Melissa A. Polusny - US grants

DESCRIPTION (Adapted from applicant's abstract): Research has demonstrated that children and adolescents who experience natural disasters are at increased risk for the development of posttraumatic stress disorder (PTSD) symptoms or other behavioral problems. Although symptoms of PTSD typically decrease over time, a substantial number of children show longer-term difficulties in adjustment. Some research has indicated that children's negative reactions may become more severe in the year following the disaster. Despite this growing body of literature, little empirical research has investigated how a number of contextual variables may mediate children's responses to traumatic events. The primary purpose of this project is to investigate the impact of an F-3 tornado disaster on the psychological functioning of adolescents and their parents. The first goal of this study is to identify predictors of adolescents' posttraumatic stress symptoms following a natural disaster. The second goal of this study is to identify predictors of adolescents' behavior problems. The third goal is to identify predictors of parent's psychological response to the disaster. In this study, 1,500 adolescents' and their families who were exposed to a severe natural disaster will be surveyed. Severity and degree of disaster exposure, symptoms of PTSD, parent-report of child behavior problems, coping strategies, as well as parent and family functioning will be evaluated. The project will also investigate the bi-directional influence of adolescent's PTSD and behavior problems on parents' PTSD symptomatology. Hypotheses will be tested using linear regression procedures. Findings from this study will provide information critical to the development of more comprehensive treatment interventions and prevention programs for disaster survivors.

DESCRIPTION (provided by applicant): Chronic pain is a prevalent, debilitating, and costly national health problem. Nearly half of OEF/OIF Veterans receiving VA health care have at least one documented pain-related diagnosis, yet this high risk population remains understudied. Veterans with chronic pain and co-morbid mental health conditions, especially PTSD, are more likely to receive opioids for pain, to receive higher-dose opioids, and to experience opioid-related adverse events. Thus, it is imperative to better understand how post-deployment PTSD and other mental health problems as well as broad predisposing vulnerability factors such as personality might contribute to the development of chronic pain outcomes and influence health services utilization for pain management. There is also an urgent need to obtain a deeper understanding of OEF/OIF Veterans' perspectives on pain management to develop interventions that promote a patient-centered model of care emphasizing a holistic approach to pain management, including integration of evidence based complementary and alternative medicine (CAM) and other non-pharmacological pain management approaches. The long-term objective of this project is to improve pain management and reduce opioid-related harms for OEF/OIF Veterans with chronic pain and co-morbid mental health conditions. The primary goal of this proposal is to develop a comprehensive model for understanding the development of chronic pain outcomes, utilization of CAM and other non-pharmacological approaches, and utilization of opioid analgesics for chronic pain as well as gain a deeper understanding of Veterans' preferences and attitudes towards pain management approaches. Specific aims are to: 1) Identify predictors of chronic pain among OEF/OIF National Guard Veterans; 2) Characterize patterns of use of CAM, other non-pharmacological pain management approaches, and opioid analgesics; 3) Test a model of health services utilization that identifies prospectively assessed predisposing individual characteristics; facilitators and barriers; and need factors predictive of OEF/OIF Veterans' utilization of CAM, other non-pharmacological approaches, and opioid analgesics; and 4) Identify potential strategies for influencing OEF/OIF Veterans' use of CAM and other non-pharmacological approaches by gaining a richer understanding of patients' experiences with chronic pain and perspectives on pain management health services. The proposed project will capitalize on an existing longitudinal dataset that prospectively assessed 3,458 National Guard Soldiers prior to OEF/OIF deployments (2006-2010) and re-assessed Veterans across post-deployment waves. The current proposal utilizes a multi-phase, mixed methods design guided by an innovative conceptual framework integrating personality theory, a vulnerability-resilience model of chronic pain, and the Andersen Behavioral Model of Health Services Use. It will extend the existing longitudinal cohort by adding an additional wave of quantitative data focused on chronic pain outcomes and in-depth qualitative data examining Veteran perspectives on chronic pain and pain management health services.

