Workplace Harassment, Macro-Level Stressors, Substance Use and Health Outcomes: A Long-Term Follow Up

工作场所骚扰(WH)是一种创伤性应激源，一直与药物使用和滥用有关， 心理健康状况不佳，出现健康症状。然而，严重精神病的长期风险、发病率和 死亡率仍未得到研究。在我们之前关于WH和物质使用的工作的基础上，我们专注于四个目标：1) 描述WH在25年期间对发病率和死亡率的长期影响；2)使用三个 方法，测试物质滥用、心理和认知中介(痛苦、疏远和 反思性)，以及压力敏化，以及这些因素的可能整合，来解释长期 WH对精神病理学和不良健康后果的影响，包括死亡率 压力源和与工作相关的关键结构和背景因素；3)检查风险和保护因素 (服务使用、应对和应对效力、性别和种族/族裔)修改 以前和现在的应激源和药物滥用、精神病理学和不良健康后果，以及4) 通过比较当前WH经历和物质使用情况来检验长期回忆WH经历和物质使用的可靠性 召回之前的报告。这项拟议研究的一个核心创新是描绘了WH，一种微观层面的压力源， 可能会敏化对后期微观和宏观应激源的反应，增加对物质的长期风险 虐待、精神病和不良健康后果。充分利用现有的8波数据集 10年后，这项后续研究将每隔3年重新调查一批首次接受调查的成年人，同时 1996年雇用(N=2478)；b)以结构化访谈补充调查，以评估存在和 根据DSM-5标准，现在和过去的精神病理学和药物滥用的时间，WH的长期召回 和药物滥用，以及与工作有关的结构和背景因素，这些因素有助于卫生保健；以及c)使用 国家死亡指数，以确定死亡率，包括死亡日期和死因，关于自#年以来发生的死亡率 上一次研究的结束。这一设计将允许我们测试WH对发病率影响的纵向模型 和死亡率，包括近端和远端机制，并包括心理因素， 模型中的行为因素和与工作相关的结构/背景因素，以解释WH的长期影响 关于结果的。这将是第一次对与WH相关的死亡率的长期风险进行研究。鉴于……的财富 之前的数据表征了样本，这项研究提供了一个独特的机会，以告知可行的战略 预防和解决与WH相关的物质滥用、精神病理学、慢性健康问题和死亡率，以及 告知有针对性的、及时的治疗和预防策略，以减轻与健康有关的负面影响 个人、工作场所和政策层面的WH。

Workplace harassment (WH) is a traumatic stressor that is consistently linked to substance use and abuse, poor mental health, and health symptoms. However, long-term risk for serious psychopathology, morbidity, and mortality remains unstudied. Building on our prior work on WH and substance use, we focus on four aims: 1) delineate long-term consequences of WH on morbidity and mortality over a 25 year period; 2) using three approaches, test the role of substance abuse, psychological and cognitive mediators (distress, alienation, and rumination), and stress sensitization, and the possible integration of these factors, to explain the long-term effects of WH on psychopathology and adverse health outcomes, including mortality, in the context of other stressors and key work-related structural and contextual factors; 3) examine risk and protective factors (services use, coping and coping effectiveness, gender and race/ethnicity) modifying the relationships between prior and current stressors and substance abuse, psychopathology, and adverse health outcomes, and 4) examine the reliability of long-term recall of prior WH experiences and substance use by comparing current recall to prior reports. A central innovation of the proposed study is delineating how WH, a micro-level stressor, may sensitize reactions to later micro- and macro-level stressors, increasing long-term risk for substance abuse, psychopathology, and adverse health outcomes. Capitalizing on an existing 8-wave dataset spanning 10 years, this follow-up study will a) re-survey at 3 one-year intervals a cohort of adults first surveyed while employed in 1996 (N=2478); b) supplement the survey with structured interviews to assess presence and timing of current and past psychopathology and substance abuse as per DSM-5 criteria, long-term recall of WH and substance abuse, and work-related structural and contextual factors that contribute to WH; and c) use the National Death Index to ascertain mortality, including date and cause of death, on mortality occurring since the end of the prior study. This design will allow us to test longitudinal models of the effects of WH on morbidity and mortality, incorporating both proximal and distal mechanisms, and incorporating intrapsychic factors, behavioral factors, and work-related structural/contextual factors in models to explain long-term effects of WH on outcomes. This will be the first study of long-term risk for mortality associated with WH. Given the wealth of previous data characterizing the sample, this study presents a unique opportunity to inform viable strategies to prevent and address WH-related substance abuse, psychopathology, chronic health issues, and mortality, and to inform targeted, timely treatment and prevention strategies to ameliorate negative health-related effects of WH at individual, workplace, and policy levels.