Nonsuicidal Self Injury in Veterans

迫切需要确定与退伍军人自杀增加相关的危险因素。非自杀性 自伤(NSSI)是指故意破坏身体组织，而没有意识到死亡的意图。其中 平民，最近的证据表明，NSSI是自杀企图的有力预测指标，表现优于许多 预测模型中公认的风险因素。NSSI障碍患者也报告有很大的功能 与没有NSSI障碍的精神病患者相比，NSSI障碍和更高的治疗利用率水平。然而， 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令人震惊的NSSI终生比率。具体来说，我们 研究发现，57%-66%的寻求治疗创伤后应激障碍的男性退伍军人支持终身NSSI，45%-55%的人报告 在之前的两周内参与了NSSI。我们还展示了NSSI与 退伍军人中的自杀意念，即使在考虑了创伤后应激障碍和抑郁之后也是如此。还需要做更多的工作：(1) 确定退伍军人中与NSSI和NSSI障碍相关的长期功能结局，以及(2) 确定在退伍军人中维持NSSI的可修改的治疗相关机制。这一知识将是一种 朝着我们的长期目标迈出的关键的第一步，即制定有效的筛查和干预策略 这将减少退伍军人中的NSSI和其他形式的自残行为(即自杀行为)。 此应用程序的总体目标是确定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特定前因后果。与一致 我们的概念模型，我们的中心假设是，NSSI之前有精神痛苦的恶化 并通过个人内部(例如，精神症状的暂时减少)和 人际关系的加强(例如，增加他人的关注)。建议进行这项研究的理由是 确定支持和维持退伍军人NSSI的因素将促进 针对这些退伍军人的具体需求的治疗方法。 在目标1中，我们将对最近有NSSI病史(N=120)的退伍军人进行为期1年的纵向研究，以 评估与这种破坏性行为相关的长期功能后果。我们假设 基线NSSI频率和基线NSSI紊乱状态将预测功能增加 残疾，更高的治疗利用率，更多的自杀行为，以及1年内NSSI频率的增加 在考虑了精神疾病的共病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 在AIM 1中符合以下标准的退伍军人子集中维持这种行为的后果 NSSI障碍(N=40)。我们假设，精神困扰和NSSI相关动机的增加将是 NSSI事件的重要前传。我们进一步假设NSSI事件将与 精神痛苦暂时减少，积极情绪和社会支持暂时增加。 总而言之，这些研究将提供关键数据，这些因素有助于启动和 维持NSSI，并将指导今后的治疗开发工作，旨在减少 NSSI和退伍军人中的其他形式的自我伤害(即自杀行为)。

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.