PTSD, Negative and Positive Emotion Dysfunction and Substance USE in IPV Victims

项目摘要/摘要 IPV是一个普遍而严重的公共卫生问题，影响着全国近三分之一的妇女 1接触IPV的妇女滥用药物和酒精的比率比 全国范围内的妇女。2，3多达70%的吸烟者。3[接触IPV的妇女与更危险的人发生性行为 伴侣，包括艾滋病毒阳性者、静脉吸毒者和非性别者，4，5和更有可能 从事无保护措施的性行为6-8和性交易，9和报告更多的性伴侣。4，7]创伤后应激障碍在 接触IPV的女性(31%到84%)、3，10和IPV相关的创伤后应激障碍症状与药物呈正相关，11-13 酒精，14，15和烟草使用16，17和艾滋病毒/性风险。18，19尽管创伤后应激障碍在这方面有明显的临床相关性 人口，特别是在物质使用和危险性行为方面，没有任何研究阐明其机制 这可能解释了创伤后应激障碍症状和药物使用以及艾滋病毒/性危险行为之间的关系。 在接触过IPV的女性中。情绪障碍被认为是其发病的关键机制之一。 广泛的心理障碍和适应不良行为，20包括创伤后应激障碍，21-24药物使用，25- 29和艾滋病毒/性风险。25、30-32然而，对这些健康结果背后的一般机制的研究，以及 尤其是情绪障碍的潜在机制，在这一人群中缺失。接触IPV的妇女 构成有别于其他创伤暴露人群的独特人群。IPV是慢性的；女性是 反复受到伴侣的伤害，并反复暴露于潜在的创伤刺激中 33，34这一独特的背景增加了创伤后应激障碍症状、情绪障碍、 物质使用和艾滋病毒/性风险。治疗创伤后应激障碍及其伴发疾病的现有干预模式 物质使用和/或危险的性行为(例如，寻求安全，35项目联系36)不是为以下女性开发的 仍然处于不安全的情况下，很少以社区为基础，并且没有综合关注IPV、创伤后应激障碍、 物质使用和艾滋病毒/性风险。与当前的倡议(例如，国家卫生研究院战略计划37)保持一致，确定 跨多个系统(即，生理和行为)的机械性过程，构成关系的基础 在创伤后应激障碍中，药物使用和艾滋病毒/性风险是发展的关键的第一步 对社区感染IPV的妇女安全的有针对性的干预。102,103拟议的研究 用创新的、针对具体情况的、多方法的方法解决研究中的这些关键差距 在目前正在经历IPV和使用药物的150名妇女中。调查结果将[确定以下各项之间的关系 生理、性和心理IPV和情绪功能障碍；]阐述情绪功能障碍在 创伤后应激障碍症状和实验室中的冒险倾向，以及现实世界中的药物使用和艾滋病毒/性风险； 并对实验室数据和实际数据的收敛有效性进行了检验。情绪障碍在创伤后应激障碍症状中的作用 冒险倾向将通过一种新的实验范式在实验室和现实世界中进行测量 通过日常评估(即经验抽样)。 Weiss博士非常适合指导以患者为导向的研究事业发展 由美国国立卫生研究院颁发的奖项。她是一位由NIDA资助的高效的T32博士后 耶鲁大学精神病学系药物滥用预防研究研究员 医学部。在拟议的培训期间，韦斯博士将被安置在 耶鲁大学医学院的精神病学。她还将利用所提供的丰富资源 通过康涅狄格大学卫生中心的临床和翻译科学研究所 科罗拉多大学丹佛安舒茨医学院。在这些设置中，她将可以访问 在研究设计、方法和分析方面拥有世界级的专业知识。韦斯博士的研究计划侧重于 情绪障碍在创伤后应激障碍(PTSD)及相关物质使用中的作用 艾滋病毒/性风险。她发表了关于这些主题的[12]第一作者和[8]合著者手稿。她长长的- 任期目标是成为旨在预防和减少药物使用和艾滋病毒/性风险的研究的领导者 在经历过亲密伴侣暴力(IPV)的创伤后应激障碍女性中；建立强大的多学科 伙伴关系，以确定潜在的生理机制和潜在的物质使用行为过程 和感染IPV的患有创伤后应激障碍的妇女的艾滋病毒/性风险；并制定预防和干预措施 针对患有创伤后应激障碍的暴露于IPV的妇女的药物使用和艾滋病毒/性风险的努力。续 赞助、指导和定向研究将促进高级研究技能的发展。 韦斯可以走在这些领域的前沿研究的前沿。短期职业目标侧重于 精通(A)生理学(即交感、副交感和神经内分泌)和 消极和积极情绪障碍的行为评估；(B)微观纵向研究设计， 方法和分析；以及(C)[最佳设计和实施战略，例如道德和安全 与对经历IPV和使用药物的妇女进行研究有关的问题。]

PROJECT SUMMARY/ABSTRACT IPV is a pervasive and serious public health issue, affecting nearly one in three women nationally in their lifetime.1 IPV-exposed women have rates of drug and alcohol misuse that are 2–7 times higher than women nationally.2,3 As many as 70% are tobacco smokers.3 [IPV-exposed women have sex with more risky partners, including those who are HIV-positive, IV drug users, and nonmomgomous,4,5 and are more likely to engage in unprotected sex6-8 and trade sex,9 and report more sex partners.4,7] PTSD is highly prevalent among IPV-exposed women (31 to 84%),3,10 and IPV-related PTSD symptoms are positively associated with drug,11-13 alcohol,14,15 and tobacco use16,17 and HIV/sexual risk.18,19 Despite the clear clinical relevance of PTSD in this population, particularly with regard to substance use and risky sex, no studies have explicated mechanisms that may account for relations between PTSD symptoms and substance use and HIV/sexual risk behaviors among IPV-exposed women. Emotion dysfunction has been identified as a key mechanism in the pathogenesis of a wide range of psychological difficulties and maladaptive behaviors,20 including PTSD,21-24 substance use,25- 29 and HIV/sexual risk.25,30-32 Yet, research on mechanisms underlying these health outcomes generally, and the potential mechanism of emotion dysfunction in particular, is absent in this population. IPV-exposed women constitute a unique population distinct from other trauma-exposed populations. IPV is chronic; women are recurrently victimized by their partners and repeatedly exposed to potentially traumatic stimuli in their environment.33,34 This unique context poses increased risk for PTSD symptoms, emotion dysfunction, substance use, and HIV/sexual risk. Existing intervention