Models of Risk for PTSD

创伤后应激障碍 (PTSD) 风险模型

• 批准号: 8567388
• 负责人: Matthew C. Morris
• 金额: $ 17.44万
• 依托单位: MEHARRY MEDICAL COLLEGE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-09 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8567388
• 关键词: Accounting; Acute; Address; Adrenal Glands; Area; Chronic stress; Clinical; Cognitive; Consultations; Control Groups; Coping Skills; Cross-Sectional Studies; Data Collection; Early Intervention; Early treatment; Emotional; Event; Exposure to; Fright; Goals; Healthcare; Hydrocortisone; Hypothalamic structure; Individual; Individual Differences; Interpersonal Violence; Intervention; Laboratories; Life Stress; Link; Literature; Maintenance; Major Depressive Disorder; Measures; Mental Health; Mentors; Methods; Modeling; Mood Disorders; Nervous System Physiology; Neurobiology; Neuropsychological Tests; Neurosecretory Systems; Outcome; Output; Pathway interactions; Patient Self-Report; Pattern; Performance; Peripheral; Physiological; Pituitary Gland; Pituitary-Adrenal System; Play; Post-Traumatic Stress Disorders; Problem behavior; Process; Psychosocial Factor; Psychosocial Stress; Public Health; Reading; Research; Research Training; Risk; Risk Factors; Risk Marker; Role; Safety; Saliva; Salivary; Sampling; Schools; Social Problems; Stress; Sympathetic Nervous System; Symptoms; System; Time; Training; Training Programs; Trauma; United States; Woman; Work; alpha-amylase; base; biological adaptation to stress; coping; depressive symptoms; disorder risk; executive function; experience; high risk; hypothalamic-pituitary-adrenal axis; indexing; innovation; intervention program; longitudinal design; meetings; men; neurobiological mechanism; pediatric trauma; physical assault; programs; psychosocial; public health relevance; response; sexual assault; skills; treatment program; violence against women

DESCRIPTION (provided by applicant): This application seeks to identify cognitive and neurobiological markers of risk for posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD) in the acute aftermath of trauma. In addition, a plan is outlined for the candidate to acquire the necessary training to develop an independent program of research focused on understanding markers and mechanisms of risk for PTSD and MDD. The candidate's prior training in life stress, mood disorders and PTSD research has allowed him to hone many skills necessary for achieving this goal. However, he requires additional training, mentoring and experience in five key areas: (1) diurnal sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) activity; (2) SNS and HPA reactivity to stress; (3) neurobiological risk markers for PTSD; (4) cognitive risk factors for PTSD and MDD; and (5) longitudinal designs to study coping and neuroendocrine trajectories for the onset and course of PTSD and/or MDD. A comprehensive training plain has been developed that includes hands-on didactic experiences, formal coursework, independent readings, seminars, webinars, mentoring meetings and consultation with experts in these five key areas. The proposed study will investigate longitudinal pathways leading from interpersonal violence (IPV) exposure to PTSD and/or MDD in a sample of 60 women recently exposed to IPV and 40 non-exposed women using four waves of data collection (within 1 month after exposure to IPV, and at 1, 3, and 6 months following the initial assessment). Although women are twice as likely as men to develop PTSD and/or MDD after exposure to trauma, the mechanisms underlying this increased risk remain unclear. Identifying individuals at elevated risk for these disorders is critical for developing effective early intervention programs. The HPA and SNS systems serve as main lines of defense in responding to stress or trauma. Individuals who develop PTSD have reduced activity in the HPA system and increased activity in the SNS following trauma. Cross-sectional studies suggest that a progressive divergence of HPA and SNS activity following trauma may contribute to the maintenance of PTSD, but there is scant longitudinal research to support this hypothesis. Although PTSD and MDD frequently co-occur, the role of MDD symptoms in the patterns of HPA and SNS function following trauma-exposure has not yet been described. The primary aims of the proposed study are to (a) examine whether a progressive divergence in SNS and HPA daily output is associated with higher levels of PTSD symptoms over time, and (b) to determine whether women at greater risk for PTSD fail to habituate in terms of their cortisol responses to a psychosocial stress task. Secondary goals will examine the role of co-occurring MDD symptoms on diurnal secretion and reactivity of HPA/SNS systems. Psychosocial factors such as coping strategies may also determine the risk for PTSD and/or MDD and may influence SNS/HPA function. Results will identify cognitive and neurobiological factors associated with risk for PTSD and/or MDD that could be used to develop more "personalized" early intervention programs.

描述（由申请人提供）：本申请旨在确定创伤后应激障碍（PTSD）和/或主要抑郁症（MDD）的认知和神经生物学标志物（MDD）。此外，概述了一项计划，概述了候选人获得必要的培训，以制定一项独立的研究计划，该计划的重点是理解PTSD和MDD风险的标记和机制。候选人先前在生活压力，情绪障碍和PTSD研究方面进行的培训使他能够磨练实现这一目标所需的许多技能。但是，他需要在五个关键领域进行额外的培训，指导和经验：（1）昼夜交感神经系统（SNS）和下丘脑 - 垂体 - 肾上腺（HPA）活动； （2）SNS和HPA对压力的反应性； （3）PTSD的神经生物学风险标记； （4）PTSD和MDD的认知风险因素； （5）研究应对和神经内分泌轨迹的纵向设计，以进行PTSD和/或MDD的发作和过程。已经开发了一个全面的培训平原，其中包括动手教学经验，正式课程，独立阅读，研讨会，网络研讨会，指导会议以及与这五个关键领域的专家进行磋商。拟议的研究将调查从人际际暴力（IPV）暴露于PTSD和/或MDD的纵向途径，该样本最近暴露于IPV和40名非暴露妇女的样本中使用四波数据收集（在暴露于接触后的1个月内） IPV，以及初次评估后的1、3和6个月）。尽管女性在接触创伤后发展PTSD和/或MDD的可能性是男性的两倍，但这种增加的风险的机制仍不清楚。确定这些疾病风险较高的人对于制定有效的早期干预计划至关重要。 HPA和SNS系统是应对压力或创伤的主要防御线。发生PTSD的个体在HPA系统中的活性降低，创伤后SNS的活动增加。横断面研究表明，创伤后HPA和SNS活性的逐渐差异可能有助于维持PTSD，但是有很少的纵向研究以支持这一假设。尽管PTSD和MDD经常同时发生，但尚未描述MDD症状在HPA和SNS功能模式中的作用。拟议的研究的主要目的是（a）检查SNS和HPA每日产量的进行性差异随着时间的推移是否与较高水平的PTSD症状有关，并且（b）确定PTSD风险更大的女性是否不习惯于习惯就其皮质醇对心理压力任务的反应而言。次要目标将检查同时发生的MDD症状在HPA/SNS系统的昼夜分泌和反应性中的作用。诸如应对策略之类的社会心理因素也可能决定PTSD和/或MDD的风险，并可能影响SNS/HPA功能。结果将确定与PTSD和/或MDD风险相关的认知和神经生物学因素，这些因素可用于开发更多“个性化”的早期干预计划。