PTSD symptoms and alcohol-related problems among veterans: Temporal associations and vulnerability.
PTSD symptoms and alcohol-related problems among veterans: Temporal associations and vulnerability.
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退伍军人中的PTSD症状和与酒精有关的问题：时间关联和脆弱性。
DOI：
10.1037/abn0000376
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发表时间：
2018-11
影响因子：
4.6
通讯作者：
Andal K
中科院分区：
文献类型：
--
作者：
Simons JS;Simons RM;Keith JA;Grimm KJ;Stoltenberg SF;O'Brien C;Andal K
创伤后应激障碍与酒精使用障碍(AUD)和相关行为问题的风险增加有关，这些问题与行为和情绪失调有关。我们进行了一项密集的纵向爆破设计研究，在1.5年的时间里对250名经历过最近冲突的退伍军人进行了10周的经验抽样。我们测试了创伤后应激症状(PTSS)、酒精依赖综合征和品行问题之间日常联系的时间序列模型。PTSS的恶化预示着更高的依赖综合征和第二天的行为问题。在控制了饮酒和结果之间的同时(即，同一天)关联以及从一天到第二天结果之间的关联强度(即，自回归)后，这种影响是显著的。情感不稳定和去抑制是假想的易损性因素，增加了依赖综合症和行为问题的个人预测因素的强度。在随访期内，不稳定和去抑制与更严重的依赖综合征症状和行为问题相关。与预期一致的是，不稳定而不是解除抑制增加了饮酒和依赖综合征之间的关联，以及从一天到第二天依赖综合征症状之间的关联强度。在品行问题模型中，去抑制的调节作用不显著。重要的是，结果表明随着时间的推移，相互关联。易感性加强了依赖综合征症状和次日PTSS之间的联系，而去抑制则加强了行为问题和次日PTSS之间的联系。结果表明，PTSS、AUD症状和行为问题之间随着时间的推移存在复杂的动态联系，这表明存在广泛的调节障碍。这项研究表明，创伤后应激障碍症状的日常变化增加了酒精使用障碍(AUD)症状和人际冲突等问题的风险，这是由于调节行为和情绪的能力存在相关缺陷。此外，AUD症状预示着第二天创伤后应激障碍症状的短暂增加，创造了一个复杂的自我维持系统。酒精使用障碍，在一定程度上可能表现为日常障碍症状的时间联系的强度。许多退伍军人与创伤后应激障碍、酒精使用障碍和一系列行为问题作斗争，这些问题降低了他们服役后的生活质量。然而，这些问题不是静态的，而是个人内部的动态过程。目前的结果表明，这些结果表现出复杂的时间相互依存关系。退伍军人有好日子，也有糟糕的日子，正如这项研究的结果所支持的那样，退伍军人有缓解期，中间穿插着痛苦、失控的饮酒和社会关系问题。这些结果中的每一个都是基本监管过程中的干扰。去抑制增加了PTSS和品行问题之间的相互关联。情绪失调性表明情绪调节系统脆弱，表现为在调节酒精消费方面的缺陷，以及PTSS和酒精依赖综合征之间的相互关联的加强。解决这些基本监管过程中的任何一个中断都有可能在创伤后应激障碍、酒精使用及相关问题方面产生有意义的临床变化，并因此提高退伍军人的生活质量。
Posttraumatic stress disorder is associated with elevated risk of both alcohol use disorder (AUD) and related conduct problems, which are associated with behavioral and emotional dysregulation. We conducted an intensive longitudinal burst design study with 10 weeks of experience sampling over the course of 1.5 years with 250 veterans of recent conflicts. We tested time-series models of daily associations between posttraumatic stress symptoms (PTSS), alcohol dependence syndrome, and conduct problems. Exacerbations of PTSS predicted higher dependence syndrome and conduct problems the next day. This effect was significant after controlling for both concurrent (i.e., same-day) associations between drinking and the outcomes as well as the strength of associations between the outcomes from one day to the next (i.e., autoregression). Affect lability and disinhibition were hypothesized vulnerability factors increasing the strength of within-person predictors of dependence syndrome and conduct problems. Lability and disinhibition were associated with greater dependence syndrome symptoms and conduct problems over the follow-up period. Consistent with expectation, lability rather than disinhibition increased the association between drinking and dependence syndrome as well as the strength of association between dependence syndrome symptoms from one day to the next. Moderating effects of disinhibition in the conduct problems model were not significant. Importantly, results indicated reciprocal associations over time. Lability potentiated the association between dependence syndrome symptoms and next day PTSS, whereas disinhibition potentiated the association between conduct problems and next day PTSS. Results demonstrate complex dynamic associations between PTSS, AUD symptoms, and conduct problems over time indicative of broad regulatory impairments. This study suggests that day-to-day changes in PTSD symptoms confer increased risk for symptoms of alcohol use disorder (AUD) and problems such as interpersonal conflict due to associated deficits in the ability to regulate behavior and emotion. In addition, AUD symptoms predict transient increases in PTSD symptoms the next day, creating a complex self-perpetuating system. Alcohol use disorder, in part, may be manifest in the strength of temporal associations of disorder symptoms from day-to-day. Many veterans struggle with PTSS, alcohol use disorder, and a range of conduct problems that reduce their quality of life after service. However, these problems are not static, but rather dynamic processes within the individual. The present results illustrate that these outcomes exhibit complex temporal interdependencies. Veterans have good days and bad days, and, as supported by the results of this study, have periods of remission interspersed with periods of distress, dyscontrolled alcohol use, and problems with social relationships. Common to each of these outcomes are disruptions in basic regulatory processes. Disinhibition increased reciprocal associations between PTSS and conduct problems. Affective lability was indicative of a vulnerable emotional regulatory system manifesting in deficits in regulating alcohol consumption and strengthening of reciprocal associations between PTSS and alcohol dependence syndrome. Addressing disruptions in any of these basic regulatory processes has the potential to produce meaningful clinical changes in PTSD, alcohol use, and associated problems and improve veterans’ quality of life as a result.
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影响因子：
3.4
作者：
Coffey, Scott F.;Schumacher, Julie A.;Stasiewicz, Paul R.
通讯作者：
Stasiewicz, Paul R.
影响因子：
7.6
作者：
Cooper, M. Lynne
通讯作者：
Cooper, M. Lynne
影响因子：
6.9
作者：
Aas, M.;Henry, C.;Etain, B.
通讯作者：
Etain, B.
影响因子：
10.3
作者：
Armour, Cherie;Fried, Eiko I.;Pietrzak, Robert H.
通讯作者：
Pietrzak, Robert H.
DOI：
10.1037/a0035725
发表时间：
2014-03
期刊：
Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors
影响因子：
--
作者：
Cohn A;Hagman BT;Moore K;Mitchell J;Ehlke S
通讯作者：
Ehlke S