A Relationship Process Model of Individual Psychopathology

描述(申请人提供)：每年大约每4个成年人中就有1人患有某种形式的精神疾病，每年在精神障碍的治疗上花费近1500亿美元；然而，只有一半寻求精神病理学治疗的人实际上在临床上经历了显著的改善。拟议研究的总体目标是开发和测试一个综合理论模型，解释关键风险因素如何相互作用，通过整合素质的关键组成部分--精神病理学的应激、内化和外化模型以及关系功能障碍的脆弱性-压力-适应模型，解释关键风险因素如何相互作用，促进内在化(抑郁和焦虑)和外在化(酒精使用)障碍的发展过程。我的中心假设是，精神疾病的遗传脆弱性会导致更大的环境压力和更差的关系功能，这反过来又会导致精神病理学的进程。拟议的研究有5个具体目标，将在2个独立研究中进行测试。研究1：目标1-2将在275对社区夫妇的样本中进行检查，在7年内进行6次评估。第一个目的是解释全球关系不和谐与婚姻前7年的精神病态症状之间的纵向联系，以确定亲密关系在多大程度上有助于精神病态的发展进程。第二个目标是使用Kraemer等人的S标准来开发一个完整的概念框架，以解释关系功能如何与遗传脆弱性和环境应激相互作用，从而促进精神病理症状的发展。第三个目标是确定在目标2中制定的框架内有助于内化和外化症状发展的具体关系过程(例如，支持、冲突)。研究2：目标4和5将在一次评估的临床样本(100名门诊患者)中进行检查。第四个目标是利用Kraemer等人的S标准开发一个框架，解释全球关系功能如何与基因和压力相互作用，从而对目前的精神病理学诊断做出贡献。第五个目标是确定与寻求治疗的个体同时存在的内化性和外部性障碍相关的具体关系过程。将实施自我报告问卷和客观半结构化访谈。这项拟议的研究是朝着我开发/加强针对抑郁、焦虑和酒精使用障碍的预防和治疗计划的长期目标迈出的第一步，考虑到它有可能减轻我们社会中的精神疾病负担，因此与公共健康特别相关。

DESCRIPTION (provided by applicant): Approximately 1 in 4 adults suffers from some form of mental illness in a given year, and almost $150 billion is spent annually on the treatment of mental disorders; however, only half of individuals seeking treatment for psychopathology actually experience clinically significant improvement. The overall objective of the proposed research is to develop and test an integrated theoretical model explaining how key risk factors interact to contribute to the developmental courses of internalizing (depression and anxiety) and externalizing (alcohol use) disorders, by integrating key components of diathesis-stress, internalizing, and externalizing models of psychopathology and a vulnerability-stress-adaptation model of relationship dysfunction. My central hypothesis is that genetic vulnerabilities for mental illness contribute to greater environmental stress and poorer relationship functioning, which in turn contribute to the course of psychopathology. There are 5 specific aims to the proposed research to be tested across 2 independent studies. Study #1: Aims 1 -2 will be examined in a sample of 275 community couples assessed 6 times over 7 years. The 1st aim is to explain the longitudinal associations between global relationship discord and psychopathology symptoms over the first 7 years of marriage, to determine the extent to which intimate relationships contribute to the developmental course of psychopathology. The 2nd aim is to develop an integrated conceptual framework using Kraemer et al.'s criteria to explain how relationship functioning interacts with genetic vulnerabilities and environmental stress to contribute to the development of psychopathology symptoms. The 3rd aim is to identify the specific relationship processes (e.g., support, conflict) contributing to the development of internalizing and externalizing symptoms within the framework developed in Aim 2. Study #2: Aims 4 and 5 will be examined in a clinical sample (100 outpatients) assessed once. The 4th aim is to develop a framework using Kraemer et al.'s criteria that explains how global relationship functioning interacts with genes and stress to contribute to current diagnoses of psychopathology. The 5th aim is to identify the specific relational processes associated with concurrent internalizing and externalizing disorders for treatment-seeking individuals. Self-report questionnaires and objective semi-structured interviews will be implemented. The proposed research is the first step toward my long-term goal to develop/enhance prevention and treatment programs targeting depression, anxiety, and alcohol use disorders and has particular relevance to public health given its potential to reduce the burden of mental illness in our society.