Durazzo Timothy C, Humphreys Keith, LaRocca Michael A
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine,Stanford, CA 94305, USA.
Mental Illness Research and Clinical Centers (TCD), Center for Innovation to Implementation (KH), VA Palo Alto Health Care System, Palo Alto, CA 94304, USA.
Mil Med. 2024 May 18;189(5-6):e1064-e1071. doi: 10.1093/milmed/usad405.
Lifetime and past-year alcohol use disorder (AUD) prevalence is significantly higher in US Armed Services Veterans than in non-veterans across adulthood. This study examined the associations of perceived transformational leadership styles (TLS) experienced during military service and anhedonic depression and self-efficacy related to confidence to abstain or reduce alcohol consumption in Veterans seeking treatment for AUD. The ramifications of perceived leadership styles on multiple aspects of follower psychiatric functioning, including depressive and PTSD symptomatology, during and after military service, may be substantial and enduring. Higher anhedonic depression and lower abstinence self-efficacy are related to increased risk of relapse after treatment. We predicted Veterans, in treatment for AUD, who reported higher perceived levels of transformational leadership during military service, demonstrate lower anhedonic depressive symptoms and higher alcohol abstinence self-efficacy.
Veterans with AUD (n = 60; 50 ± 14 years of age) were recruited from residential treatment at the VA Palo Alto Health Care System. All procedures were approved by the VA Palo Alto Health Care System and Stanford University institutional review boards. A series of mediation analyses were completed with The Multifactor Leadership Questionnaire measures of TLS (average across leadership measures [transformational leadership average; TLS average]) as predictor and the Alcohol Abstinence Self-Efficacy Scale, Mood and Anxiety Symptom Questionnaire, anhedonic depression subscale, as dependent measures. PTSD Checklist for DSM-5 score was tested as a mediator variable.
Higher reported perceived TLS average during military service was significantly related to lower anhedonic depressive symptoms. Higher TLS average was related to higher self-efficacy to resist alcohol use in contexts involving experience of physical issues and withdrawal/cravings and urges. These relationships were not mediated by PTSD symptomatology or duration of military service, age, education, time since military service, military branch, combat exposure, or current psychiatric diagnosis.
The significant associations of perceived TLS during military service with anhedonic depression and alcohol use self-efficacy are clinically relevant because these measures are associated with relapse risk after AUD treatment. Further study of the implications of perceived TLS during military service for AUD and other substance use disorder treatment outcome is warranted in Veterans.
在美国武装部队退伍军人中，终身和过去一年酒精使用障碍（AUD）的患病率显著高于成年期的非退伍军人。本研究调查了在寻求AUD治疗的退伍军人中，服役期间所感知到的变革型领导风格（TLS）与快感缺失性抑郁以及与戒酒或减少饮酒信心相关的自我效能之间的关联。在服役期间及之后，所感知到的领导风格对追随者精神功能多个方面（包括抑郁和创伤后应激障碍症状）的影响可能是重大且持久的。更高的快感缺失性抑郁和更低的戒酒自我效能与治疗后复发风险增加有关。我们预测，正在接受AUD治疗的退伍军人若报告在服役期间所感知到的变革型领导水平较高，则会表现出较低的快感缺失性抑郁症状和较高的戒酒自我效能。
从帕洛阿尔托退伍军人医疗保健系统的住院治疗机构招募了患有AUD的退伍军人（n = 60；年龄50±14岁）。所有程序均获得帕洛阿尔托退伍军人医疗保健系统和斯坦福大学机构审查委员会的批准。以TLS的多因素领导问卷测量值（领导测量值的平均值[变革型领导平均值；TLS平均值]）作为预测变量，以戒酒自我效能量表、情绪和焦虑症状问卷、快感缺失性抑郁子量表作为因变量，完成了一系列中介分析。将DSM-5创伤后应激障碍检查表得分作为中介变量进行了测试。
报告的服役期间TLS平均水平较高与较低的快感缺失性抑郁症状显著相关。TLS平均水平较高与在涉及身体问题以及戒断/渴望和冲动体验的情境中抵抗饮酒的较高自我效能相关。这些关系未由创伤后应激障碍症状、服役时间、年龄、教育程度、退伍后时间、军种、战斗暴露或当前精神诊断所介导。
服役期间所感知到的TLS与快感缺失性抑郁和酒精使用自我效能之间的显著关联具有临床相关性，因为这些指标与AUD治疗后的复发风险相关。有必要对服役期间所感知到的TLS对退伍军人AUD及其他物质使用障碍治疗结果的影响进行进一步研究。
