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

工作场所骚扰（WH）是一种创伤性压力源，一直与药物使用和滥用有关， 心理健康状况不佳和健康症状。然而，严重精神病理学、发病率和 死亡率仍然没有研究。基于我们之前关于WH和物质使用的工作，我们专注于四个目标：1） 描述25年内WH对发病率和死亡率的长期影响; 2）使用三种 方法，测试药物滥用的作用，心理和认知中介（痛苦，异化， 反刍），和应激敏感化，以及这些因素的可能整合，以解释长期 在其他情况下，WH对精神病理学和不良健康结局（包括死亡率）的影响 压力源和关键的工作相关的结构和背景因素; 3）检查风险和保护因素 （服务使用、应对和应对有效性、性别和种族/族裔） 先前和当前的压力源和药物滥用，精神病理学和不良健康结果，以及4） 通过比较目前的健康状况，检查长期回忆以前的健康经历和物质使用的可靠性。 回顾之前的报道。拟议研究的一个核心创新是描绘了WH，一个微观层面的压力源， 可能会使反应敏感，以后来的微观和宏观层面的压力，增加长期风险的物质 虐待、精神病理学和不良健康后果。利用现有的8波数据集， 10年后，这项后续研究将a）每隔3年重新调查一批首次接受调查的成年人， 1996年雇用的人（N=2478）; B）用结构化访谈补充调查，以评估存在， 根据DSM-5标准，当前和既往精神病理学和药物滥用的时间，WH的长期回忆 和药物滥用，以及与工作有关的结构和背景因素，有助于工作场所卫生;和c）使用 国家死亡指数，以确定死亡率，包括死亡日期和原因， 结束之前的研究。这种设计将使我们能够测试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， 行为因素和模型中与工作相关的结构/背景因素，以解释WH的长期影响 关于结果。这将是第一项与WH相关的长期死亡风险研究。由于财富的 以前的数据表征样本，这项研究提供了一个独特的机会，告知可行的战略， 预防和解决卫生相关物质滥用、精神病理学、慢性健康问题和死亡率，以及 为有针对性的及时治疗和预防战略提供信息， 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.