Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System.
Department of Psychiatry, Boston University School of Medicine.
Med Care. 2021 Feb 1;59:S51-S57. doi: 10.1097/MLR.0000000000001476.
This study aimed to (1) examine whether the latent class structure of individuals engaging in self-directed violence and indirect self-harm behaviors (eg, substance use, disordered eating) varied by gender in a sample of US veterans, and (2) test the associations of posttraumatic stress disorder (PTSD) and depressive symptoms with the resulting classes.
Cross-sectional data from 3581 veterans, ages 18-50 (51.9% identified as women) were analyzed. Veterans self-reported histories of self-directed violence, substance use, and disordered eating. Latent class analysis and latent class regression were used to explore class structure by gender and examine association of class membership with PTSD and depressive symptoms.
A 4-class model was supported in the sample. Class 1 (20.0%) was characterized by substance use and self-directed violent thoughts and behaviors. Class 2 (8.3%) was characterized by substance use, disordered eating, and self-directed violent thoughts and behaviors. Class 3 (12.6%) was distinguished by indirect self-harm behaviors (substance use and disordered eating). Class 4 (59.6%) reflected low likelihood of behavioral dysregulation. Classes were partially invariant across gender; endorsement of substance use behaviors was generally higher for men in each class. Comorbid clinically significant depressive and PTSD symptoms were associated with the class characterized by highest behavioral dysregulation.
Self-directed violent thoughts and behaviors present comorbidly with indirect self-harm in men and women veterans, although patterns of indirect self-harm behaviors differ slightly by gender. Such comorbidity may be associated with more severe presentations of psychiatric concerns.
本研究旨在：(1) 检验在一个美国退伍军人样本中，个体从事自我伤害和间接自我伤害行为（如物质使用、饮食失调）的潜在类别结构是否因性别而异；(2) 测试创伤后应激障碍（PTSD）和抑郁症状与所得类别之间的关联。
对 3581 名年龄在 18-50 岁（51.9%为女性）的退伍军人的横断面数据进行分析。退伍军人自我报告有自我伤害、物质使用和饮食失调的历史。采用潜在类别分析和潜在类别回归来探索性别差异的类别结构，并检验类别成员身份与 PTSD 和抑郁症状的关联。
在样本中支持 4 类模型。第 1 类（20.0%）的特征是物质使用和自我伤害的想法和行为。第 2 类（8.3%）的特征是物质使用、饮食失调和自我伤害的想法和行为。第 3 类（12.6%）以间接自伤行为（物质使用和饮食失调）为特征。第 4 类（59.6%）反映了行为失调的可能性较低。类别在性别间部分不变；在每个类别中，物质使用行为的认可度总体上男性更高。同时存在临床上显著的抑郁和 PTSD 症状与表现出最高行为失调的类别相关。
男性和女性退伍军人中存在自我伤害的想法和行为与间接自伤行为共病，尽管间接自伤行为的模式略有性别差异。这种共病可能与更严重的精神问题表现有关。
