Disaster-exposed youth, in comparison to adult samples, are at significantly greater risk for Posttraumatic Stress Disorder (PTSD), with symptoms often persisting for many months and years post-disaster. However, other disaster-exposed youth show resilience and rapid recovery without PTSD development. Efforts have been initiated to identify specific PTSD risk and resiliency factors;however, this work has relied largely on self- report strategies. Although useful in many circumstances, the sole reliance on self-report for identified PTSD risk and resiliency factors can be problematic. Thus, the development of innovative behavioral technologies that draw upon the methods of translational research and experimental psychopathology, and that assess specific risk and protective factors not easily or reliably measured through self-report, would be a valuable contribution to PTSD risk assessment. In the current study, we propose to develop and evaluate a state of the art comprehensive tool for PTSD risk assessment among disaster-exposed youth through the use of novel behavioral assessment tasks targeting two factors theoretically and empirically linked with PTSD (distress tolerance and risk-taking propensity), in combination with the use of other empirically identified disaster, child, and parent risk factors. If successful, this tool will help improve the understanding of more basic mechanisms underlying the development of PTSD in relation to disaster-related trauma, and potentially to other types of trauma, and also will likely aid in targeted early intervention development, modification, and implementation efforts. To accomplish these goals, this project will recruit a population-based sample of 3,000 disaster- exposed youth and their parents participating in an NIH-funded longitudinal, web-based intervention study (R01MH081056). Youth and parent participants will complete an initial phone-based, baseline assessment, where information regarding disaster exposure, other traumatic event experiences and incident characteristics, family-related variables, and PTSD and other mental health symptomatology will be gathered. Participants also will be asked to complete an additional web-based assessment following the baseline interview, which will involve both youth and parents completing novel computerized behavioral assessment tasks targeting distress tolerance and risk-taking propensity, as well as an additional self-report measure of trait anxiety. Phone-based interviews will be readministered at four- and twelve-months post-baseline to reassess PTSD symptoms. Sophisticated statistical procedures, including Receiver Operating Characteristics Tree methods, will be used to further examine the relation between the factors assessed and PTSD symptoms, to determine sensitive and specific cut-scores on the aforementioned tasks, measures, and variables for clinical decision-making, and to develop a decision algorithm that includes all significant PTSD predictors. Specifically, we seek to create an optimized, staged approach to PTSD risk assessment that balances accuracy against feasibility and costs to provide a practical, functional assessment battery that will generalize to multiple clinical settings. Given the high prevalence of disasters world-wide and the costly, debilitating impact of PTSD on disaster- exposed youth and their families, the proposed work is highly relevant to public health needs. Specifically, if successful in attaining the aims proposed for the current study, the sophisticated development of a PTSD risk assessment clinical tool would aid in the accurate and cost-effective identification of youth who are at greatest risk for PTSD. Such identification would help target post-disaster risk-reduction efforts and would likely reduce the incidence of full diagnostic PTSD and its associated costs and suffering.

Public Health Relevance

Given the high prevalence of disasters world-wide and the costly, debilitating impact of PTSD on disaster- exposed youth and their families, the proposed work is highly relevant to public health needs. Specifically, if successful in attaining the aims proposed for the current study, the sophisticated development of a PTSD risk assessment clinical tool would aid in the accurate and cost-effective identification of youth who are at greatest risk for PTSD. Such identification would help target post-disaster risk-reduction efforts and would likely reduce the incidence of full diagnostic PTSD and its associated costs and suffering.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21MH086313-02
Application #
7901551
Study Section
Special Emphasis Panel (ZMH1-ERB-N (04))
Program Officer
Tuma, Farris K
Project Start
2009-07-28
Project End
2012-12-31
Budget Start
2010-07-01
Budget End
2012-12-31
Support Year
2
Fiscal Year
2010
Total Cost
$154,433
Indirect Cost
Name
Medical University of South Carolina
Department
Psychiatry
Type
Schools of Medicine
DUNS #
183710748
City
Charleston
State
SC
Country
United States
Zip Code
29425
Danielson, Carla Kmett; Cohen, Joseph R; Adams, Zachary W et al. (2017) Clinical Decision-Making Following Disasters: Efficient Identification of PTSD Risk in Adolescents. J Abnorm Child Psychol 45:117-129
Danielson, Carla Kmett; Sumner, Jennifer A; Adams, Zachary W et al. (2017) Adolescent Substance Use Following a Deadly U.S. Tornado Outbreak: A Population-Based Study of 2,000 Families. J Clin Child Adolesc Psychol 46:732-745
Bountress, Kaitlin; Danielson, Carla Kmett; Williamson, Vernell et al. (2017) Genetic and psychosocial predictors of alcohol use trajectories among disaster-exposed adolescents. Am J Addict 26:623-631
Cohen, Joseph R; Adams, Zachary W; Menon, Suvarna V et al. (2016) How should we screen for depression following a natural disaster? An ROC approach to post-disaster screening in adolescents and adults. J Affect Disord 202:102-9
Cohen, Joseph R; Danielson, Carla Kmett; Adams, Zachary W et al. (2016) Distress Tolerance and Social Support in Adolescence: Predicting Risk for Internalizing and Externalizing Symptoms Following a Natural Disaster. J Psychopathol Behav Assess 38:538-546
Ruggiero, Kenneth J; Davidson, Tatiana M; McCauley, Jenna et al. (2015) Bounce Back Now! Protocol of a population-based randomized controlled trial to examine the efficacy of a Web-based intervention with disaster-affected families. Contemp Clin Trials 40:138-49
Adams, Zachary W; Danielson, Carla Kmett; Sumner, Jennifer A et al. (2015) Comorbidity of PTSD, Major Depression, and Substance Use Disorder Among Adolescent Victims of the Spring 2011 Tornadoes in Alabama and Joplin, Missouri. Psychiatry 78:170-85
Ruggiero, Kenneth J; Price, Matthew; Adams, Zachary et al. (2015) Web Intervention for Adolescents Affected by Disaster: Population-Based Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 54:709-17
Sumner, Jennifer A; Pietrzak, Robert H; Danielson, Carla Kmett et al. (2014) Elucidating dimensions of posttraumatic stress symptoms and their functional correlates in disaster-exposed adolescents. J Psychiatr Res 59:85-92
Adams, Zachary W; Sumner, Jennifer A; Danielson, Carla Kmett et al. (2014) Prevalence and predictors of PTSD and depression among adolescent victims of the Spring 2011 tornado outbreak. J Child Psychol Psychiatry 55:1047-55

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