Nonsuicidal Self Injury in Veterans

退伍军人的非自杀性自伤

• 批准号: 10314014
• 负责人: Nathan A. Kimbrel
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10314014
• 关键词: Accounting; Adherence; Affect; Aggressive behavior; Anxiety; Area; Attention; Behavior; Borderline Personality Disorder; Clinical; Conscious; DSM-V; Data; Diagnosis; Disease; Distress; Ecological momentary assessment; Emotional; Exhibits; Feeling suicidal; Frequencies; Future; Goals; Guilt; Health; Healthcare; Impairment; Impulsivity; Intervention; Knowledge; Long-Term Effects; Longitudinal Studies; Maintenance; Masculine; Mental Depression; Mental disorders; Methods; Modeling; Patients; Population; Post-Traumatic Stress Disorders; Psychological reinforcement; Psychosocial Factor; Punishment; Recording of previous events; Regulation; Reporting; Research; Risk Factors; Risk-Taking; Safety; Self-Injurious Behavior; Severities; Social isolation; Social support; Suicide; Suicide attempt; Suicide prevention; Testing; Tissues; Veterans; Work; comorbidity; follow-up; functional disability; functional outcomes; help-seeking behavior; improved; male; negative affect; non-suicidal self injury; predictive modeling; prospective; psychiatric disability; psychiatric symptom; screening; substance misuse; suicidal behavior; suicidal risk; therapy development

There is a critical need to identify risk factors associated with increased suicidality in Veterans. Nonsuicidal self-injury (NSSI) refers to the deliberate destruction of body tissue without conscious intent to die. Among civilians, recent evidence suggests that NSSI is a robust predictor of suicide attempts, outperforming a number of well-established risk factors in prediction models. Patients with NSSI Disorder also report great functional impairment and higher levels of treatment utilization than psychiatric patients without NSSI Disorder. However, to date, this important clinical issue has been largely overlooked among Veterans. We recently documented alarming lifetime rates of NSSI among help-seeking Veterans. Specifically, we found that 57-66% of male Veterans seeking treatment for PTSD endorsed lifetime NSSI, and 45-55% reported engaging in NSSI during the previous two weeks. We have also shown that NSSI is uniquely associated with suicidal ideation in Veterans, even after accounting for PTSD and depression. More work is needed to: (1) Define the long-term functional outcomes associated with NSSI and NSSI Disorder in Veterans, and (2) Identify modifiable treatment-relevant mechanisms that maintain NSSI in Veterans. This knowledge will be a critical first step toward our long-term goal, which is to develop effective screening and intervention strategies that will reduce NSSI and other forms of self-injurious behavior (i.e., suicidal behavior) among Veterans. The overall objective of this application is to identify the long-term effects of NSSI on Veterans’ functioning as well as the specific antecedents and consequences that maintain this destructive behavior. Consistent with our conceptual model, our central hypothesis is that NSSI is preceded by exacerbations in psychiatric distress and maintained through both intrapersonal (e.g., temporary reductions in psychiatric symptoms) and interpersonal reinforcement (e.g., increased attention from others). The rationale for the proposed research is that the identification of factors that underlie and maintain NSSI in Veterans will facilitate the development of treatment approaches that are specific to the needs of these Veterans. In Aim 1, we will conduct a 1-year longitudinal study of Veterans with a history of recent NSSI (N = 120) to evaluate the long-term functional outcomes associated with this destructive behavior. We hypothesize that baseline NSSI frequency and baseline NSSI Disorder status will prospectively predict increased functional disability, greater treatment utilization, increased suicidal behavior, and increased NSSI frequency at 1-year follow-up after accounting for psychiatric comorbidity and known risk factors. In Aim 2, we will use ecological momentary assessment (EMA) to identify antecedents that predict the occurrence of NSSI as well as the consequences that serve to maintain this behavior in a subset of Veterans from Aim 1 who meet criteria for NSSI Disorder (N = 40). We hypothesize that increases in psychiatric distress and NSSI-related motives will be significant antecedents of NSSI episodes. We further hypothesize that NSSI episodes will be associated with temporary reductions in psychiatric distress and temporary increases in positive affect and social support. Together, these studies will provide critical data on key factors that contribute to the initiation and maintenance of NSSI and will guide future treatment development efforts aimed at reducing the occurrence of NSSI and other forms of self-injury (i.e., suicidal behavior) among Veterans.

