PTSD Symptoms and Alcohol Problems: Vulnerability and Resilience Factors

描述(申请人提供)：创伤后应激障碍(PTSD)是一种衰弱的精神疾病，正在影响许多OEF/OIF退伍军人的生活。创伤后应激障碍和酒精使用障碍是高度共存的。多达50%-85%的创伤后应激障碍患者患有共病的酒精使用障碍(Kessler等人，1995年)。这种联系通常被归因于个人使用酒精自我用药(Stewart，1997)。然而，创伤后应激障碍症状和酒精障碍之间的确切功能联系尚不清楚。例如，有一些证据表明，创伤后应激障碍可能与自控力下降有关，这反过来又增加了与酒精有关的问题(Miller等人，2006年)。此外，冲动和情商等特征可以作为脆弱性或韧性因素，缓和症状和酒精结果之间的联系(Simons等人，2005；Austin，Saklofske，Egan，2005；Riley&Shutte，2003；Brackett，Mayer&Warner，2004)。此前的研究主要依靠调查来检验人与人之间的差异。通过近乎实时的重复行为评估来检查人与人之间和人内的联系，可以提高对创伤后应激障碍症状和酒精使用障碍之间潜在联系的功能机制的了解。建议对OEF/OIF退伍军人进行的为期两周的经验抽样研究检查了创伤后应激障碍症状与酒精消费和问题之间的联系的人与人之间的机制。(1)基线创伤后应激障碍症状被假设与饮酒率增加和问题有关，这些联系被假设为通过增加负面情感和负面紧迫感(即冲动)来调节。以前的研究已经发现，消极情感和冲动是被试之间水平的中介(Miller等人，2006年)。这项拟议的研究考察了负面情感在人与人之间和人内层面上的中介作用。此外，这项拟议的研究还将检查冲动的一个特定方面，即消极紧迫感(2)创伤后应激障碍症状的日常变化与负面情绪和随后的夜间饮酒和问题之间将存在正相关。在控制负面情绪时，半偏回归系数的显著程度将决定创伤后应激障碍症状是否与酒精行为有关。以前的研究已经确定了创伤后应激障碍症状与负面情绪和酒精问题之间的重大前瞻性联系(Miller等人，2006年)。本研究将这项研究扩展到在事件层面上考察这些关联，以准确地考察功能性关联。也就是说，创伤后应激障碍症状和酒精问题在日常生活中是如何变化的？最后，拟议的研究审查了保护性因素和脆弱性因素。(3)情绪智力会减弱创伤后应激障碍症状和消极情绪以及随后的饮酒和问题之间的人内联系，而消极紧迫感会增加。这些假设将通过测试跨级别的相互作用来检验。公共卫生相关性：这项研究使用创新的方法来探索创伤症状、脆弱性(冲动性)和复原力因素(情商)、酒精使用和新近归来的退伍军人中的问题之间的关系。这项研究测试了一种评估创伤应激症状和相关问题的新方法，并旨在检查这些困难的潜在机制，这些机制可能在治疗中得到解决。人们还希望，这一结果将促进未来便携式计算机技术在创伤应激研究中的使用，以更好地了解归来退伍军人的问题和优势。

DESCRIPTION (provided by applicant): Post-traumatic stress disorder (PTSD) represents a debilitating psychiatric condition that is affecting the lives of many returning OEF/OIF veterans. PTSD and alcohol use disorders are highly comorbid. As many as 50- 85% of individuals with PTSD have a comorbid alcohol use disorder (Kessler et al., 1995). This association is commonly attributed to individuals using alcohol to self-medicate (Stewart, 1997). However, the precise functional associations between PTSD symptoms and alcohol disorder are not well understood. For example, there is some evidence that PTSD may be associated with decreased self-control, which in turn increases alcohol-related problems (Miller et al., 2006). In addition, characteristics such as impulsivity and emotional intelligence may act as vulnerability or resilience factors, moderating associations between symptoms and alcohol outcomes (Simons et al., 2005; Austin, Saklofske, Egan, 2005; Riley & Shutte, 2003; Brackett, Mayer & Warner, 2004). Previous research has relied primarily on surveys to examine between-person differences. Examining both between- and within- person associations by repeated assessments of behavior in near real time can improve knowledge of functional mechanisms underlying associations between PTSD symptoms and alcohol use disorder. The proposed 2-week experience sampling study of OEF/OIF veterans examines between- and within- person mechanisms that underlie associations between PTSD symptoms and alcohol consumption and problems. (1) Baseline PTSD symptoms are hypothesized to be associated with increased rates of alcohol consumption and problems and these associations are hypothesized to be mediated by increased negative affectivity and negative urgency (i.e., impulsivity). Previous research has identified negative affectivity and impulsivity as mediators at the between-subject level (Miller et al., 2006). The proposed study examines the mediation role of negative affectivity at both the between- and within- person levels. Also, the proposed study will examine a specific aspect of impulsivity, negative urgency (2) There will be positive associations between daily variability of PTSD symptoms and negative affect and subsequent nighttime drinking and problems. Significance of the semi-partial regression coefficients will determine whether PTSD symptoms are associated with alcohol behaviors when controlling for negative affect. Previous research has identified significant prospective associations between PTSD symptoms and negative affect and alcohol problems (Miller et al., 2006). The proposed study extends this research to examine these associations at the event level to precisely examine the functional association. That is, how do PTSD symptoms and alcohol problems covary on a day-to-day basis? Finally, the proposed study examines protective and vulnerability factors. (3) Emotional intelligence will attenuate, and negative urgency increase, the within-person associations between PTSD symptoms and negative affect and subsequent alcohol use and problems. These hypotheses will be examined by testing cross-level interactions. PUBLIC HEALTH RELEVANCE: This research uses innovative methodology to explore the relationships among traumatic symptoms, vulnerability (impulsivity) and resilience factors (emotional intelligence), and alcohol use and problems among recent returning veterans. This research tests a novel approach to assessing traumatic stress symptoms and associated problems and aims to examine mechanisms underlying these difficulties that may be addressed in treatment. It is also hoped that the results will stimulate future use of portable computer technology in traumatic stress research to better understand the problems and strengths of returning veterans.