Risk and Resilience in Urban Black American Acute Trauma Survivors

美国城市黑人急性创伤幸存者的风险和复原力

• 批准号: 10379585
• 负责人: Christine L Larson
• 金额: $ 79.2万
• 依托单位: UNIVERSITY OF WISCONSIN MILWAUKEE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-16 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10379585
• 关键词: Accident and Emergency department; Acute; Adult; Affect; African American; Amines; Amygdaloid structure; Anxiety; Arousal; Behavioral; Biological; Brain; Child Abuse and Neglect; Chronic; Chronic Post Traumatic Stress Disorder; Communities; Complement; Data; Disadvantaged; Discrimination; Distress; Early Intervention; Early identification; Endocannabinoids; Environmental Risk Factor; Exposure to; Goals; Health; Hospitals; Image; Individual; Inflammatory; Intervention; Knowledge; Lead; Light; Link; Machine Learning; Measures; Mental Depression; Mental Health; Mental disorders; Minority; Minority Groups; Nature; Neighborhoods; Neurobiology; Outcome; Partner in relationship; Pathology; Patient Self-Report; Play; Population; Post-Traumatic Stress Disorders; Predictive Factor; Process; Prognosis; Public Health; Quality of life; Race; Recording of previous events; Recovery; Regulation; Research; Resources; Risk; Risk Factors; Role; Sampling; Sensitivity and Specificity; Social Environment; Specific qualifier value; Stress; Suicide; Survivors; Symptoms; System; Trauma; United States; Violence; Visit; Wisconsin; Work; adverse outcome; allostatic load; base; biological adaptation to stress; brain health; cytokine; deprivation; emotion regulation; ethnic minority population; experience; high risk; improved; indexing; innovation; intersectionality; medical schools; neural circuit; neurobehavioral; neurobiological mechanism; neuroimaging marker; neuromechanism; pediatric trauma; physical conditioning; post-trauma; predictive marker; preventive intervention; protective factors; racial and ethnic; racial minority; recruit; relating to nervous system; resilience; risk prediction; socioenvironmental factor; stress management; stressor; trauma exposure; trauma symptom; violence exposure

PROJECT ABSTRACT Trauma is common and increases risk for a host of negative health outcomes, most notably posttraumatic stress disorder (PTSD). Given the potential harmful sequelae of trauma exposure, it is crucial to identify acute post-trauma risk factors that predict chronic PTSD. Moreover, urban racial/ethnic minorities can experience significant environmental stress that puts them at particularly high risk for PTSD. At this juncture relatively little data exists to aid in prediction of risk specific to urban racial minorities, or that takes into account how disadvantage and minority stress may impact neurobiological stress systems in the months following trauma, and how that affects risk for long-term distress. Thus, under the guidance of a community advisory board our team will 1) identify acute post-trauma neurobehavioral predictors of risk for chronic PTSD among urban Black Americans, with a focus on prefrontal-subcortical function during processing of threat, 2) characterize how the longitudinal interaction of socioenvironmental risk and resilience factors and biological stress markers following trauma impacts risk, and 3) use machine learning to identify the most robust set of predictors of chronic PTSD drawn from a comprehensive assessment of neuroimaging, biomarkers, self-report and geocoded risk and resilience variables. We will recruit 190 adults who identify as Black or African American from the Emergency Department at Froedtert Hospital/Medical College of Wisconsin in Milwaukee, and conduct comprehensive assessments at 2 weeks, and 3, 6, and 12 months following trauma exposure. The two-week and 12-month assessments will include measures of neural systems for threat processing, including both anticipation of and reactivity to threat. All visits will include measures of PTSD and other symptoms, neurobiological stress markers, particularly endocannabinoids, and socioenvironmental risk and resilience factors, especially those relevant for urban Black Americans. We will examine how acute post-trauma neurocircuitry variables (2 week) predict PTSD and other outcomes twelve months later, and how pre-trauma environmental variables (resource deprivation, child maltreatment, violence exposure) moderate this relationship (Aim 1). We will also assess how, in the months following trauma, socio-environmental risk and resilience factors influence neurobiological stress systems, and how this interaction impacts risk for PTSD, poor physical health, and emotion regulation neurocircuitry at twelve months (Aim 2). We will use both hypothesis-driven analyses focusing on a priori specified predictors (Aims 1 and 2), as well as comprehensive data-driven machine learning analyses (Aim 3). This approach will allow for determination of the additional utility of neurobiological markers for predicting risk beyond previously identified self-report indicators. We expect this project to lead to identification of predictors of PTSD following trauma for urban Black Americans at high risk that are linked to underlying processes (hyper-responsivity to threat, aberrant neurobiological stress response) that can inform preventive interventions, ultimately improving the quality of life for urban Black American trauma survivors.

项目摘要 创伤很常见，会增加一系列负面健康结果的风险，尤其是创伤后 应激障碍（PTSD）。鉴于创伤暴露可能造成有害后遗症，识别急性创伤至关重要 预测慢性 PTSD 的创伤后危险因素。此外，城市少数族裔/族裔可以经历 巨大的环境压力使他们面临创伤后应激障碍（PTSD）的高风险。此时此刻相对较少 数据的存在是为了帮助预测城市少数族裔特有的风险，或者考虑到如何 弱势和少数群体的压力可能会在创伤后的几个月内影响神经生物学压力系统， 以及这如何影响长期困扰的风险。因此，在社区咨询委员会的指导下，我们 研究小组将 1) 确定城市黑人慢性 PTSD 风险的急性创伤后神经行为预测因素 美国人在处理威胁过程中重点关注前额皮质下功能，2）描述了 社会环境风险和复原力因素以及生物应激标记的纵向相互作用 创伤影响风险，3) 使用机器学习来识别慢性 PTSD 的最稳健的预测因子 来自对神经影像、生物标志物、自我报告和地理编码风险的综合评估， 弹性变量。我们将从紧急情况中招募 190 名黑人或非裔美国人的成年人 位于密尔沃基的弗罗德特医院/威斯康星医学院的部门，并进行全面的 创伤暴露后 2 周、3、6 和 12 个月时进行评估。两周和12个月 评估将包括威胁处理神经系统的测量，包括预测和威胁处理 对威胁的反应。所有访问都将包括创伤后应激障碍 (PTSD) 和其他症状、神经生物学压力的测量 标记物，特别是内源性大麻素，以及社会环境风险和复原力因素，特别是那些 与美国城市黑人相关。我们将检查急性创伤后神经回路的变化（2 周） 预测 12 个月后的 PTSD 和其他结果，以及创伤前环境变量如何（资源 剥夺、虐待儿童、暴力暴露）调节这种关系（目标 1）。我们还将评估 在创伤后的几个月里，社会环境风险和复原力因素如何影响神经生物学 压力系统，以及这种相互作用如何影响创伤后应激障碍、身体健康状况不佳和情绪调节的风险 十二个月时的神经回路（目标 2）。我们将使用两种侧重于先验的假设驱动分析 指定的预测变量（目标 1 和 2），以及全面的数据驱动机器学习分析（目标 3）。 这种方法将允许确定神经生物学标记物在预测风险方面的额外效用 超出先前确定的自我报告指标。我们期望这个项目能够识别预测变量 美国城市黑人高危人群遭受创伤后创伤后应激障碍（PTSD）的风险与潜在过程相关 （对威胁的过度反应、异常的神经生物学应激反应）可以为预防提供信息 干预措施，最终改善美国城市黑人创伤幸存者的生活质量。