San Francisco VA Medical Center, San Francisco, California.
Department of Psychiatry, University of California, San Francisco.
JAMA Psychiatry. 2023 Mar 1;80(3):220-229. doi: 10.1001/jamapsychiatry.2022.4533.
Adverse posttraumatic neuropsychiatric sequelae after traumatic stress exposure are common and have higher incidence among socioeconomically disadvantaged populations. Pain, depression, avoidance of trauma reminders, reexperiencing trauma, anxiety, hyperarousal, sleep disruption, and nightmares have been reported. Wrist-wearable devices with accelerometers capable of assessing 24-hour rest-activity characteristics are prevalent and may have utility in measuring these outcomes.
To evaluate whether wrist-wearable devices can provide useful biomarkers for recovery after traumatic stress exposure.
DESIGN, SETTING, AND PARTICIPANTS: Data were analyzed from a diverse cohort of individuals seen in the emergency department after experiencing a traumatic stress exposure, as part of the Advancing Understanding of Recovery After Trauma (AURORA) study. Participants recruited from 27 emergency departments wore wrist-wearable devices for 8 weeks, beginning in the emergency department, and completed serial assessments of neuropsychiatric symptoms. A total of 19 019 patients were screened. Of these, 3040 patients met study criteria, provided informed consent, and completed baseline assessments. A total of 2021 provided data from wrist-wearable devices, completed the 8-week assessment, and were included in this analysis. The data were randomly divided into 2 equal parts (n = 1010) for biomarker identification and validation. Data were collected from September 2017 to January 2020, and data were analyzed from May 2020 to November 2022.
Participants were recruited for the study after experiencing a traumatic stress exposure (most commonly motor vehicle collision).
Rest-activity characteristics were derived and validated from wrist-wearable devices associated with specific self-reported symptom domains at a point in time and changes in symptom severity over time.
Of 2021 included patients, 1257 (62.2%) were female, and the mean (SD) age was 35.8 (13.0) years. Eight wrist-wearable device biomarkers for symptoms of adverse posttraumatic neuropsychiatric sequelae exceeded significance thresholds in the derivation cohort. One of these, reduced 24-hour activity variance, was associated with greater pain severity (r = -0.14; 95% CI, -0.20 to -0.07). Changes in 6 rest-activity measures were associated with changes in pain over time, and changes in the number of transitions between sleep and wake over time were associated with changes in pain, sleep, and anxiety. Simple cutoffs for these biomarkers identified individuals with good recovery for pain (positive predictive value [PPV], 0.85; 95% CI, 0.82-0.88), sleep (PPV, 0.63; 95% CI, 0.59-0.67, and anxiety (PPV, 0.76; 95% CI, 0.72-0.80) with high predictive value.
These findings suggest that wrist-wearable device biomarkers may have utility as screening tools for pain, sleep, and anxiety symptom outcomes after trauma exposure in high-risk populations.
创伤后应激暴露后出现不良的创伤后神经精神后遗症很常见，在社会经济地位较低的人群中发病率更高。已经报道了疼痛、抑郁、回避创伤提醒、创伤再体验、焦虑、过度警觉、睡眠中断和噩梦。能够评估 24 小时休息-活动特征的腕戴式设备很普遍，可能在测量这些结果方面具有实用性。
评估腕戴式设备是否可以为创伤后应激暴露后的恢复提供有用的生物标志物。
设计、设置和参与者：对在经历创伤后应激暴露后在急诊室就诊的不同人群的队列进行了数据分析，这是 Advancing Understanding of Recovery After Trauma (AURORA) 研究的一部分。从 27 个急诊部门招募的参与者在急诊室开始佩戴腕戴式设备 8 周，并完成了一系列神经精神症状的评估。共有 19019 名患者接受了筛查。其中，3040 名患者符合研究标准，同意并完成了基线评估。共有 2021 名患者提供了腕戴式设备的数据，完成了 8 周的评估，并纳入了本分析。数据被随机分为 2 等份（n=1010）用于生物标志物识别和验证。数据收集于 2017 年 9 月至 2020 年 1 月，数据分析于 2020 年 5 月至 2022 年 11 月进行。
参与者在经历创伤后应激暴露（最常见的是机动车碰撞）后被招募参加研究。
从腕戴式设备中得出并验证了与特定自我报告症状领域相关的休息-活动特征，这些特征在特定时间点与症状严重程度随时间的变化有关。
在纳入的 2021 名患者中，1257 名（62.2%）为女性，平均（SD）年龄为 35.8（13.0）岁。在推导队列中，有 8 个腕戴式设备生物标志物对不良创伤后神经精神后遗症的症状超过了显著性阈值。其中一个是 24 小时活动方差减少，与更严重的疼痛严重程度相关（r=−0.14；95%CI，−0.20 至−0.07）。6 项休息-活动测量的变化与疼痛随时间的变化有关，睡眠和清醒之间的转换次数的变化与疼痛、睡眠和焦虑随时间的变化有关。这些生物标志物的简单截止值可识别出具有良好疼痛（阳性预测值 [PPV]，0.85；95%CI，0.82-0.88）、睡眠（PPV，0.63；95%CI，0.59-0.67）和焦虑（PPV，0.76；95%CI，0.72-0.80）恢复的个体，具有较高的预测价值。
这些发现表明，腕戴式设备生物标志物可能具有作为高危人群创伤后疼痛、睡眠和焦虑症状结果的筛查工具的效用。
