"Testing a Video and Text Messaging Intervention to reduce PTSD and Opioid Misuse Among Sexual Violence Survivors"

“测试视频和短信干预措施以减少性暴力幸存者的创伤后应激障碍和阿片类药物滥用”

• 批准号: 10812062
• 负责人: Katie L Walsh
• 金额: $ 40.75万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812062
• 关键词: Accident and Emergency department; Acute; Address; Alcohol consumption; Caring; Clip; Communities; Data; Disease; Distress; Early Intervention; Elements; Emergency department visit; Feedback; Forcible intercourse; Forensic Medicine; Health; Helping to End Addiction Long-term; Individual; Intervention; Medical; Memory impairment; Mental Depression; Mental Health; Opiate Addiction; Opioid; Outcome; Participant; Pathway interactions; Personal Satisfaction; Post-Traumatic Stress Disorders; Prevention; Public Health; Randomized; Randomized, Controlled Trials; Recording of previous events; Recovery; Reporting; Research; Risk; Sampling; Sequential Multiple Assignment Randomized Trial; Site; Stress; Subgroup; Survivors; Testing; Text Messaging; Time; Training and Education; United States; United States National Institutes of Health; Woman; active control; acute stress; acute traumatic stress disorder; adaptive intervention; assault; care systems; chronic pain; comorbidity; coping; cost; empowerment; evidence base; experience; marijuana use; meetings; memory encoding; men; mindfulness; nicotine use; novel; opioid epidemic; opioid misuse; opioid mortality; opioid use; opioid use disorder; pilot test; prescription opioid; prescription opioid misuse; prevent; programs; recruit; reduce symptoms; response; sexual assault; sexual violence; skills; skills training; substance misuse; suicidal; text messaging intervention; tool; treatment as usual; trial comparing; trial design; usability; violence exposure

Responding to NIH’s Helping to End Addiction Long-term (HEAL) initiative NOSI titled “Opioid Use Disorder Care Pathways for Individuals with Histories of Exposure to Violence,” this R61/R33 project seeks to develop and evaluate a brief video and text messaging intervention delivered in the emergency department (ED) to prevent the onset or escalation of opioid use, misuse, or disorder among recent sexual assault (SA) survivors. More than 1 in 4 women will experience an attempted or completed rape in her lifetime. PTSD and opioid misuse are prevalent in the wake of sexual violence, and the opioid epidemic is having a unique impact on women, with sharper increases in prescription opioid deaths, a greater likelihood of meeting criteria for opioid use disorder (OUD), and increased likelihood of comorbid mental health conditions compared to men. ED visits for sexual assault medical forensic exams (SAMFEs) have increased more than 1500% in the last two decades and may provide an important opportunity to intervene to prevent the onset or escalation of PTSD and opioid misuse and disorder. Our team developed and tested a brief video intervention delivered in the ED to women presenting for a SAMFE in two randomized controlled trials. Compared to treatment as usual (TAU), the video was associated with reductions in PTSD, depression, suicidality, alcohol, marijuana, and nicotine use for subgroups of survivors when followed over 6 months. However, in our second RCT, an active control mindfulness video better reduced post-SA opioid use compared to TAU for survivors with pre-SA opioid misuse. Thus, we propose to develop a new video, Skills Training in Active Recovery (STAR) based on the evidence-based principles of both videos to better address PTSD and opioid misuse. In the previous RCTs, survivors reported substantial distress at the SAMFE; given that distress can impair memory encoding, we propose to develop a 3-week daily text messaging program called TextSTAR that will reinforce content presented in the video but give opportunities for survivors to engage with the material in a different setting and over a longer period of time. During the R61, we propose to develop the STAR video and TextSTAR and get feedback from a community advisory board of sexual assault survivors about the wording and presentation of the content to maximize acceptability and utility. We will pilot test STAR and TextSTAR with a separate sample of survivors (N = 50) recruited from 5 ED sites within the Better Tomorrow Network, a research network of SAMFE programs throughout the US, to gather preliminary data about our recruitment approach, acceptability of the intervention, and efficacy. In the R33, we will conduct a SMART trial where survivors will be randomized to receive STAR or no video at the ED, assessed at 1 week, and those above threshold for acute stress/PTSD or opioid use, misuse or disorder will be randomized to receive TextSTAR or no text intervention for 3 weeks. We will re-assess PTSD and opioid misuse and disorder at 1, 3, and 6 months. If efficacious, this intervention is a low-cost and easy-to-disseminate approach to reduce PTSD and opioid outcomes among SA survivors.

响应 NIH 帮助结束成瘾长期 (HEAL) 倡议 NOSI，题为“阿片类药物使用障碍” 有暴力历史的个人的护理途径”，该 R61/R33 项目旨在开发 并评估急诊室 (ED) 提供的简短视频和短信干预措施，以 防止近期性侵犯 (SA) 幸存者中阿片类药物使用、滥用或紊乱的发生或升级。 超过四分之一的女性在其一生中会经历过强奸未遂或完成的强奸和创伤后应激障碍（PTSD）和阿片类药物。 性暴力之后滥用现象十分普遍，阿片类药物的流行对人们产生了独特的影响 女性处方阿片类药物死亡人数急剧增加，符合阿片类药物标准的可能性更大 与男性相比，使用障碍（OUD）以及合并心理健康问题的可能性更高。 过去二十年，性侵犯法医学检查 (SAMFE) 增加了 1500% 以上 并可能提供重要的干预机会，以防止 PTSD 和阿片类药物的发作或升级 我们的团队开发并测试了在急诊室向女性提供的简短视频干预。 与常规治疗 (TAU) 相比，该视频在两项随机对照试验中展示了 SAMFE。 与创伤后应激障碍（PTSD）、抑郁症、自杀倾向、酒精、大麻和尼古丁使用的减少有关 然而，在我们的第二个随机对照试验中，对幸存者亚组进行了 6 个月的随访。 与 TAU 相比，对于使用 SA 前阿片类药物的幸存者来说，正念视频可以更好地减少 SA 后阿片类药物的使用 因此，我们建议根据以下内容开发一个新视频：主动恢复技能训练 (STAR)。 两个视频的循证原则可以更好地解决创伤后应激障碍和阿片类药物滥用问题。 幸存者在 SAMFE 报告了严重的痛苦；鉴于痛苦会损害记忆编码，我们 建议开发一个名为 TextSTAR 的为期 3 周的每日短信计划，该计划将强化内容 视频中呈现，但为幸存者提供了在不同环境中接触材料的机会， 在R61期间，我们建议开发STAR视频和TextSTAR并得到。 性侵犯幸存者社区咨询委员会对措辞和表述的反馈 我们将使用单独的示例对 STAR 和 TextSTAR 进行试点测试。 幸存者 (N = 50) 是从 Better Tomorrow Network 内的 5 个 ED 站点招募的，该网络是一个研究网络 SAMFE 计划遍布美国各地，收集有关我们的招聘方法、可接受性的初步数据 在 R33 中，我们将进行 SMART 试验，幸存者将被随机分组​​。 在 ED 接受 STAR 或不接受视频，在 1 周时进行评估，以及高于急性应激/PTSD 阈值的患者 或阿片类药物使用、误用或障碍将随机接受 TextSTAR 或无文本干预 3 周。 如果这种干预措施有效，我们将在 1、3 和 6 个月时重新评估 PTSD 和阿片类药物滥用和障碍。 是一种低成本且易于传播的方法，可减少 SA 幸存者的 PTSD 和阿片类药物后果。