Psychological Drivers of Self-Destructive Behaviors in PTSD

创伤后应激障碍（PTSD）自毁行为的心理驱动因素

• 批准号: 10700993
• 负责人: Rachel L Zelkowitz
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700993
• 关键词: Address; Affect; Affective; Alcohols; Area; Assessment tool; Award; Behavior; Behavioral; Behavioral Symptoms; Binge Eating; Boston; Characteristics; Clinical; Clinical Investigator; Clinical Psychology; Cognition; Cognitive; Complex; Computing Methodologies; Data Analyses; Data Collection; Detection; Development; Disease; Disparate; Distal; Distress; Drug usage; Eating Disorders; Ecological momentary assessment; Emotional; Environment; Feeling suicidal; Future; Gender; Goals; Health Sciences; Healthcare Systems; Impairment; Individual; Injury; Intervention; Knowledge; Link; Maps; Mental disorders; Mentorship; Methodology; Methods; Modeling; Monitor; Moods; Outcome; Pathway Analysis; Physiological; Post-Traumatic Stress Disorders; Postdoctoral Fellow; Principal Investigator; Process; Protocols documentation; Regression Analysis; Reporting; Research; Research Personnel; Research Priority; Risk; Risk Marker; Sampling; Secondary to; Self Destructive Behavior; Self Direction; Self-Injurious Behavior; Services; Suicide; Suicide attempt; Suicide prevention; Supervision; Symptoms; System; Techniques; Testing; Time; Training; Trauma; Treatment outcome; Universities; Validation; Veterans; Violence; Woman; Women' s Health; adaptive intervention; career; career development; clinically significant; comorbidity; density; depressive symptoms; experience; follow-up; food restriction; improved; men; network models; non-suicidal self injury; personalized care; post 9/11; psychologic; purge; real time model; recruit; response; skill acquisition; stressor; substance use; suicidal; suicidal behavior; suicidal morbidity; tool; trauma exposure; traumatic stress

Self-destructive behaviors are frequently comorbid with posttraumatic stress disorder (PTSD) among Veterans, where they are linked to increased distress and impairment. Self-destructive behaviors encompass those with the potential for immediate injury (e.g., [suicidal and nonsuicidal] self-directed violence) and those with more distal consequences (e.g., substance use, disordered eating). The proposed research aims to apply advanced quantitative methods to model interrelations of [PTSD and depressive symptoms] and self-destructive behaviors at both the group and individual levels. In Aim 1, network models of relations of these constructs will be developed in a gender-balanced sample of Veterans from all service eras (N = 1,187). Results will identify which [symptoms bridge (i.e., connect) to suicide-related outcomes and other nonsuicidal self-destructive behaviors and whether these differ by gender.] Analyses will also test whether baseline bridge symptoms predict self-destructive behaviors [(specifically suicide-related outcomes)] at 12-month follow-up. Results will be validated in a separate gender-balanced sample of post-9/11 Veterans (N = 1,494). Aim 2 is to examine real-time, dynamic changes in network models of PTSD-related constructs and self-destructive behaviors at the intrapersonal level. A new sample of Veterans (target N = 60, 50% women) who meet criteria for subthreshold/threshold PTSD and report recent suicidal ideation and at least one other self-destructive behavior will be recruited to complete an ecological momentary assessment (EMA) protocol reporting on these constructs. Multilevel autovector regression analysis techniques will be used to model real-time changes in networks of PTSD and depressive symptoms, and self-destructive behaviors. The candidate is a postdoctoral fellow in clinical psychology at the Women’s Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System. Research and training will take place within the environment of VA Boston Healthcare System and its academic affiliate, Boston University under the supervision of a distinguished mentorship team with content and methodological expertise relevant to the proposal. The training aims associated with this proposal include: 1) Gain advanced knowledge of models of traumatic stress and self- destructive behaviors; 2) acquire skills in advanced quantitative methods for analyzing complex, multivariate relations; 3) gain expertise in EMA data collection and analyses; and 4) engage in professional development to prepare the candidate for a successful career as a VA clinical investigator. The research and training associated with this CDA2 will prepare the principal investigator to achieve her immediate goal of preparing a successful VA Research Merit Award application to study the impact of trauma-focused treatments on mechanisms of self-destructive behaviors identified in this proposal. The candidate’s long-term goal is to become an expert in the dynamic processes of psychological mechanisms maintaining self-destructive behaviors secondary to trauma exposure. Through this expertise, the candidate aims to produce knowledge that can be used to enhance trauma-focused treatments and develop personalized, adaptive intervention/assessment tools for self-destructive behaviors.

