Understanding the effects of mass trauma, such as 9/11, on the development and mental health outcomes of exposed youth is a Public Health priority of the first order. Previous studies, including a study by our own group, the New York City Board of Education Study (NYC-BOE, PI: Hoven), documented increased rates of categorically defined (DSM-IV) mental health disorders in some school children six months after 9/11. While some exposed children respond to trauma with resilience and go on to normal adult development, others are plagued by ongoing psychological issues. Yet, relatively little is known about how the environmental context in which children live during a traumatic event, potentially impacts the effect that the trauma has on their long- and short-term functional outcomes. If post-disaster interventions are to significantly improve, we need to know more about which contexts should receive immediate interventions post-disaster. Two very recent advances in psychiatry support a reassessment of the NYC-BOE data to help answer these questions: 1) The development of a more contextualized view of the role that race/ethnicity play in mental health, as exemplified by the DSM-5's Cultural Formulation Interview (CFI). The CFI captures the rich interactive contexts which place race/ethnicity in a broader framework of the experienced cultural and physical environment. Applying this framework focuses our attention, not only on trauma and its outcome, but on the intervening environmental experience that may significantly influence how the trauma ultimately affects functional outcomes. 2) There is a movement away from simple diagnostic categorization and towards a more comprehensive, dimensional view of mental functioning, as exemplified by the Research Domain Criteria project (RDoC) launched by NIMH in 2010. The RDoCs approach encourages evaluating a more comprehensive set of emotional and behavioral difficulties than those captured by categorical diagnostic criteria alone. This proposed Trauma, Outcomes Context and (TOC) Study will use data from the NYC-BOE Study (which includes extensive information on family characteristics) in conjunction with additional datasets on neighborhood and school characteristics, to examine how race/ethnicity interacts with the child's environment (family, school and neighborhood) to affect the impact of trauma on dimensional mental functioning outcomes among youth exposed to 9/11. Our ultimate goal is to understand how these contextual factors influence a post-traumatic pathway to different functional outcomes. This research will therefore facilitate a new and more complete understanding of post-9/11 functioning of NYC's children.
The proposed study will identify the role that race/ethnicity, interacting with children's environmental context (family, school and neighborhood), has on the mental health outcomes of youth exposed to trauma. Importantly, because the study's dataset (NYC-BOE Study) is representative, large (N=8,236), with previously identified high rates of eight categorically defined disorders, and diverse, with significant representation of Black, Hispanic, Asian and White students, there is a unique opportunity to explore dimensions (domains) of mental health functioning according to RDoC, including improved understanding the role of environmental context in such dimensions. It is expected that this understanding will support the development of better prevention and treatment strategies targeting both dimensional and categorical diagnostic aspects of child and adolescent mental health, as well as enhance public health policies for those exposed to mass trauma.
| Guffanti, Guia; Geronazzo-Alman, Lupo; Fan, Bin et al. (2016) Homogeneity of Severe Posttraumatic Stress Disorder Symptom Profiles in Children and Adolescents Across Gender, Age, and Traumatic Experiences Related to 9/11. J Trauma Stress 29:430-439 |