迫切需要确定与退伍军人自杀倾向增加相关的风险因素。非自杀 自我伤害（NSSI）是指故意破坏身体组织，而没有意识到死亡的意图。之间 平民，最近的证据表明，NSSI是自杀企图的一个强有力的预测，超过了一些 在预测模型中建立的风险因素。患有NSSI障碍的患者也报告功能性 与无NSSI障碍的精神病患者相比，NSSI障碍的患者具有更高的治疗利用水平。然而，在这方面， 到目前为止，这一重要的临床问题在退伍军人中基本上被忽视了。 我们最近记录了寻求帮助的退伍军人中NSSI的惊人终身率。我们特别 发现57-66%的男性退伍军人寻求治疗创伤后应激障碍赞同终身NSSI，45-55%的人报告说， 在过去的两周里参与了NSSI。我们还表明，NSSI是唯一相关的， 即使在考虑了创伤后应激障碍和抑郁症后，退伍军人的自杀意念。需要做更多的工作：（1） 定义与退伍军人中的NSSI和NSSI障碍相关的长期功能结局，以及（2） 确定可修改的治疗相关机制，维持退伍军人的NSSI。这些知识将是一个 这是实现我们长期目标的关键第一步，即制定有效的筛查和干预策略 这将减少NSSI和其他形式的自我伤害行为（即，自杀行为）。 本申请的总体目标是确定NSSI对退伍军人功能的长期影响 以及维持这种破坏性行为的具体前因和后果。符合 我们的概念模型，我们的中心假设是，NSSI之前是精神痛苦的加重 并通过个人内部（例如，暂时减轻精神症状）， 人际强化（例如，引起别人的注意）。拟议研究的基本原理是 确定退伍军人NSSI的基础和维持因素将促进 治疗方法是针对这些退伍军人的需要。 在目标1中，我们将对有近期NSSI病史的退伍军人（N = 120）进行为期1年的纵向研究， 评估与这种破坏性行为相关的长期功能结果。我们假设 基线NSSI频率和基线NSSI疾病状态将前瞻性预测功能增加 1年时残疾、更高的治疗利用率、自杀行为增加和NSSI频率增加 在考虑精神科合并症和已知的危险因素后进行随访。在目标2中，我们将使用生态 瞬时评估（EMA），以确定预测NSSI发生的前因以及 结果，有助于维持这种行为的一个子集的退伍军人从目标1谁符合标准， NSSI障碍（N = 40）。我们假设，增加精神痛苦和NSSI相关的动机， NSSI事件的重要前因。我们进一步假设，NSSI发作将与 精神痛苦暂时减少，积极影响和社会支持暂时增加。 总之，这些研究将提供关键数据的关键因素，有助于启动和 维持NSSI，并将指导未来的治疗开发工作，旨在减少 NSSI和其他形式的自我伤害（即，自杀行为）。

项目成果

Traditional Masculine Gender Role Norms and Nonsuicidal Self-Injury in Veterans.

传统的男性性别角色规范和退伍军人的非杀伤性自我伤害。

• DOI: 10.1037/men0000419
• 发表时间: 2022-12-08
• 期刊: PSYCHOLOGY OF MEN & MASCULINITIES
• 影响因子: 2.7
• 作者: Beagley, Marin C;Mann, Adam J;Patel, Tapan A;McConnell, A Alex;Caron, Kelly M;Kinner, Dina G;Boeding, Sara E;Kimbrel, Nathan A
• 通讯作者: Kimbrel, Nathan A