Influence of PTSD Symptoms on Chronic Pain Development after Sexual Assault

PTSD 症状对性侵犯后慢性疼痛发展的影响

基本信息

批准号：
8893895
负责人：
SAMUEL A. MCLEAN
金额：
$ 64.59万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-17 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8893895
关键词：
Accident and Emergency department Acute Adrenal Glands Affect Aftercare Caring Chronic Cohort Studies Complex Consent Cross-Sectional Studies Data Development Dimensions Emergency Care Emergency Department Physician Emergency Situation Emergency department visit Enrollment Ensure Equation Etiology Evaluation Factor Analysis Genetic Genetic Variation Health Hypothalamic structure Individual Individual Differences Intervention Trial Link Mediating Modeling Musculoskeletal Pain Nurses Observational Study Outcome Pain Pain Measurement Participant Pilot Projects Pituitary Gland Population Population Study Post-Traumatic Stress Disorders Preventive Intervention Prospective Studies Recovery Reporting Research Personnel Study Section Subgroup Survivors Symptoms System Testing Time Training Trauma Veterans Woman assault chronic pain cohort design disaster survivor experience genetic variant high risk improved prevent prospective sexual assault therapy development

项目摘要

DESCRIPTION (provided by applicant): Each year more than 100,000 US women seek emergency medical care after sexual assault (SA). Most women do not return for/receive further care related to SA after initial emergency evaluation. Thus the emergency care visit represents a unique opportunity to identify SA survivors for preventive interventions to improve recovery. Cross-sectional studies indicate that chronic musculoskeletal pain (MSP) is reported by many SA survivors and is associated with substantial suffering and poor health outcomes. However, no prospective studies evaluating chronic MSP outcomes after SA have been performed, and therefore a firm etiologic link between SA and chronic MSP has not been established. In a recent prospective pilot study (n = 83), the investigators found that 41% of women SA survivors enrolled developed chronic moderate or severe MSP. Initial pain scores collected from all women approached for pilot study participation showed that more than half of those at high risk of chronic MSP consented and enrolled in the pilot study. In addition, data collected indicate that women SA survivors who participated in the pilot study are the same group of SA survivors who would be willing to participate in preventive intervention trials. However, currently no informatio exists regarding key factors that influence the transition from acute to chronic post-SA MSP to inform the design of such trials. Available evidence suggests that posttraumatic stress disorder (PTSD) symptoms may be key factors mediating the transition from acute to chronic post-SA MSP. PTSD symptom clusters have been found to mediate the transition from acute to chronic MSP in other trauma populations, and the investigator's pilot data support these relationships in the study population. Importantly, despite evidence that PTSD symptoms are key factors mediating chronic post-SA MSP development, available data also indicate that not all individuals with acute MSP develop PTSD symptoms, and not all individuals with PTSD symptoms develop chronic MSP. This suggests that important individual differences moderate these relationships. Available evidence, and the investigator's pilot data, suggests that genetic variants affecting the function of hypothalamic-pituitary-adrenal (HPA) and catecholaminergic systems constitute such important individual differences. The investigators propose a prospective cohort study of women SA survivors (n = 900) evaluated 1 week, 6 weeks, 6 months, and 12 months after SA. A methodological approach including Confirmatory Factor Analyses and Structural Equation Modeling will be used to test the hypotheses that chronic MSP is common in the study population, that PTSD symptom clusters mediate the relationship between acute and chronic MSP after SA, and that the proposed genetic factors moderate these relationships. Results of this groundbreaking study will generalize to a large population of women SA survivors who experience a high burden of chronic post-SA MSP, and will inform the development of preventive interventions for this understudied population.

描述（由申请人提供）：每年有超过 100,000 名美国女性在性侵犯 (SA) 后寻求紧急医疗护理。大多数女性在初次紧急评估后不会返回/接受与 SA 相关的进一步护理。因此，紧急护理就诊提供了一个独特的机会来识别 SA 幸存者，以采取预防性干预措施以改善康复。横断面研究表明，许多 SA 幸存者都患有慢性肌肉骨骼疼痛 (MSP)，并且与严重的痛苦和不良的健康结果相关。然而，还没有评估 SA 后慢性 MSP 结局的前瞻性研究，因此尚未建立 SA 和慢性 MSP 之间牢固的病因学联系。在最近的一项前瞻性试点研究 (n = 83) 中，研究人员发现，41% 的女性 SA 幸存者患有慢性中度或重度 MSP。从参与试点研究的所有女性中收集的初始疼痛评分显示，超过一半的慢性 MSP 高风险女性同意并参加试点研究。此外，收集的数据表明参与试点研究的女性 SA 幸存者与愿意参加预防性干预试验的 SA 幸存者是同一组。然而，目前尚无关于影响 SA MSP 后急性向慢性转变的关键因素的信息，以指导此类试验的设计。现有证据表明，创伤后应激障碍 (PTSD) 症状可能是介导 SA 后 MSP 从急性向慢性转变的关键因素。已发现 PTSD 症状群可以介导其他创伤人群中从急性到慢性 MSP 的转变，并且研究者的试点数据支持研究人群中的这些关系。重要的是，尽管有证据表明 PTSD 症状是介导慢性 SA 后 MSP 发展的关键因素，但现有数据还表明，并非所有患有急性 MSP 的个体都会出现 PTSD 症状，也并非所有患有 PTSD 症状的个体都会出现慢性 MSP。这表明重要的个体差异调节了这些关系。现有证据和研究人员的试验数据表明，基因变异影响下丘脑-垂体-肾上腺（HPA）和儿茶酚胺能系统的功能构成了如此重要的个体差异。研究人员提出了一项针对女性 SA 幸存者（n = 900）的前瞻性队列研究，在 SA 后 1 周、6 周、6 个月和 12 个月进行评估。将使用包括验证性因素分析和结构方程模型在内的方法来检验以下假设：慢性 MSP 在研究人群中很常见，PTSD 症状群介导 SA 后急性和慢性 MSP 之间的关系，以及所提出的遗传因素调节这些关系。这项开创性研究的结果将推广到大量经历了长期 SA 后 MSP 的高负担的女性 SA 幸存者，并将为这一未被充分研究的人群制定预防干预措施提供信息。