Explaining the Attenuation Effect in Epidemiological Studies

描述(申请人提供)：虽然流行病学家和临床研究人员依靠纵向评估来研究过程和变化，但几十年来，人们已经知道，健康问题的调查报告显示出偏差，从第一次访谈到随后的访谈，它们的频率和严重程度莫名其妙地下降。这种下降被称为衰减效应，在精神病学中比在酒精使用障碍中有更好的记录，但这种差异可能是由于对后者的研究较少。在酒精滥用和精神障碍的调查中存在衰减偏差可能会导致对这些疾病及其前驱疾病的病程得出错误的结论。对于衰减效应，已经提出了几种解释，包括重复评估的治疗益处，参与者对这些评估的不同解释，或者参与者反应的学习/优化过程，但这些解释尚未得到检验。此外，在精神障碍和酒精障碍的对比背景下，这些解释还没有被联合考虑，在精神障碍中，衰减效应已经得到很好的证实，而在酒精障碍中，衰减效应尚未得到证实。我们提出了两个具体目标。1)在对大学生进行的两项密集的纵向研究中，通过对酒精问题和精神健康的调查在四个月的时间里反复评估，以及对面临严重压力事件的学生的酒精使用和精神状态的日常日记研究，仔细描述了衰减效应的大小。2)在实验研究中再现这一效果，并检验假设，部分原因是a)重复评估的治疗效果，b)参与者对评估工具的理解增加，或c)参与者使用对话规范来判断他们应该报告什么和他们认为调查人员希望听到什么。这些目标将通过四项研究来实现，其中三项是随机实验，一项是心理生理学实验室研究。公共卫生相关性：这项研究将帮助研究人员收集在纵向调查中评估的关于酒精和精神障碍的更准确的数据。反过来，这将有助于了解这些疾病的原因和过程，从而能够设计预防和干预计划。

DESCRIPTION (provided by applicant): Although epidemiologists and clinical researchers depend on longitudinal assessments to study process and change, for decades it has been known that survey reports of health problems show a bias where they decline inexplicably in frequency and severity from first to subsequent interviews. This decline, called the attenuation effect, is better documented in psychiatric than in alcohol use disorders, but this difference could be due to the paucity of research on the latter. The presence of attenuation biases in surveys of alcohol abuse and psychiatric disorders can lead to erroneous conclusions about the course of these diseases and of their precursors. Several explanations for the attenuation effect have been proposed, including a therapeutic benefit of repeated assessments, participants' changing interpretations of those assessments, or a process of learning/optimization of participant responses, but these explanations have not been tested. Moreover, the explanations have not been jointly considered in contrasting contexts of psychiatric disorders where the attenuation effect is well established, and alcohol disorders, where it is not yet established. We propose two specific aims. 1) To carefully delineate the attenuation effect in two intensive longitudinal studies of college students, by estimating its magnitude in a) surveys of alcohol problems and mental health assessed repeatedly over a four month period, and b) daily diary studies of alcohol use and mental state among students facing an acutely stressful event. 2) To reproduce the effect in experimental studies and to test hypotheses that it is due in part to a) a therapeutic effect of the repeated assessments, b) participants' increased understanding of the assessment instrument, or c) a tendency for participants use conversation norms to judge what they should report and what they think investigators expect to hear. These aims will be approached with four studies, three of which are randomized experiments and one a psychophysiology lab study. PUBLIC HEALTH RELEVANCE: This study will help researchers gather more accurate data on alcohol and psychiatric disorders assessed in longitudinal surveys. This, in turn, will facilitate understanding of causes and courses of these disorders, enabling prevention and intervention programs to be designed.