models for treating PTSD and co-occurring substance use and/or risky sex (e.g., Seeking Safety,35 Project Connect36) were not developed for women who remain in unsafe situations, are seldom community-based, and do not have an integrated focus on IPV, PTSD, substance use, and HIV/sexual risk. Consistent with current initiatives (e.g., NIH strategic plans37), identifying mechanistic processes, across multiple systems (i.e., physiological and behavioral), underlying the relations among PTSD, substance use, and HIV/sexual risk in this population is a critical first step in developing targeted interventions that are safe for IPV-exposed women in the community.102,103 The proposed study addresses such critical gaps in the research with an innovative, context-specific, multi-method approach among 150 women currently experiencing IPV and using substances. Findings will [identify relations among physical, sexual, and psychological IPV and emotion dysfunction;] explicate the role of emotion dysfunction in PTSD symptoms and risk-taking propensity in the lab and substance use and HIV/sexual risk in the real-world; and test the convergent validity of lab and real-world data. The role of emotion dysfunction in PTSD symptoms and risk-taking propensity will be measured in the lab via a novel experimental paradigm and in the real world via daily assessments (i.e., experience sampling). Dr. Weiss is extremely well-qualified for the Mentored Patient-oriented Research Career Development Award from the National Institutes of Health. She is a highly productive NIDA-funded T32 Post-doctoral Fellow in Substance Abuse Prevention Research in the Department of Psychiatry at the Yale University School of Medicine. During the proposed training period, Dr. Weiss will be housed within the Department of Psychiatry at the Yale University School of Medicine. She will also draw from the rich resources provided through the Institute for Clinical and Translational Science at the University of Connecticut Health Center and the University of Colorado Denver Anschutz Medical Campus. Across these settings, she will have access to world-class expertise in research design, methodology, and analysis. Dr. Weiss' program of research focuses on the role of emotion dysfunction in posttraumatic stress disorder (PTSD) and related substance use and HIV/sexual risk. She has published [12] first-author and [8] co-author manuscripts on these topics. Her long- term goals are to be a leader in research aimed at preventing and reducing substance use and HIV/sexual risk among women with PTSD who experience intimate partner violence (IPV); to build strong multi-disciplinary partnerships to identify potential physiological mechanisms and behavioral processes underlying substance use and HIV/sexual risk among IPV-exposed women with PTSD; and to develop prevention and intervention efforts targeting substance use and HIV/sexual risk among IPV-exposed women with PTSD. Continued sponsorship, mentoring, and directed study will facilitate the development of advanced research skills so Dr. Weiss can be at the forefront of cutting-edge research in these areas. Short-term career objectives focus on the development of proficiency in (a) physiological (i.e., sympathetic, parasympathetic, and neuroendocrine) and behavioral assessments of negative and positive emotion dysfunction; (b) micro-longitudinal research design, methods, and analysis; and (c) [optimal design and implementation strategies, such as ethical and safety issues, pertinent to the conduct of research with women who experience IPV and use substances.]