Psychological Drivers of Self-Destructive Behaviors in PTSD

在退伍军人中，自毁行为经常与创伤后应激障碍(PTSD)并存。 在那里，它们与增加的痛苦和损害有关。自毁行为包括那些有 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，药物使用、饮食失调)。拟议的研究旨在应用先进的 [创伤后应激障碍和抑郁症状]与自毁的相互关系的定量建模方法 群体和个人层面的行为。在目标1中，这些结构的关系的网络模型将 在所有服役时期(N=1 187)的退伍军人中进行性别均衡抽样。结果将确定 哪些[症状与自杀相关的结果和其他非自杀性的自毁行为有关 以及这些行为是否因性别而不同。]分析还将测试基线桥梁症状 在12个月的随访中预测自毁行为[(特别是与自杀相关的结果)]。结果将 在9/11事件后退伍军人(N=1,494)的单独性别均衡样本中进行验证。目标2是检查 与创伤后应激障碍相关的结构和自毁行为的网络模型的实时动态变化 个人内部的层面。新的退伍军人样本(目标N=60，50%是女性)，他们符合以下标准 阈值以下/阈值创伤后应激障碍，并报告最近有自杀意念和至少一种其他自毁行为 行为将被招募来完成生态瞬时评估(EMA)协议，报告这些 构造。将使用多水平自动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，以及自毁行为。候选人是博士后 弗吉尼亚州国家创伤后应激障碍中心女性健康科学部临床心理学研究员 波士顿医疗系统。研究和培训将在退伍军人事务部波士顿的环境中进行 医疗保健系统及其学术附属机构，波士顿大学在杰出的监督下 具有与建议书相关的内容和方法专业知识的指导团队。培训目标 与这一提议相关的内容包括：1)获得创伤应激模型的高级知识和自我 破坏性行为；2)掌握分析复杂、多变量的高级定量方法的技能 关系；3)获得EMA数据收集和分析方面的专业知识；4)从事专业发展，以 为作为退伍军人管理局临床研究员的成功职业生涯做好准备。研究和培训 与此相关的CDA2将使首席调查员做好准备，以实现她的直接目标 成功申请退伍军人事务部研究优秀奖，研究创伤重点治疗对 本提案中确定的自毁行为的机制。候选人的长期目标是 成为维持自我毁灭的心理机制动态过程的专家 继发于创伤暴露的行为。通过这些专业知识，应聘者的目标是产生知识 可用于加强以创伤为重点的治疗，并开发个性化、适应性 针对自毁行为的干预/评估工具。

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.