Risk and Protective Factors for Adjustment of College Women After a Mass Shooting

描述（由申请方提供）：拟议研究集的具体目的是前瞻性检查即刻和长期（长达2年）调整结局（即，2008年2月14日，在伊利诺斯州迪卡尔布的北方伊利诺斯大学（NIU）校园发生大规模枪击事件后，创伤后应激障碍症状、抑郁症状和焦虑症状）。在拍摄的时候，一个大样本（N = 816）的女大学生在NIU正在参与性再次受害的纵向研究。鉴于创伤为重点的性质，再受害研究，它提供了一个独特的机会，检查射击后的调整结果，同时控制射击前的调整水平。到目前为止，653名女性（80%的受害者）已经完成了一项在线调查，NIU创伤研究（NTS）：时间1，平均在大规模枪击事件发生后27天。该调查包括对枪击后调整、枪击暴露程度以及其他风险和保护因素（例如，社会支持、创伤后成长）。建议在拍摄后3.5个月、7.5个月、1年和2年进行额外评估。假设有几个因素影响创伤后适应的变化。这些包括射击前的风险因素[例如，童年或其他创伤暴露，应激激素的失调（即，射击前唾液皮质醇水平）和功能失调的影响调节策略]，与射击相关的因素（例如，暴露的严重程度），以及对大规模枪击事件的立即反应（例如，创伤周围分离和应对枪击相关痛苦的情感调节策略）。除了拟议的风险和保护因素对六个时间点调整水平变化的直接影响外，还将检验一些相互作用。拍摄后1年评估后，将招募一部分参与者（N = 160）参与临床再评价研究，以将自我报告筛选措施校准为金标准面对面结构化诊断访谈。此外，一个独特的实验室为基础的研究[表达性写作研究（EWS）]也提出了一个子集的参与者（N = 100）谁在NTS：时间1报告高和低暴露于射击。在EWS中，参与者将写下关于大规模枪击事件的文章，然后在收集生理数据的同时大声朗读他们的文章。EWS的一个目的是检查是否生理反应，唾液皮质醇的变化，并在EWS的情绪回避的自我报告是预测长期的结果，在调整作为一个功能的严重程度暴露于射击。表达性写作的具体内容也将被考察。NTS调查的纵向跟踪调整数据也将作为EWS的跟踪数据。综合起来，这些拟议项目的数据将提供关键和独特的信息，说明风险因素和保护因素在预测大规模枪击事件后的调整方面的作用。如果成功，拟议的研究将（i）提供有关经历或目睹大规模枪击事件的心理后果的信息，同时控制枪击前的症状和调整水平;（ii）确定枪击前调整的直接和调节作用（例如，创伤史、情感调节功能障碍、应激激素调节功能障碍）对射击后调整结果的影响;以及（iii）提供关于参与表达性书写和阅读任务的生理反应性（和恢复）的信息，作为暴露于大规模射击的函数。拟议的一系列研究旨在促进NIH从纵向角度了解有助于创伤后应激障碍和其他创伤相关精神疾病发展的因素（风险和保护）。

DESCRIPTION (provided by applicant): The specific aim of the proposed set of studies is to prospectively examine immediate and long-term (up to 2 years) adjustment outcomes (i.e., posttraumatic stress disorder symptoms, depression symptoms, and anxiety symptoms) following the mass shooting that occurred on the Northern Illinois University (NIU) campus in DeKalb, Illinois, on February 14, 2008. At the time of the shooting, a large sample (N = 816) of female undergraduates at NIU were participating in a longitudinal study of sexual revictimization. Given the trauma- focused nature of the revictimization study, it provided a unique opportunity to examine post-shooting adjustment outcomes while controlling for pre-shooting adjustment levels. To date, 653 women (80% of eligibles) have completed an online survey, NIU Trauma Study (NTS): Time 1, an average of 27 days after the mass shooting. The survey contained assessments of post-shooting adjustment, degree of exposure to the shooting, and additional risk and protective factors (e.g., social support, posttraumatic growth). Additional assessments are proposed for 3.5 months, 7.5 months, 1 year, and 2 years post-shooting. Several factors are hypothesized to influence changes in adjustment in the aftermath of the trauma. These include pre-shooting risk factors [e.g., childhood or other trauma exposure, dysregulation of stress hormones (i.e., pre-shooting salivary cortisol levels), and dysfunctional affect regulation strategies], factors associated with the shooting (e.g., severity of exposure), and immediate reactions to the mass shooting (e.g., peritraumatic dissociation and affect regulation strategies for coping with shooting-related distress). In addition to direct effects of proposed risk and protective factors on changes in adjustment level across the six time points, a number of interactive effects will also be tested. Following the 1-year post-shooting assessment, a subset of participants (N = 160) will be recruited to participate in a clinical reappraisal study in order to calibrate the self-report screening measures to gold-standard face-to-face structured diagnostic interviews. In addition, a unique laboratory-based study [Expressive Writing Study (EWS)] is also proposed for a subset of participants (N = 100) who at NTS: Time 1 report high and low exposure to the shooting. In the EWS, participants will write about the mass shooting and then read their essay aloud to themselves while their physiological data are collected. One aim of the EWS is to examine whether physiological reactivity, salivary cortisol changes, and self-reports of emotional avoidance during the EWS are predictive of longer-term outcomes in adjustment as a function of severity of exposure to the shooting. The specific content of the expressive writing will also be examined. Longitudinal follow-up data on adjustment from the NTS survey will also serve as follow-up data for the EWS. In combination, data from these proposed projects will provide crucial and unique information about the role of risk factors and protective factors in predicting adjustment following a mass shooting. If successful, the proposed research will (i) provide information regarding the psychological consequences of experiencing or witnessing a mass shooting while controlling for pre-shooting levels of symptoms and adjustment; (ii) identify the direct and moderating effects of pre-shooting adjustment (e.g., trauma history, dysfunctional affect regulation, dysregulation of stress hormones) on post-shooting adjustment outcomes; and (iii) provide information regarding the physiological reactivity (and recovery) of engaging in an expressive writing and reading task as a function of exposure to the mass shooting. The proposed set of studies seeks to promote NIH's interests in understanding, from a longitudinal perspective, the factors (risk and protective) that contribute to the development of posttraumatic stress disorder and other trauma-related mental illnesses.