Graduate School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
Addict Behav. 2011 May;36(5):465-9. doi: 10.1016/j.addbeh.2011.01.006. Epub 2011 Jan 25.
Research has consistently shown that drinking to alleviate negative emotional states predicts alcohol use and relapse among clients with co-occurring disorders including depressive and posttraumatic stress disorders. However, studies examining the mediating role of drinking motives in persons with severe mental illness (SMI) are few. The current survey of 116 community mental health clients (51.7% men; 47.4% women) diagnosed with either a schizophrenia spectrum disorder (41, 35.3%) or major mood disorder (75, 64.7%) tested the hypothesis that convivial drinking and drinking to cope with negative emotions would mediate posttraumatic stress symptoms (PSS-I) and alcohol consumption (QF). A series of path models revealed that convivial drinking fully mediated hyper-arousal symptoms and alcohol consumption, and negative coping fully mediated total posttraumatic stress symptoms, avoidance and hyper-arousal symptoms and alcohol consumption. The results support an emotional distress reduction model of alcohol use in people with severe mental illness, and highlight the need to assess specific drinking motives and target them in cognitive-behavioral treatment approaches. The cross sectional design employed limits cause-effect inferences regarding mediation, and highlights the need for longitudinal designs to sort out causal pathways among symptoms, drinking motives and alcohol consumption in clients with SMI.
研究一直表明，为缓解负面情绪而饮酒会预测同时患有抑郁和创伤后应激障碍等共病障碍的患者的饮酒和复发。然而，研究严重精神疾病（SMI）患者饮酒动机的中介作用的研究很少。目前对 116 名社区心理健康患者（51.7%为男性；47.4%为女性）进行了调查，这些患者被诊断为精神分裂症谱系障碍（41 例，占 35.3%）或主要心境障碍（75 例，占 64.7%），检验了以下假设：欢乐饮酒和饮酒应对负面情绪会在创伤后应激症状（PSS-I）和酒精消耗（QF）中起中介作用。一系列路径模型显示，欢乐饮酒完全中介了过度唤醒症状和酒精消耗，而消极应对完全中介了总创伤后应激症状、回避和过度唤醒症状以及酒精消耗。结果支持了严重精神疾病患者饮酒的情绪困扰减轻模型，并强调需要评估特定的饮酒动机，并在认知行为治疗方法中针对这些动机。所采用的横断面设计限制了关于中介作用的因果推断，并强调需要进行纵向设计，以理清 SMI 患者症状、饮酒动机和酒精消耗之间的因果途径。
