Richman J A, Rospenda K M
Department of Psychiatry, University of Illinois, Chicago 60612.
J Nerv Ment Dis. 1992 Oct;180(10):619-26. doi: 10.1097/00005053-199210000-00002.
Psychiatric epidemiological research has focused disproportionate attention on traditionally female disorders such as depression. This paper shifts epidemiological gears to elaborate and test an etiological model of a traditionally male disorder, that of alcohol abuse. We argue that social-relational deficits (narcissistic orientations) lead to abuse of alcohol for stress reduction purposes, given interpersonally oriented stressors and the incapacity to form social supports. The model was tested in the context of training for a traditionally male occupation encompassing both social-relational demands and limited social supports. A cohort of medical students was surveyed from medical school entrance through a portion of clinical training. Time 1 social-relational deficits were predictive of time 3 alcohol abuse, partially as a function of social support deficits and, to a lesser extent, patient care-related stressors. Moreover, there was an initial gender difference in social-relational deficits and a trend-level gender difference in alcohol abuse that disappeared when social-relational deficits were held constant. By time 3, women did not differ from men in social-relational deficits or alcohol abuse.
精神病流行病学研究过度关注了诸如抑郁症等传统上被认为是女性易患的疾病。本文转变了流行病学研究方向，详细阐述并检验一种传统上被认为是男性易患疾病——酒精滥用的病因模型。我们认为，鉴于人际导向的压力源以及无法形成社会支持，社会关系缺陷（自恋倾向）会导致为减轻压力而滥用酒精。该模型在一种对传统男性职业进行培训的情境中进行了检验，这种职业既包含社会关系需求，又有有限的社会支持。对一组医学院学生从入学到部分临床培训阶段进行了调查。时间1时的社会关系缺陷可预测时间3时的酒精滥用，部分原因是社会支持缺陷，且在较小程度上是与患者护理相关的压力源。此外，社会关系缺陷最初存在性别差异，酒精滥用也存在趋势层面的性别差异，但当社会关系缺陷保持不变时，这种差异就消失了。到时间3时，女性在社会关系缺陷或酒精滥用方面与男性没有差异。
