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 - 西班牙裔成年人自杀，毒品中毒（尤其是来自阿片类药物）和酒精性肝脏。疾病似乎是罪魁祸首，并被称为“绝望的死亡”。非法吸毒和酒精问题（或“绝望的疾病，“国防部”） - 可能先前的条件）这些死亡 - 是该应用程序的重点，以及这些国防部的途径。研究，面对自杀的上升和自然的开放性鸦片，我们缺乏准确的公共卫生紧急情况明显的预测是谁会屈服于国防部，并将被掩盖。需要对DOD的开发的见解，以告知效果以扭转这些能力仅通过数十年的预期长度数据产生，并覆盖多个级别从分子机制的社区环境中的风险和保护因素 - 与临床相关国防部的特征。实际上，没有单个段落数据集可以完成这些遗产。近期人群的术语纵向研究以及最近的年轻成人评估可以提供ANN 未经预言的机会。跨越童年，青春期和年轻成年的纵向数据集，最近评估年轻成年。健康（Add Health）允许对个人和社区进行细粒度的社会结构特征受国防部的影响。（GSM）收集在阿巴拉契亚州大多数贫困的农村社区中， DOD流行病。参与者的亚组超过15年，可以保护国防部。年度随机临床干预试验具有15年的随访数据针对性机制？最近的DOD途径的关键是第一个目标。国防部在全国范围内的早期寿命中的表演女性学增加了健康和农村的健康 Appalachian GSM具有大型美洲印第安人子样本。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，还可以测试可以在每个途径上进行干预的保护因素。以发现为重点的机器学习算法可以发现新的途径，以增加健康和GSM。第三个目的是评估儿童引擎盖干预措施对GSM和快速轨道中的DOD的影响。