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: 10700993
• 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/10700993
• 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; Disparate; Distal; Distress; Drug usage; Eating Disorders; Ecological momentary assessment; Emotional; Environment; Feeling suicidal; 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; Risk; Risk Marker; Sampling; Secondary to; Self Destructive Behavior; Self Direction; Self-Injurious Behavior; Services; 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; experience; follow-up; food restriction; improved; men; network models; non-suicidal self injury; personalized care; post 9/11; psychologic; purge; real time model; recruit; response; skill acquisition; stressor; substance use; suicidal; suicidal behavior; suicidal morbidity; tool; trauma exposure; traumatic stress; 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; Disparate; Distal; Distress; Drug usage; Eating Disorders; Ecological momentary assessment; Emotional; Environment; Feeling suicidal; 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; Risk; Risk Marker; Sampling; Secondary to; Self Destructive Behavior; Self Direction; Self-Injurious Behavior; Services; 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; experience; follow-up; food restriction; improved; men; network models; non-suicidal self injury; personalized care; post 9/11; psychologic; purge; real time model; recruit; response; skill acquisition; 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.

自我毁灭行为经常与退伍军人之间的创伤后应激障碍（PTSD）合并， 它们与增加的困扰和障碍有关。自我毁灭行为包括 立即受伤的可能 远端后果（例如，使用物质，饮食混乱）。拟议的研究旨在应用高级 定量方法来建模[PTSD和抑郁症状]和自毁性的相互关系 小组和个人级别的行为。在AIM 1中，这些结构的关系网络模型将 在所有服务时代的退伍军人的性别平衡样本中开发（n = 1,187）。结果将确定 哪个[症状桥接（即连接）与自杀相关的结果和其他不杀人的自我毁灭性 行为以及它们是否通过性别与众不同。]分析还将测试基线桥符号是否 在12个月的随访中预测自我毁灭行为（特别是自杀相关的结果）。结果将 在9/11后退伍军人的单独性别平衡样本中得到验证（n = 1,494）。目标2是检查 PTSD相关构造的网络模型和自我毁灭行为的实时动态变化 人际。符合条件的新的退伍军人样本（目标n = 60％，女性50％） 子阈值/阈值PTSD并报告最近的自杀想法，至少有一个自我毁灭性的想法 将招募行为以完成有关这些报告的生态瞬时评估（EMA）协议 构造。多级Autovector回归分析技术将用于建模实时更改 PTSD和抑郁症状的网络以及自毁行为。候选人是博士后 弗吉尼亚州国家PTSD国家中心女子健康科学系临床心理学研究员 波士顿医疗保健系统。研究和培训将在波士顿VA环境中进行 医疗保健系统及其学术会员，波士顿大学的监督 具有内容和方法论专业知识的识别团队与该提案相关。培训目标 与该建议相关的包括：1）获得创伤压力模型的先进知识 破坏性行为； 2）获取高级定量方法的技能，用于分析复合物多变量 关系3）在EMA数据收集和分析方面获得专业知识； 4）从事专业发展 为VA临床调查员成功事业准备候选人。研究和培训 与此CDA2相关 成功的VA研究功绩奖申请，以研究以创伤为中心的治疗的影响 本提案中确定的自我毁灭行为的机制。候选人的长期目标是 成为维持自我毁灭的心理机制动态过程的专家 继发创伤暴露的行为。通过这种专业知识，候选人旨在产生知识 可以用来增强以创伤为中心的治疗并发展个性化的自适应 干预/评估工具的自我毁灭行为。