Harford Thomas C, Yi Hsiao-Ye, Chen Chiung M, Grant Bridget F
CSR, Incorporated, 4250 N. Fairfax Drive, Suite 500, Arlington, VA 22203, United States.
CSR, Incorporated, 4250 N. Fairfax Drive, Suite 500, Arlington, VA 22203, United States.
J Affect Disord. 2018 Jan 1;225:365-373. doi: 10.1016/j.jad.2017.08.021. Epub 2017 Aug 15.
Previous studies have identified a violence typology of self- and other-directed violence. This study examines the extent to which substance use disorders (SUDs) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), independent of serious psychological distress, major depressive episodes, assault arrest, and criminal justice involvement, are associated with these violence categories.
Data were obtained from the National Survey on Drug Use and Health (NSDUH) pooled across survey years 2008-2015, with a combined sample of 314,881 adult respondents. According to self-report data on suicide attempt (self-directed) and attacking someone with the intent for serious injury (other-directed), violence was categorized in four categories: none, self-directed only, other-directed only, and combined self-/other-directed. Multinomial logistic regression was used to estimate the adjusted odds ratios associated with the risk factors for different forms of violence.
Nicotine dependence and the number of DSM-IV SUDs criteria (except the criterion of legal problems) for alcohol, marijuana, and pain reliever use disorders are significantly associated with the self-/other-directed violence categories.
Cross-sectional data do not allow assessment of directionality of important factors.
The identification of the combined self- and other-directed violence among adults in the general population extends studies in the adolescent population, and significant correlation between self- and other-directed violence provides additional support for clinical studies that established this association. Findings expand the associated risk factors identified in previous studies for the adult population. Prevention and treatment programs need to address both forms of violence and suicidality.
先前的研究已经确定了一种自我导向和他人导向暴力的类型学。本研究考察了《精神疾病诊断与统计手册》第四版（DSM-IV）所定义的物质使用障碍（SUDs）在独立于严重心理困扰、重度抑郁发作、攻击逮捕和刑事司法介入的情况下，与这些暴力类别之间的关联程度。
数据来自2008 - 2015年调查年份合并的全国药物使用和健康调查（NSDUH），共有314,881名成年受访者的综合样本。根据关于自杀未遂（自我导向）和意图严重伤害他人（他人导向）的自我报告数据，暴力被分为四类：无、仅自我导向、仅他人导向以及自我/他人导向合并。使用多项逻辑回归来估计与不同形式暴力的风险因素相关的调整后优势比。
尼古丁依赖以及酒精、大麻和止痛药使用障碍的DSM-IV SUDs标准数量（法律问题标准除外）与自我/他人导向暴力类别显著相关。
横断面数据不允许评估重要因素的方向性。
在一般人群的成年人中识别出自我和他人导向合并的暴力扩展了青少年人群中的研究，并且自我和他人导向暴力之间的显著相关性为确立这种关联的临床研究提供了额外支持。研究结果扩展了先前针对成年人群体确定的相关风险因素。预防和治疗项目需要同时应对这两种形式的暴力和自杀行为。
