Web-based Intervention for Disaster-affected Adolescents and Families

描述(由申请人提供)：一场灾难、恐怖袭击或其他大规模事件可能会对成千上万的青年和家庭造成不利影响。直接后果可能包括得不到满足的基本需求和家庭沉重的经济负担。灾难还会极大地影响家庭日常生活、婚姻压力、亲子互动，以及更广泛的家庭角色和关系。虽然大多数青年在灾难发生后都能适应(即不会出现严重的精神或身体健康问题)，但各种对公共卫生有影响的问题仍然普遍存在，如创伤后应激障碍、抑郁和药物滥用。这突显了需要有效、可广泛获得和具有成本效益的干预措施，以促进抗灾能力或快速恢复，而不是灾害对健康的影响。到目前为止，还没有开发出基于证据的早期干预措施。儿童和青少年在灾害研究中的代表性不足，受灾家庭没有足够的机会获得循证资源。很少有早期干预措施经过严格的科学评估；很少有针对年轻人的干预措施。此外，有许多有效的自助和基于网络的干预措施适用于普通民众，但没有适用于受灾青年和家庭。最近，我们的研究团队开发并探索了一种针对成年人的网络传递的、基于教育的干预措施的可行性，旨在降低普遍存在的心理健康风险和灾难的健康风险后果。在9·11恐怖袭击发生两年后，我们对325名纽约市地区成年人进行的初步研究结果支持了灾后基于网络的教育方法的可行性和潜在的效用。拟议项目的主要目的是：(A)为受灾青少年和父母开发以与灾害的健康相关因素为目标的网上干预措施(即发展阶段)；(B)开展一项基于随机对照人群的研究，对3 000名受灾青少年及其父母进行干预措施的可行性和初步效力的审查(即随机对照研究阶段)；(C)根据可行性和效力数据完善干预措施；以及(D)为灾后急性期开展更大规模的研究做好准备。我们针对广泛的症状表现以及阈值下和诊断水平的战略与公共卫生建议是一致的，这些建议基于调查结果，表明了与循证早期干预相关的降低医疗成本和积极结果方面的好处。 与公共健康相关：灾难经常在美国发生，可能会同时对数千个家庭造成负面影响。灾害对心理健康的影响是巨大的，但为青年和家庭提供的资源很少，可以帮助他们了解社区可能为他们提供的健康应对战略和服务。该项目的目标是为受灾害影响的青少年和父母开发和评估一个在线自助资源。自助资源将具有教育性、高度互动性和吸引力，旨在降低灾难后出现精神健康问题的风险，如创伤后应激反应、抑郁症以及酒精和药物使用问题。

DESCRIPTION (provided by applicant): A single disaster, terrorist attack, or other large-scale incident can adversely affect thousands of youth and families. Immediate consequences may include unmet basic needs and high economic burden to families. Disasters also can dramatically affect family routines, marital stress, parent-child interactions, and, more broadly, family roles and relationships. Whereas most youth are resilient (i.e., do not develop serious mental or physical health problems) in the aftermath of disasters, various problems of public health significance are prevalent, such as PTSD, depression, and substance abuse. This underscores the need for effective, widely accessible, and cost-efficient interventions that foster resilience or rapid recovery secondary to the health effects of disasters. To date, few evidence-based early interventions have been developed. Children and adolescents are underrepresented in disaster research, and disaster- affected families have insufficient access to evidence-based resources. Few early interventions have undergone rigorous scientific evaluation; fewer have targeted youth. Further, many efficacious self-help and Web-based interventions exist for the general population, but none exist for disaster-affected youth and families. Recently, our research team developed and explored the feasibility of a Web-delivered, education-based intervention for adults designed to reduce risk for prevalent mental health and health-risk consequences of disasters. Results of our pilot study with 325 New York City-area adults two years after the September 11th terrorist attacks supported the feasibility and potential utility of Web-based educational approaches post- disaster. The primary aims of the proposed project are to (a) develop a Web-based intervention for disaster-affected adolescents and parents targeting health-related correlates of disasters (i.e., development phase), (b) conduct a randomized controlled population-based study to examine feasibility and preliminary efficacy of the intervention with 3,000 disaster-affected adolescents and their parents (i.e., RCT phase), (c) refine the intervention based on feasibility and efficacy data, and (d) prepare for larger-scale research in the acute post-disaster phase. Our 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 positive outcomes associated with evidence- informed early interventions. PUBLIC HEALTH RELEVANCE: Disasters occur often in the U.S. and can negatively affect thousands of families simultaneously. The mental health consequences of disasters are significant, but few resources are available for youth and families to help them learn about healthy coping strategies and services that might be available to them in their communities. The goal of this project is to develop and evaluate an online, self-help resource for adolescents and parents who are affected by disasters. The self-help resource will be educational, highly interactive and engaging, and will be designed to reduce risk for the development of mental health problems after a disaster, such as posttraumatic stress reactions, depression, and alcohol and drug-use problems.