Background: Resilience is defined as the capacity to adapt successfully through multiple processes in response to adverse events. While explanatory models are still in their infancy, theoretical and empirical evidence suggest that self-regulatory processes may underlie resilient functioning. This proposal will develop (Phase 1, Year 1) and then implement (Phase 2, Years 2-5) a study of 1,200 National Guard recruits in the first two years of their enlistment in order to identify patterns and processes of adaptive (resilient) functioning in the face of Basic Combat Training (BCT) and other adverse events. Aims: The aims for Phase 1 are focused on planning and preparing for a longitudinal study of resilience in National Guard recruits and include: 1) Use prior datasets to develop statistical algorithms for selecting ilot baseline data collection procedures to determine feasibility of enrollment and response rate targets for longitudinal study, 3) Develop and refine contextualized measures of National Guard training stressor exposure, and 4) Evaluate the feasibility and acceptability of neurobehavioral markers of resilience processes. During Phase 2, a comprehensive model of resilience will be investigated using a four-year, mixed-method, longitudinal study to participants with high and low probabilities of resilience, 2) P 1) Characterize latent trajectories of adjustment among new military recruits beginning prior to BCT over two years, 2) Identify promotive and protective predictors of resilient functioning in National Guard soldiers, and 3) Investigate neurobehavioral pathways of self-regulation predictive of resilience trajectories in new military recruits. Procedures and Analyses: In Phase 1, prediction algorithms will be established using analysis of datasets gathered in prior National Guard studies. The measurement of BCT stressors, and feasibility of Phase 2 recruitment plans, will involve online surveys of 100 National Guard recruits before, during and immediately after BCT. The feasibility and acceptability of neurobiological measures through imaging and laboratory tasks piloting procedures will be assessed with 10 recruits undergoing procedures before and after BCT. In Phase 2, on-line self-reports of symptoms (depression, anxiety, alcohol or drug use), adaptive social functioning, and promotive, protective, and risk factors will be collected before and at 4 time points after BCT with 1200 National Guard recruits. Growth mixture modeling will establish resilient and non-resilient trajectories of adaptive functioning. Aim 2 will use predictive modeling of trajectories using predictors collected during the baseline and subsequent time points. In Aim 3, 120 recruits will complete laboratory tasks (Farmer's task, go/no-go task, dot probe task, performance monitoring task) before and after BCT while undergoing MRI or EEG scans. Analyses will determine if these tasks can discriminate between recruits in the resilient vs. non- resilient trajectories of functioning established in Aim 1.

Background: Resilience is defined as the capacity to adapt successfully through multiple processes in response to adverse events. While explanatory models are still in their infancy, theoretical and empirical evidence suggest that self-regulatory processes may underlie resilient functioning. This proposal will develop (Phase 1, Year 1) and then implement (Phase 2, Years 2-5) a study of 1,200 National Guard recruits in the first two years of their enlistment in order to identify patterns and processes of adaptive (resilient) functioning in the face of Basic Combat Training (BCT) and other adverse events. Aims: The aims for Phase 1 are focused on planning and preparing for a longitudinal study of resilience in National Guard recruits and include: 1) Use prior datasets to develop statistical algorithms for selecting ilot baseline data collection procedures to determine feasibility of enrollment and response rate targets for longitudinal study, 3) Develop and refine contextualized measures of National Guard training stressor exposure, and 4) Evaluate the feasibility and acceptability of neurobehavioral markers of resilience processes. During Phase 2, a comprehensive model of resilience will be investigated using a four-year, mixed-method, longitudinal study to participants with high and low probabilities of resilience, 2) P 1) Characterize latent trajectories of adjustment among new military recruits beginning prior to BCT over two years, 2) Identify promotive and protective predictors of resilient functioning in National Guard soldiers, and 3) Investigate neurobehavioral pathways of self-regulation predictive of resilience trajectories in new military recruits. Procedures and Analyses: In Phase 1, prediction algorithms will be established using analysis of datasets gathered in prior National Guard studies. The measurement of BCT stressors, and feasibility of Phase 2 recruitment plans, will involve online surveys of 100 National Guard recruits before, during and immediately after BCT. The feasibility and acceptability of neurobiological measures through imaging and laboratory tasks piloting procedures will be assessed with 10 recruits undergoing procedures before and after BCT. In Phase 2, on-line self-reports of symptoms (depression, anxiety, alcohol or drug use), adaptive social functioning, and promotive, protective, and risk factors will be collected before and at 4 time points after BCT with 1200 National Guard recruits. Growth mixture modeling will establish resilient and non-resilient trajectories of adaptive functioning. Aim 2 will use predictive modeling of trajectories using predictors collected during the baseline and subsequent time points. In Aim 3, 120 recruits will complete laboratory tasks (Farmer's task, go/no-go task, dot probe task, performance monitoring task) before and after BCT while undergoing MRI or EEG scans. Analyses will determine if these tasks can discriminate between recruits in the resilient vs. non- resilient trajectories of functioning established in Aim 1.