A prospective study of posttraumatic stress symptom development and cannabis use among trauma exposed injured emerging adults following Emergency Department discharge

急诊科出院后遭受创伤的受伤新兴成年人的创伤后应激症状发展和大麻使用的前瞻性研究

• 批准号: 10331947
• 负责人: Leslie Ann Daline Brick
• 金额: $ 40.7万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10331947
• 关键词: Accident and Emergency department; Acute; Adult; Affect; Affective; Anxiety; Arousal; Behavior; Belief; Cannabinoids; Cannabis; Centers of Research Excellence; Chronic; Clinical; Cognition; Collection; Communities; Complex; Consumption; Coupling; Development; Diagnosis; Distress; Ecological momentary assessment; Emergency Department evaluation; Goals; Health; Heart Rate; Hospitals; Individual; Injury; Intensive Care; Interview; Laws; Lead; Legal; Licensing; Life; Link; Long-Term Effects; Medical Marijuana; Mental Depression; Modeling; Monitor; Negative Reinforcements; Outcome; Output; Participant; Patient Self-Report; Pattern; Physiological; Physiology; Play; Post-Traumatic Stress Disorders; Prospective Studies; Psychopathology; Qualifying; Recovery; Reporting; Research; Rhode Island; Risk; Role; Safety; Sampling; Self Medication; Severities; Sleep Disorders; Sleeplessness; Stress; Substance Use Disorder; Symptoms; Therapeutic; Time; Trauma; Trauma patient; Trauma recovery; Traumatic injury; United States; Vehicle crash; Withdrawal Symptom; acute stress; acute symptom; aged; alcohol and other drug; anxiety states; biological adaptation to stress; clinically significant; coping; critical period; emerging adult; endogenous cannabinoid system; experience; follow-up; high risk; injured; insight; marijuana legalization; marijuana use; marijuana use disorder; marijuana user; mortality; negative affect; negative mood; patient oriented; physical assault; post-trauma; post-traumatic symptoms; prospective; recruit; reduce symptoms; response; smart watch; social relationships; stress related disorder; stress symptom; substance misuse; substance use; symptom cluster; trauma centers; trauma exposure; trauma symptom; wearable sensor technology

PROJECT SUMMARY Individuals who experience traumatic physical injury are at a heightened risk for a range of negative outcomes such as posttraumatic stress disorder (PTSD) and substance misuse. The early post-trauma period (i.e., the days, weeks, and months following exposure) represents a critical period of recovery and may be especially important for understanding symptom development among emerging adults (aged 18-25), who are characterized by a developmental peak in substance use behaviors and an increased risk for trauma exposure and injury. As regional laws, cultures, and beliefs about cannabis use (CU) continue to shift, there is concern that traumatic injury may result in escalations in cannabis use, as many individuals report using cannabis to relieve distress, hyperarousal, and other post-trauma symptoms. Furthermore, while the majority of US states that have legalized cannabis for medical use include outcomes of stress and trauma (such as PTSD) as qualifying conditions for a state-issued medical marijuana license, little is known about how CU may impact the early post-trauma course, including development of PTSD and other stress-related outcomes such as depression, anxiety, and substance misuse. Despite the known role of the endocannabinoid system in regulating the stress response, limited (and contradicting) evidence exists regarding safety and efficacy of cannabis precludes strong conclusions about its role during acute post-trauma recovery, with some prospective studies demonstrating detrimental or no long-term effects of CU on PTSD symptoms. The overarching goals of the proposed study are to characterize CU as related to post-trauma symptoms and cannabis misuse during the period immediately following trauma exposure among a sample of injured emerging adults. We will recruit N=100 trauma-exposed cannabis users (aged 18-25) presenting to the Emergency Department for evaluation after acute injury (e.g., physical assault, serious vehicular crashes). Upon discharge, participants will complete 4-weeks of ecological momentary assessment (EMA) to record CU behavior and PTSD symptom development, paired with passive collection of physiological output (heart rate) via wearable biosensors (smartwatch) to monitor physiology. Participants will return for completion of clinical interview and self-report of symptoms at 4-weeks and 6-months post-discharge. The main objectives of this research are to: (a) characterize the course of PTSD symptom development, physiology, and cannabis use during the acute post-trauma period and (b) evaluate effects of the acute post-trauma response on long term development of PTSD and other stress sensitive outcomes (depression, anxiety, cannabis misuse) at 6-month follow-up.

项目概要 经历过身体创伤的个人出现一系列负面后果的风险更高 例如创伤后应激障碍（PTSD）和药物滥用。创伤后早期（即 暴露后的几天、几周和几个月）代表了恢复的关键时期，并且可能尤其如此 对于了解新兴成年人（18-25 岁）的症状发展非常重要，他们 其特点是物质使用行为的发展高峰和创伤暴露风险增加 和伤害。随着有关大麻使用 (CU) 的地区法律、文化和信仰不断发生变化，人们开始担心 创伤性伤害可能导致大麻使用升级，因为许多人报告使用大麻 缓解痛苦、过度警觉和其他创伤后症状。此外，虽然美国大多数州 将大麻用于医疗用途合法化的因素包括压力和创伤（如创伤后应激障碍）的后果 国家颁发的医用大麻许可证的资格条件，对于 CU 可能如何影响人们知之甚少 创伤后早期过程，包括创伤后应激障碍（PTSD）的发展和其他与压力相关的结果，例如 抑郁、焦虑和药物滥用。尽管内源性大麻素系统在 调节应激反应，关于安全性和有效性的证据有限（且相互矛盾） 大麻排除了关于其在急性创伤后恢复过程中的作用的强有力的结论，一些人认为 前瞻性研究表明 CU 对 PTSD 症状有有害或没有长期影响。这 拟议研究的总体目标是描述 CU 与创伤后症状相关的特征，以及 受伤者样本在遭受创伤后立即滥用大麻 新兴成年人。我们将招募 N=100 名遭受创伤的大麻使用者（18-25 岁），向 急诊科在急性损伤（例如人身攻击、严重车祸）后进行评估。 出院后，参与者将完成为期 4 周的生态瞬时评估 (EMA) 以记录 CU 行为和 PTSD 症状的发展，配合被动收集生理输出（心率） 通过可穿戴生物传感器（智能手表）来监测生理机能。参与者将返回完成临床 出院后 4 周和 6 个月的访谈和症状自我报告。本次活动的主要目标 研究目的是：(a) 描述 PTSD 症状发展、生理学和大麻使用过程的特征 (b) 评估急性创伤后反应对长期的影响 6 个月时出现 PTSD 和其他压力敏感结果（抑郁、焦虑、大麻滥用） 后续行动。