Psychological Drivers of Self-Destructive Behaviors in PTSD

创伤后应激障碍（PTSD）自毁行为的心理驱动因素

• 批准号: 10481132
• 负责人: Rachel L Zelkowitz
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10481132
• 关键词: Address; Affect; Affective; Alcohols; Area; Assessment tool; Award; Behavior; Behavioral; Behavioral Symptoms; Binge Eating; Boston; Characteristics; Clinical; Clinical Investigator; Clinical Psychology; Cognition; Cognitive; Complex; Computing Methodologies; Data Analyses; Data Collection; Detection; Development; Disease; Distal; Distress; Drug usage; Eating Disorders; Ecological momentary assessment; Emotional; Environment; Feeling suicidal; Foundations; Future; Gender; Goals; Health Sciences; Healthcare Systems; Impairment; Individual; Injury; Intervention; Knowledge; Link; Maps; Mental disorders; Mentorship; Methodology; Methods; Modeling; Monitor; Moods; Outcome; Pathway Analysis; Physiological; Post-Traumatic Stress Disorders; Postdoctoral Fellow; Principal Investigator; Process; Protocols documentation; Regression Analysis; Reporting; Research; Research Personnel; Research Priority; Research Training; Risk; Risk Marker; Sampling; Secondary to; Self Destructive Behavior; Self-Direction; Self-Injurious Behavior; Services; Substance Use Disorder; Suicide; Suicide attempt; Suicide prevention; Supervision; Symptoms; System; Techniques; Testing; Time; Training; Trauma; Treatment outcome; Universities; Validation; Veterans; Violence; Woman; Women' s Health; adaptive intervention; career; career development; clinically significant; comorbidity; density; depressive symptoms; follow-up; food restriction; improved; men; network models; non-suicidal self injury; personalized care; post 9/11; psychologic; purge; real time model; recruit; response; skills; stress related disorder; stressor; substance use; suicidal; suicidal behavior; suicidal morbidity; tool; trauma exposure; traumatic stress

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.

退伍军人中的自毁行为经常与创伤后应激障碍（PTSD）共存， 它们与增加的痛苦和损伤有关，包括那些患有自毁行为的人。 立即受伤的可能性（例如，[自杀性和非自杀性]自我导向暴力）以及遭受更多伤害的人 拟议的研究旨在应用先进的后果（例如物质使用、饮食失调）。 模拟[创伤后应激障碍和抑郁症状]与自我毁灭之间相互关系的定量方法 在目标 1 中，这些结构的关系的网络模型将在群体和个人层面上进行。 是在所有服役时期的退伍军人的性别平衡样本中制定的（N = 1,187），结果将确定。 [症状桥接（即连接）与自杀相关的结果和其他非自杀性自我毁灭性的结果 行为以及这些行为是否因性别而异。]分析还将测试基线桥梁症状是否 在 12 个月的随访中预测自我毁灭行为 [（特别是与自杀相关的结果）]。 在 9/11 后退伍军人的单独性别平衡样本中进行验证（N = 1,494）。目标 2 是进行检查。 PTSD 相关结构和自我毁灭行为的网络模型的实时动态变化 符合以下标准的退伍军人新样本（目标 N = 60，其中 50% 为女性） 亚阈值/阈值 PTSD 并报告最近的自杀意念和至少一种其他自毁行为 将招募行为来完成生态瞬时评估（EMA）协议报告这些 多级自动向量回归分析技术将用于对实时变化进行建模。 创伤后应激障碍（PTSD）和抑郁症状以及自毁行为的网络 该候选人是一名博士后。 弗吉尼亚州国家创伤后应激障碍中心妇女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 VA 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 具有与培训目标相关的内容和方法专业知识的指导团队。 与该提案相关的内容包括： 1) 获得创伤应激和自我应激模型的高级知识 破坏性行为；2) 获得分析复杂、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； 为候选人作为 VA 临床研究者的成功职业生涯做好准备 研究和培训。 与此 CDA2 相关的内容将使主要研究者做好准备，以实现她准备一个 成功申请退伍军人管理局研究优异奖，研究以创伤为重点的治疗对患者的影响 该提案中确定的自我毁灭行为的机制是候选人的长期目标。 成为维持自我毁灭的心理机制动态过程的专家 通过这种专业知识，候选人的目标是产生知识。 可用于加强以创伤为中心的治疗并开发个性化的、适应性的 自毁行为的干预/评估工具。