在退伍军人中，自我毁灭行为经常与创伤后应激障碍（PTSD）共病， 与痛苦和损伤的增加有关。自我毁灭行为包括那些 直接伤害的可能性（例如，[自杀和非自杀]自我导向的暴力）和那些有更多 远端后果（例如，物质使用，饮食失调）。这项研究旨在应用先进的 定量方法来建模[创伤后应激障碍和抑郁症状]和自我毁灭的相互关系 在群体和个人层面上的行为。在目标1中，这些结构的关系的网络模型将 在来自所有服役时期的退伍军人的性别平衡样本中开发（N = 1，187）。结果将确定 其中[症状桥接（即，连接）自杀相关的结果和其他非自杀性自我毁灭 行为以及这些行为是否因性别而异。分析还将测试基线桥梁症状是否 预测12个月随访时的自毁行为[（特别是自杀相关的结果）]。结果将 在9/11后退伍军人（N = 1，494）的单独性别平衡样本中进行验证。目的二是检查 PTSD相关结构和自我毁灭行为的网络模型的实时动态变化 个人层面。符合以下标准的退伍军人新样本（目标N = 60，50%女性） 阈下/阈下PTSD和报告最近自杀意念和至少一次其他自我毁灭 行为将被招募，以完成生态瞬时评估（EMA）协议，报告这些 结构。将使用多水平自向量回归分析技术来模拟 创伤后应激障碍和抑郁症状的网络，以及自我毁灭行为。候选人是博士后 弗吉尼亚州国家创伤后应激障碍中心妇女健康科学部临床心理学研究员 波士顿医疗系统研究和培训将在VA波士顿的环境中进行 医疗保健系统及其学术附属机构，波士顿大学的监督下，一个杰出的 具有与提案相关的内容和方法专门知识的指导团队。培训的目的 与此相关的建议包括：1）获得先进的知识模型的创伤性压力和自我， 破坏性行为; 2）掌握高级定量方法的技能，用于分析复杂的，多变量的 关系; 3）获得EMA数据收集和分析方面的专业知识;以及4）参与专业发展， 准备候选人成功的职业生涯作为VA临床研究员。研究和培训 与本CDA 2相关的主要研究者将为实现其近期目标做好准备， 成功的VA研究优异奖申请，以研究创伤为重点的治疗对 自我毁灭行为的机制在这个建议中确定。候选人的长期目标是 成为保持自我毁灭的心理机制的动态过程的专家 创伤暴露后继发的行为通过这种专业知识，候选人的目标是产生知识 可以用来加强创伤治疗， 自我毁灭行为的干预/评估工具。

项目成果

Gender differences in direct and indirect associations of trauma types with disordered eating in a national U.S. veteran sample.

在美国退伍军人样本中，创伤类型与饮食失调的直接和间接关联存在性别差异。

• DOI: 10.1037/tra0001353
• 发表时间: 2023
• 期刊: Psychological trauma : theory, research, practice and policy
• 作者: Zelkowitz,RachelL;Sienkiewicz,MeganE;Vogt,DawneS;Smith,BrianN;Mitchell,KarenS
• 通讯作者: Mitchell,KarenS