Ecological Momentary Assessment of Posttraumatic Stress Disorder and Prenatal Bonding Predicting Opioid Use Disorder Relapse Among Pregnant Women

创伤后应激障碍的生态瞬时评估和预测孕妇阿片类药物使用障碍复发的产前联系

• 批准号: 9894212
• 负责人: Pilar M Sanjuan
• 金额: $ 23.13万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-15 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9894212
• 关键词: Accounting; Address; Affect; Alcohol or Other Drugs use; Area; Behavior; Biological; Characteristics; Child; Cues; Data; Data Collection; Development; Drug usage; Ecological momentary assessment; Event; Family; Feeling; Fetal Development; Fetus; Goals; Intervention; Knowledge; Link; Mediating; Mediator of activation protein; Mission; Mobile Health Application; Modeling; National Institute of Drug Abuse; Neonatal Abstinence Syndrome; Opioid; Outpatients; Parents; Population; Post-Traumatic Stress Disorders; Postpartum Depression; Pregnancy; Pregnant Women; Recording of previous events; Relapse; Research; Risk; Risk Factors; Role; Science; Severities; Sex Differences; Substance Use Disorder; Symptoms; Techniques; Testing; Time; Tobacco use; Trauma; United States; United States National Institutes of Health; Woman; alcohol consumption during pregnancy; anxiety sensitivity; associated symptom; base; comorbidity; craving; design; drug craving; drug relapse; emotion regulation; experience; fetal; handheld mobile device; improved; innovation; mHealth; medication-assisted treatment; opioid use; opioid use disorder; opioid use in pregnancy; post-traumatic symptoms; pregnant; prenatal; prenatal health; prenatal risk factor; prevent; protective factors; psychosocial; recruit; relapse risk; standard of care; therapy development; trait

This resubmitted application responds to PA-18-602 and seeks to determine on a day-to-day basis how, during pregnancy, posttraumatic stress disorder (PTSD) symptoms are associated with opioid use disorder (OUD) relapse, a fundamental gap in the research. A theoretical framework is developed that identifies prenatal bonding and opioid craving as mediators, and emotion regulation and anxiety sensitivity as moderators, of the central PTSD/relapse relationship. This will be the first study to investigate the temporal ebb and flow of risk and protective factors for OUD relapse for pregnant women and, as such, this study advances the more common situation where research, using fixed assessments, investigates pregnant women with various substance use disorders (SUD). This is an excellent model because pregnant women have unique characteristics that change over time potentially associated with relapse. They have high rates of PTSD (relapse risk factor and common OUD comorbidity), and PTSD cues induce craving that triggers relapses. Importantly, pregnant women have a unique relevant biological variable that may be a protective factor - prenatal fetal bonding. The long term goal of this research is to develop empirically-based mobile-health interventions to target proximal risks for OUD relapse as they occur in real time. The central hypothesis is that during pregnancy PTSD symptoms will fluctuate over time and will increase or reduce proximal risk of relapse, and that the PTSD/relapse relationship will be mediated by fluctuations in opioid craving and prenatal bonding and moderated by trait emotion regulation and anxiety sensitivity. The rationale is that factors associated with relapse are not static, but fluctuate over time. Moreover, relapse events occur at moments in time. We propose to use ecological momentary assessment (EMA: using mobile devices) to collect data on fluctuating risk factors and opioid use multiple times per day using a mixed event and time-based design for 6 weeks, to assess proximal risk factors for OUD relapse in pregnant women (N=75). OUD relapse during pregnancy differs from other SUD, since medication-assisted treatment is the recommended standard of care, and is thus better examined separately. Guided by strong preliminary data supporting design feasibility, this hypothesis will be tested via two specific aims: Aim 1. Examine near real time associations during pregnancy between PTSD symptoms and opioid use. Aim 2. Examine mediators (prenatal bonding and craving) and moderators (anxiety sensitivity and emotion regulation) of associations during pregnancy between PTSD symptoms and opioid use. The proposed research is significant, because it is expected to advance our understanding of how fluctuations in PTSD symptoms, craving, and a pregnancy specific protective factor – prenatal bonding – impact OUD relapse. Ultimately, this knowledge will lead to science-based mobile-health applications tailored for pregnant women. The approach is innovative because it targets an understudied population and examines fluctuation in proximal risk and protective factors for OUD relapse, while accounting for moderators, using a technique (EMA) not previously applied in this context.

这种重新提交的应用程序对PA-18-602做出了反应，并寻求在SD上确定症状与阿片类药物使用障碍（OUD）复发有关，这是一个理论框架的基本差距。 /复发关系。与潜在的复发相关的自由度剧院的目标是发展，因为中心假设是在怀孕期间PTSD症状会随着时间的推移而波动，并且会增加或减少复发的近端风险阿片类药物渴望的果实和焦虑敏感性是静态的，而是静态的，而是静态的。使用混合事件和基于时间的设计6周，评估孕妇的近端风险因素（n = 75）通过强大的初步设计可行性，该假设将通过两个特定的目的来击败：AIM 1。PTSD症状和阿片类药物使用的怀孕期间的社会。在PTSD症状和阿片类药物的使用之间并使用以前在这种情况下未应用的技术（EMA）来检查主持人的波动。