Multiple Levels of Analysis: Trauma, Violence and PTSD Among Youths'

描述（由申请人提供）：尽管全国趋势显示暴力犯罪下降，但研究表明，暴力在一些社区以及家庭，学校和媒体中仍然高得惊人。这一拟议的R21项目有两个目标：以青年的心理健康为基础，对青年在社会环境中遭受暴力的情况进行多信息源、多方法的评估;为开展新的研究奠定基础，以减少和预防青年遭受暴力的有害心理健康后果。我们的新的评估方法是由一个四维概念的暴力暴露的基础上的背景（设置），内容（影响），渠道（曝光模式），和慢性（曝光频率）的具体暴力行为。我们的测量与心理健康（外化，内化和创伤性应激障碍）的综合评估相关联，以提供基于发展精神病理学当前理论的暴力暴露负担的总体评估。这项调查将在社会经济困难的城市社区进行，包括东北部一个主要大都市地区的一系列预计暴力风险。我们的研究人群将是有11至14岁（含）儿童的家庭;我们将对看护者-青少年配对（二元N = 200）进行抽样，以制定一个全面的协议，将这些配对的信息直接与来自各个层面的数据源的信息整合在一起。社会生态。本研究有五个目的：1）发展并实施一个跨被访者、混合方法的青少年社会环境暴力暴露评估方案; 2）利用我们新的暴力暴露四维概念来评估新的个性化方案的心理测量学特性并建立内部效度;（3）应用暴力暴露如何影响心理健康结果的双路径模型来评估新方案的标准效度; 4）采用多变量建模来分析有意义的亚群（例如，暴露的低风险和高风险），以评估新方案的普遍性;以及5）分析各种报告组合，以最终确定临床研究环境中的现场测试方案。我们的调查将提供关键信息，以了解暴力暴露如何导致负面的健康结果。最终，这一知识对于努力减少遭受暴力的负面影响至关重要。我们衡量青少年遭受暴力的方法对于制定个性化评估和干预战略以减轻儿童和青少年遭受暴力的负面后果至关重要。此外，拟议的调查是一个必要的步骤，扩大我们的知识，暴力的社会生态如何影响个人的心理健康，通过生物心理社会机制。公共卫生相关性：虽然大量研究证实，青少年在多种社会环境中遭受暴力对其心理健康状况产生有害影响，但尚未作出系统的努力，制定一种理论上知情的衡量各种环境中遭受暴力的措施。正确评估暴露于暴力沿着关键方面，包括背景以及严重程度，频率和暴露模式，是推进我们对暴力如何影响青少年心理健康结果的理解的重要一步。更好地测量接触也将转化为更精确和最终更有效的干预战略。拟议的项目旨在制定一项新的议定书，以评估青少年遭受暴力的情况，并探讨不同的遭受情况如何解释不同的精神病理模式。

DESCRIPTION (provided by applicant): Despite national trends showing declines in violent crime, studies show that violence remains alarmingly high in some communities as well as in homes, schools, and the media. The goal of this proposed R21 project is twofold: To develop a multi-informant, multi-method assessment of youths' exposure to violence in the social environment, anchored to youths' mental health; and to set a foundation for launching new research into the reduction and prevention of the deleterious mental health consequences of youth violence exposure. Our novel approach to assessment is driven by a four-dimensional conception of violence exposure based on the context (setting), content (impact), channel (mode of exposure), and chronicity (frequency of exposure) of specific acts of violence. Our measurement is tied to a comprehensive assessment of mental health (externalizing, internalizing, and traumatic stress disorders) to provide an overall assessment of the burden of violence exposure based on current theory in developmental psychopathology. This investigation will be conducted in socio-economically distressed urban neighborhoods comprising a range of projected risk for exposure to violence in a major metropolitan area of the Northeast. Our study population will be families with children between the ages of 11 and 14 inclusive; we will sample caregiver-youth pairs (dyadic N = 200) for a comprehensive protocol integrating information from the pairs directly with information from data sources across all levels of the social ecology. Our investigation is guided by five aims: 1) Develop and implement a cross-informant, mixed-method protocol for assessing youths' exposure to violence in the social environment; 2) Utilize our novel four-dimensional conception of violence exposure to evaluate the psychometric properties of the new individualized protocol and establish internal validity; 3) Apply a dual pathway model of how exposure to violence affects mental health outcomes to evaluate the criterion validity of the new protocol; 4) Employ multivariate modeling to analyze patterns of exposure and associated outcomes across meaningful subpopulations (e.g., low and high risk for exposure) to assess the generalizability of the new protocol; and 5) Analyze various combinations of reports in order to finalize a protocol for field testing in clinical research settings. Our investigation will provide information critical to understanding how violence exposure leads to negative health outcomes. Ultimately this knowledge will be essential to efforts at reducing the negative impact of exposure to violence. Our approach to measuring youths' exposure to violence is essential for formulating individualized assessment and intervention strategies for ameliorating the negative sequelae of exposure among children and adolescents. Further, the proposed investigation represents a necessary step in expanding our knowledge of how violence in the social ecology impacts individual mental health via biopsychosocial mechanisms. PUBLIC HEALTH RELEVANCE: Although a large body of research confirms detrimental effects of youths' exposure to violence in multiple social contexts on their mental health status, there have been no systematic efforts to develop a theoretically informed measure of exposure to violence across settings. Properly assessing exposure to violence along key dimensions including context as well as severity, frequency, and mode of exposure is an essential step in advancing our understanding of how violence affects youths' mental health outcomes. Better measurement of exposure also will translate into more precise and ultimately more effective intervention strategies. The proposed project aims to develop a new protocol for assessing youths' exposure to violence and exploring how different profiles of exposure account for different patterns of psychopathology.