Diseases of Despair in Young Adulthood: Risk, Resilience, and Prevention

青年期的绝望疾病：风险、恢复力和预防

基本信息

批准号：
9903905
负责人：
William Copeland
金额：
$ 41.88万
依托单位：
UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-15 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9903905
关键词：
Address Adolescence Adolescent Adult Affect Alcohol abuse Alcohol or Other Drugs use Alcoholic Liver Diseases Algorithms American Indians Americas Appalachian Region Behavior Benefits and Risks Biological Response Modifier Therapy Censuses Cessation of life Child Childhood Clinical Coin Communities Complement Complex County Data Data Analyses Data Set Development Diagnostic Disease Early Intervention Economics Education Epidemic Epidemiology Ethnic Origin Exposure to Feeling suicidal Grain Health Immune Individual Intervention Intervention Trial Knowledge Life Expectancy Longevity Longitudinal Studies Machine Learning Measurement Mediation Mining Modeling Molecular Neighborhoods Not Hispanic or Latino Opioid Participant Pathway interactions Pharmaceutical Preparations Poisoning Premature Mortality Prevalence Prevention Psychopathology Public Policy Quasi-experiment Race Randomized Research Research Design Resolution Risk Risk Factors Rural Rural Appalachia Rural Community Science Policy Series Societies Structure Subgroup Suicide Testing base clinically relevant cohort cost deprivation disorder risk experience follow-up illicit drug use insight longitudinal dataset machine learning algorithm mortality risk multimodality prevent programs prospective protective factors psychosocial public health emergency resilience secondary analysis sex social sociodemographics suicidal behavior trend young adult

项目摘要

ABSTRACT After decades of improvement, premature mortality is uniquely on the rise in the U.S. among White non- Hispanic adults with low education. Suicide, drug poisoning (particularly from opiates), and alcoholic liver disease appear to be the culprits and have been coined “deaths of despair.” Suicidal thoughts and behaviors, illicit drug use, and alcohol problems (or “diseases of despair,” DoD)—the conditions that likely precede these deaths—are the focus of this application, as are the pathways to these DoD. Despite many years of research and in the face of rising suicides and a nationwide opiates public health emergency, we lack accurate and appreciable predictions of who will succumb to DoD and who will be shielded from them. Speedy new insights on the development of DoD are needed to inform efforts to reverse the rising tide of DoD. These can only be generated with decades' worth of prospective-longitudinal data with rich coverage of multiple levels of risk and protective factors—from community contexts to molecular mechanisms—with clinically-relevant characterizations of DoD. Realistically, no single extant dataset can fulfill these requirements. Secondary data analysis of multiple long- term longitudinal studies of recent cohorts, with recent young adult assessments, can provide an unprecedented opportunity here. We capitalize on three complementary, long-standing, prospective- longitudinal data sets spanning childhood, adolescence, and young adulthood, with recent assessments in young adulthood. (1) The nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health) allows for fine-grained socio-structural characterizations of individuals and communities affected by DoD. (2) The community-representative psychiatric-diagnostic Great Smoky Mountains Study (GSMS) was collected in mostly impoverished rural communities in Appalachia—one of the epicenters of the DoD epidemic. It features a quasi-experiment that allows testing for whether cash transfers—received by a subgroup of participants for over 15 years—are protective against DoD. (3) Fast Track is a comprehensive 10- year randomized clinical intervention trial with 15 years of follow-up data that targeted mechanisms that are key in recent models of pathways to DoD. The first aim is to look longitudinally at the developmental epidemiology of DoD across the early lifespan in the nationally-representative Add Health and in the rural- Appalachian GSMS with a large American Indian subsample. The second aim is to test a childhood/adolescent strain  young adult social/economic disengagement  despair  DoD pathways model and also to test protective factors that could intervene on each pathway. We will also use discovery-focused machine learning algorithms to uncover new pathways to DoD in Add Health and GSMS. The third aim is to assess the impact of childhood interventions on DoD in GSMS and Fast Track.

抽象的经过数十年的改善，在美国白人非 - 西班牙裔成年人受教育低下。自杀，药物中毒（部分来自手术）和酒精性肝脏疾病的外表是罪魁祸首，并被造成了“绝望的死亡”。自杀的思想和行为，非法吸毒和酒精问题（或“绝望疾病”，国防部） - 可能先前的条件这些死亡 - 这是本应用的重点，以及这些国防部的途径。尽管多年研究并面对自杀的上升和全国性的公共卫生紧急情况，我们缺乏准确的并感谢谁会屈服于国防部，谁将被掩盖。快速的新需要关于国防部发展的见解，以告知努力扭转国防部的上升潮流。这些可以仅通过数十年的潜在长度数据产生，并具有多个级别的丰富覆盖率风险和受保护因素（从社区环境到分子机制）与临床相关国防部的特征。实际上，没有一个额外的数据集可以满足这些要求。多个长期数据分析近期的年轻成人评估的近期人群纵向研究可以提供这里是空前的机会。我们利用三个完整的，长期的，潜在的 - 跨越童年，青少年和成年的纵向数据集，最近评估年轻成年。（1）全国代表性的全国青少年纵向研究健康（Add Health）允许个人和社区的精细社会结构特征受国防部的影响。（2）社区代表性的精神病诊断大烟山研究（GSM）是在阿巴拉契亚大多数贫穷的农村社区中收集的，国防部流行。它具有准体验，允许对现金转移的测试 - 通过参与者的亚组已有15年以上 - 受到保护。（3）快速轨道是一个全面的10- 年度随机临床干预试验和15年的随访数据，这些数据针对的机制是最近通往国防部的途径模型的关键。第一个目的是纵向看发展国防部在全国代表性增加健康和农村地区的流行病学阿巴拉契亚GSM，拥有大型美洲印第安人子样本。第二个目的是测试童年/青少年应变年轻的成人社会/经济脱离接触绝望DOD 途径模型以及测试可以在每种途径上进行干预的受保护因素。我们还将使用以发现为重点的机器学习算法可以发现新的DOD途径以增加健康和GSM。第三个目的是评估儿童干预对GSM和快速道路中DOD的影响。