Early intervention to prevent development of PTSD in burn survivors and their caregivers

Project Summary In this K23 proposal, I detail a 4-year training plan to launch my independent clinical research career focused on mechanism-based early interventions to prevent PTSD and enhance health in traumatic injury patients and their caregivers. Through the rich training environments at the University of Southern California and National Center for PTSD, and the committed mentorship of my exemplary multidisciplinary team comprised of Dr. Haig Yenikomshian (primary), Dr. Denise Sloan (co-mentor), Dr. Johanna Thompson-Hollands (co-mentor), and Dr. Katherine Ehrlich (advisor), I will achieve training in 1) mechanism-based PTSD clinical trial research for acute care interventions, 2) implementation barriers and facilitators with medical, hospital, patient, and caregiver stakeholders, 3) advanced statistical analysis techniques for longitudinal data, 4) inflammatory biomarkers, and 5) professional competencies essential for independence. PTSD impacts approximately 1 in 3 traumatically injured hospitalized burn patients, a rate 3-4x that of the general population. Burns disproportionately impact marginalized and minoritized individuals/families with social and economic insecurities that lead to barriers in access to outpatient mental healthcare, highlighting the importance of early intervention during acute hospitalization. However, there are no validated interventions for hospitalized injury patients at risk for PTSD. The proposed study will adapt and test a brief patient-caregiver early intervention (PoED) associated with reduction of PTSS in discharged emergency department patients and extend it to hospitalized burn patients at risk for PTSD and their caregivers (PoED-B). PoED-B is a cognitive-behavioral dyadic intervention that targets reduction of dyadic social constraints (e.g., invalidating, negative statements) and avoidant coping by teaching dyads to engage in adaptive natural disclosures, supportive responses, and approach coping after the burn trauma using psychoeducation, motivational interviewing, and skills coaching. After refinement through stakeholder interviews and a case series (n=4, 2 dyads), we will conduct a small randomized clinical trial (n=40; 20 dyads) comparing PoED-B to a minimally enhanced usual care psychoeducation control (mEUC). The primary aim is to take an experimental therapeutics approach to demonstrate that PoED-B is feasible, acceptable, and engages the target of reduced social constraining behaviors in dyads relative to mEUC. A preliminary examination will also be conducted of the estimated effects of PoED-B vs mEUC and variability in patient- caregiver social constraints on PTSS improvement, relationship quality, and later PTSD diagnosis. An exploratory aim is to examine the impact of change in social constraints on PTSS and inflammatory biomarkers as theorized mechanisms of change in PoED-B. This early intervention trial aligns with NIMH Strategies 3 “Strive for Prevention and Cures” and 4 “Advance Mental Health Services to Strengthen Public Health” and has the potential to mitigate early risk for postinjury PTSD, reduce symptom burden, and improve overall health in a historically underserved comorbid mental health and medical population.