Mindfulness-intervention to Address PTSD in Trauma-exposed, Homeless Women

摘要 创伤后应激障碍(PTSD)是一种主要的公共卫生问题，对少数族裔的影响不成比例 以及那些社会经济地位较低的人，如无家可归的妇女，造成严重的健康差距。创伤后应激障碍 与下丘脑-垂体-肾上腺(HPA)功能失调和炎症增加有关， 这可能导致长期的身体健康问题和创伤后应激障碍症状的维持，加剧 差距。基于正念的干预，包括基于正念的压力减轻(MBSR)，有 显示出作为解决退伍军人和低收入少数群体创伤后应激障碍的补充工具的前景 人口中，但无家可归的妇女没有得到充分的检查。MBSR可能改善创伤后应激障碍 症状学并帮助调节创伤后应激障碍患者常见的失调应激反应， 同时改善身心健康。该项目提出了一种混合方法、开放标签、并行、 一种改良的MBSR干预措施减少无家可归妇女和 探讨治疗反应的生理学相关因素。目前的入选标准将是无家可归的妇女， 18岁-，患有标准指南定义的临床显著的创伤后应激障碍。第一阶段将是定性研究。 改进MBSR以适应少数族裔社区的文化需求，并满足 无家可归的女人。在第二阶段，参与者将被随机分配到基于MBSR的干预或健康 推广注意-控制组。在基线阶段，妇女将完成心理社会评估(例如， 抑郁、药物使用、创伤病史)，并参与一项简短的压力任务，提供唾液样本 任务前后(将检测皮质醇和C反应蛋白，这是炎症的标志)。 然后，女性将参加为期9周的基于MBSR的计划或健康促进控制组。跟进 包括心理社会和生物数据的评估将在最后干预会议结束后立即进行 6个月后又来了一次。临床上有意义的创伤后应激障碍的改善(主要结果)和次要结果 然后将检查结果(例如，抑郁、药物使用、炎症、皮质醇反应性)。这个 候选人的培训计划充分利用了不同指导团队的专业知识，整合了高级培训 在混合方法研究、基于社区的临床试验、基于正念的干预和唾液中 生物科学。该计划包括加州大学欧文分校的授课课程和一对一辅导 (混合方法、定性设计、临床试验和唾液生物科学)和洛玛琳达大学(MBIS)， 都在南加州。培训计划还包括每个实质性领域和#年的深入讲习班。 在负责任的研究行为方面的培训。考生将以混合专业知识完成K01考试- 方法，生物心理社会方法，以解决具有高度健康差异的人群中的创伤后应激障碍。

ABSTRACT Posttraumatic stress disorder (PTSD) is a major public health concern that disproportionately effects minorities and those with low-socioeconomic status, such as homeless women, creating a critical health disparity. PTSD has been linked with dysregulated hypothalamic-pituitary-adrenal (HPA) functioning and increased inflammation, which can lead to long-term physical-health problems and PTSD-symptom maintenance, exacerbating disparities. Mindfulness-based interventions, including Mindfulness-based Stress Reduction (MBSR), have shown promise as a complementary tool for addressing PTSD in veterans and with low-income, minority populations, but homeless women have not been examined adequately. MBSR may improve PTSD symptomatology and help modulate the dysregulated stress response common in individuals with PTSD, improving physical and mental health concurrently. This project proposes a mixed-methods, open-label, parallel, randomized-clinical trial of a modified-MBSR intervention to reduce PTSD symptoms in homeless women and to explore physiological correlates of treatment-response. Inclusion criteria will be currently homeless women, age 18-64, with clinically-significant PTSD as defined by standard guidelines. Phase I will be a qualitative study to refine MBSR for cultural-appropriateness in a high-minority community and to address the specific needs of homeless women. In Phase II, participants will be randomly assigned to the MBSR-based intervention or a health promotion attention-control group. At baseline, women will complete psychosocial assessments (e.g., depression, substance use, trauma history) and participate in a brief stress task, providing salivary samples before and after the task (which will be assayed for cortisol and C-reactive protein, a marker of inflammation). Women will then participate in the 9-week MBSR-based program or health-promotion control group. Follow-up assessments that include psychosocial and biological data will occur immediately after final intervention session and again 6-months later. Clinically-meaningful improvements in PTSD (primary outcome) and secondary outcomes (e.g., depression, substance use, inflammation, cortisol reactivity) will then be examined. The candidate’s training plan capitalizes on the expertise of a diverse mentoring team, integrating advanced training in mixed-methods research, community-based clinical trials, mindfulness-based interventions, and salivary biosciences. The plan includes didactic courses and on-one-one mentoring at the University of California, Irvine (mixed-methods, qualitative design, clinical trials, and salivary bioscience) and Loma Linda University (MBIs), both in Southern California. The training plan also includes in-depth workshops in each substantive area and in training in the responsible conduct of research. The candidate will complete the K01 with expertise in mixed- methods, biopsychosocial approaches to address PTSD in populations with high health-disparities.