-肾上腺（HPA）的活动;（2）SNS和HPA反应的压力;（3）神经生物学风险标志物的创伤后应激障碍;（4）认知风险因素的创伤后应激障碍和抑郁症;（5）纵向设计，研究PTSD和/或MDD发病和病程的应对和神经内分泌轨迹。一个全面的培训平原已经开发，其中包括动手教学经验，正式课程，独立阅读，研讨会，网络研讨会，辅导会议和咨询专家在这五个关键领域。拟议的研究将调查纵向路径导致从人际暴力（IPV）暴露于创伤后应激障碍和/或抑郁症的60名妇女最近暴露于IPV和40名非暴露妇女的样本使用四波数据收集（1个月内暴露于IPV后，并在1，3和6个月后的初步评估）。虽然女性在暴露于创伤后发展PTSD和/或MDD的可能性是男性的两倍，但这种风险增加的潜在机制仍不清楚。识别这些疾病的高风险个体对于制定有效的早期干预计划至关重要。HPA和SNS系统是应对压力或创伤的主要防线。发生PTSD的个体在创伤后HPA系统的活动减少，SNS的活动增加。横断面研究表明，一个渐进的分歧HPA和SNS活动创伤后可能有助于维持PTSD，但缺乏纵向研究来支持这一假设。虽然PTSD和MDD经常同时发生，但MDD症状在创伤暴露后HPA和SNS功能模式中的作用尚未被描述。拟议研究的主要目的是（a）检查SNS和HPA每日输出的渐进性差异是否与随着时间的推移PTSD症状水平较高有关，以及（B）确定PTSD风险较高的女性是否无法适应心理社会应激任务的皮质醇反应。次要目标将检查共同发生的MDD症状对HPA/SNS系统的昼夜分泌和反应性的作用。心理社会因素，如应对策略也可能决定PTSD和/或MDD的风险，并可能影响SNS/HPA功能。研究结果将确定与PTSD和/或MDD风险相关的认知和神经生物学因素，这些因素可用于制定更“个性化”的早期干预计划。

DESCRIPTION (provided by applicant): This application seeks to identify cognitive and neurobiological markers of risk for posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD) in the acute aftermath of trauma. In addition, a plan is outlined for the candidate to acquire the necessary training to develop an independent program of research focused on understanding markers and mechanisms of risk for PTSD and MDD. The candidate's prior training in life stress, mood disorders and PTSD research has allowed him to hone many skills necessary for achieving this goal. However, he requires additional training, mentoring and experience in five key areas: (1) diurnal sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) activity; (2) SNS and HPA reactivity to stress; (3) neurobiological risk markers for PTSD; (4) cognitive risk factors for PTSD and MDD; and (5) longitudinal designs to study coping and neuroendocrine trajectories for the onset and course of PTSD and/or MDD. A comprehensive training plain has been developed that includes hands-on didactic experiences, formal coursework, independent readings, seminars, webinars, mentoring meetings and consultation with experts in these five key areas. The proposed study will investigate longitudinal pathways leading from interpersonal violence (IPV) exposure to PTSD and/or MDD in a sample of 60 women recently exposed to IPV and 40 non-exposed women using four waves of data collection (within 1 month after exposure to IPV, and at 1, 3, and 6 months following the initial assessment). Although women are twice as likely as men to develop PTSD and/or MDD after exposure to trauma, the mechanisms underlying this increased risk remain unclear. Identifying individuals at elevated risk for these disorders is critical for developing effective early intervention programs. The HPA and SNS systems serve as main lines of defense in responding to stress or trauma. Individuals who develop PTSD have reduced activity in the HPA system and increased activity in the SNS following trauma. Cross-sectional studies suggest that a progressive divergence of HPA and SNS activity following trauma may contribute to the maintenance of PTSD, but there is scant longitudinal research to support this hypothesis. Although PTSD and MDD frequently co-occur, the role of MDD symptoms in the patterns of HPA and SNS function following trauma-exposure has not yet been described. The primary aims of the proposed study are to (a) examine whether a progressive divergence in SNS and HPA daily output is associated with higher levels of PTSD symptoms over time, and (b) to determine whether women at greater risk for PTSD fail to habituate in terms of their cortisol responses to a psychosocial stress task. Secondary goals will examine the role of co-occurring MDD symptoms on diurnal secretion and reactivity of HPA/SNS systems. Psychosocial factors such as coping strategies may also determine the risk for PTSD and/or MDD and may influence SNS/HPA function. Results will identify cognitive and neurobiological factors associated with risk for PTSD and/or MDD that could be used to develop more "personalized" early intervention programs.