Development and Evaluation of a Web-Based Intervention for Disaster Victims

描述（由申请人提供）：虽然大多数人在灾难或大规模暴力事件后都能迅速恢复，但这些事件与一系列精神和身体健康相关反应的风险增加有关，包括创伤后应激、恐慌、抑郁、广泛性焦虑和物质使用问题。因此，重要的是，灾害受害者能够获得安全、有效的服务，以解决或减少发生与灾害有关的身心健康风险问题的风险。有效、可广泛交付和具有成本效益的早期干预措施的潜在价值是相当大的。然而，很少有基于证据的早期干预措施被开发出来，只有一小部分经过了严格的科学评估。对于那些在灾难或大规模暴力事件中广泛暴露的普通人群中可能有用的策略，我们知之甚少。最近，我们的研究小组得到了NIDA的资助，开发和探索一种基于网络的教育干预措施的可行性，旨在减少灾害后普遍存在的情绪和健康风险后果的风险。这项干预措施是在911恐怖袭击发生两年后试行的，有325名参与者在袭击发生时居住在纽约市地区。结果令人鼓舞，并支持进一步开发和评价的必要性。拟议项目的主要目的是：(a)根据最近的研究和可行性研究数据，改进和更新处理抑郁、创伤后应激障碍、恐慌和极度忧虑症状的现有模块；(b)加强干预的技术方面；(c)制订彻底的评价机制；(d)进行一项以人群为基础的试点研究，包括基线和六个月的随访评估，以检查干预措施的初步效果。此外，为了准备在灾难发生后早期对干预措施进行评估（如果基于人群的试点研究产生有希望的数据），该项目将使我们能够完善创新的研究设计，将随机对照试验方法与纵向流行病学方法结合起来进行招募和评估。我们提出的策略是针对广泛的症状表现，以及阈下和诊断水平，这与基于研究结果的公共卫生建议是一致的，这些发现表明早期干预在降低医疗成本和获得更大的积极结果方面具有益处。

DESCRIPTION (provided by applicant): Although most individuals are resilient or recover rapidly in the aftermath of disasters or mass violence incidents, such events are associated with elevated risk of a wide range of mental and physical health-related reactions, including posttraumatic stress, panic, depression, generalized anxiety, and substance use problems. It is therefore important that disaster victims have access to safe, effective services to address-or reduce risk for the development of-disaster-related mental and physical health-risk problems. The potential value of effective, widely deliverable, and cost-efficient early interventions is considerable. However, few evidence-based early interventions have been developed, and only a small number has undergone rigorous scientific evaluation. Little is known about strategies that might be helpful within the general population broadly exposed to a disaster or mass violence incident. Recently, our research team was funded by NIDA to develop and explore the feasibility of a Web-delivered, education-based intervention designed to reduce risk for prevalent emotional and health-risk consequences in the aftermath of disasters. The intervention was piloted two years after the September 11th terrorist attacks with 325 participants who lived in the New York City area at the time of the attacks. Results were promising and supported the need for further development and evaluation. The primary purposes of the proposed project are to (a) refine and update existing modules that address symptoms of depression, PTSD, panic, and extreme worry, based on recent research and feasibility study data; (b) enhance the technical aspects of the intervention; (c) develop thorough evaluation mechanisms; and (d) conduct a population-based pilot study with baseline and six-month follow-up assessment to examine the preliminary efficacy of the intervention. Also, in preparation for future evaluation of the intervention in the early aftermath of a disaster (should the population-based pilot study yield promising data), this project would allow us to refine the innovative study design that integrates randomized controlled trial methodology with longitudinal epidemiological approaches to recruitment and assessment. Our proposed strategy to target a wide range of symptom presentations, as well as both subthreshold and diagnostic levels, is consistent with public health recommendations based on findings indicating benefits in terms of reduced health costs and greater positive outcomes associated with early intervention.