创伤后应激障碍与重性抑郁障碍症状的共生模式与机制:基于心理病理学网络视角
文献类型：学位论文
| 作者 | 陈琛
|
| 答辩日期 | 2023-12 |
| 文献子类 | 博士 |
| 授予单位 | 中国科学院大学 |
| 授予地点 | 中国科学院心理研究所 |
| 其他责任者 | 王力 |
| 关键词 | 创伤后应激障碍 重性抑郁障碍 心理病理学 网络方法 共病 |
| 学位名称 | 理学博士 |
| 学位专业 | 健康心理学 |
| 其他题名 | The co-occurring batterns and psvchopathological mechanisms in post-traumatic stress disorder and major depressive disorder: from a network perspective |
| 中文摘要 | As two common mental disorders after trauma, PTSD and MDD are highly comorbid. About half of people suffering PTSD also have MDD. The comorbidity of PTSD and MDD has many adverse consequences. Therefore, research on this topic is of great significance for understanding the mechanism of comorbidity of PTSD and MDD, establishing effective assessment and screening, and developing a precise intervention system. Traditional explanations for the high comorbidity between PTSD and MDD (e.g., the overlapping symptom hypothesis, shared factor hypothesis, causality hypothesis, etc.) are all based on the latent variable perspective, ignoring the uniqueness of symptoms and the interactions between symptoms. Based on the emerging psychopathological network perspective, this study deconstructs the comorbidity of PTSD and MDD into a symptom network system composed of the symptoms and their correlations, using advanced quantitative review network method, longitudinal cross lag panel networks, and simulated intervention technology. A network approach was used to systematically examine the co-occurring pattern of PTSD and MDD symptoms. Further, trauma, the essential prerequisite for the comorbidity of PTSD and MDD, was included in the network. By examining the activation effect of trauma on symptoms of PTSD and MDD, the moderating effect on the correlation between symptoms, and the differences between PTSD and MDD networks at different levels and types of trauma, we systematically explored the impact of trauma on the co-occurring pattern of PTSD and MDD symptoms, so as to comprehensively reveal the underlying psychopathological mechanisms of their comorbidity. The results of the first part of the study on the co-occurring model of PTSD and MDD symptoms show that: 1) The symptom network of PTSD and MDD stably presents a relatively independent network structure in which PTSD and MDD are clustered separately, and the clusters are connected by their overlapping symptoms-sleep problems, reflecting that the two represent different psychopathological processes after trauma; 2) In the longitudinal network of PTSD and MDD symptoms, PTSD symptoms have an overwhelmingly strong predictive effect on MDD, indicating that PTSD may be an "antecedent" and MDD as the "consequences" in the comorbidity of the two; 3) Different symptoms have different potential intervention effects in the comorbidity of PTSD and MDD; "psychological responses to trauma" may be an effective treatment target, and "negative beliefs about the future" may be an effective preventme target. The second part of the research on the role of trauma in the co-occurring model of PTSD and MDD symptoms shows: 1) Trauma independently activates PTSD through re-experiencing symptoms (intrusive thoughts, psychological and physiological reactions to trauma, etc.) and activates MDD symptoms through sadness; 2) Trauma may link PTSD to MDD by acting as a bridge between the "irritability" of PTSD and the "low self-worth" of MDD; 3) Specific focus on "emotional distant" with higher level of trauma exposure, and "lack of interest" with lower level of trauma exposure might be needed; 4) Compared with non-interpersonal trauma types, "irritability" and "low self-worth" are related to "suicidal ideation" more strongly in interpersonal trauma type. In general, the findings of this series of studies support the view that PTSD and MDD represent two independent psychological constructs after trauma, and partially support the demoralization model that post-traumatic PTSD is an antecedent of MDD; the "psychological response to trauma" is identified as the central symptom and the potential therapeutic intervention target in the comorbidity of PTSD and MDD; and the important driving role of the overlapped sleep problems in the comorbidity of PTSD and MDD and the development of MDD after trauma; it was also found that trauma impacts PTSD and MDD not only through the dose effect (i.e., the higher the trauma exposure, the more severe PTSD and MDD), but also directly affects the underlying psychopathological pathways bridging PTSD and MDD; and strong correlations between irritability and low self-worth with suicidal ideation under the type of interpersonal trauma. Based on these findings, a possible integrated comorbid model of "trauma-PTSD=MDD" was proposed, providing important information for understanding the underlying psychopathological mechanisms of comorbid PTSD and MDD and developing accurate and effective early screening and intervention measures. |
| 英文摘要 | 作为创伤后常见的两种精神障碍，PTSD与MDD极易共病。约一半的PTSD患者同时患有MDD o PTSD与MDD的共病有诸多不良后果。因此，对这一主题的研究对于理解二者共病现象建立有效评估筛查、发展精准化干预体系具有重要意义。 传统视角下对于二者高共病现象成因的解释(如重叠症状假说、共享因素假说、因果关系假说等)均基于潜变量视角，忽略了症状的独特性和症状间关键的相互作用。本研究基于新兴的心理病理学网络视角，将PTSD和MDD的共病解构为二者症状及症状之间相互关联组成的共生网络，采用量化综述网络方法、纵向交叉滞后网络、模拟干预技术等先进网络方法，系统性考查二者症状的共生模式。进一步在网络中纳入创伤这一PTSD和MDD共病发生的必要先决条件，通过考查创伤对PTSD与MDD症状的激活作用、对二者症状关联的调节作用、以及不同创伤水平与创伤类型中PTSD与MDD症状网络的差异，系统性探索创伤对于二者症状共生模式的影响，以全面揭示二者共病的潜在心理病理机制。 第一部分对于PTSD和MDD症状共生模式的研究结果表明:(1) PTSD与MDD症状网络稳定地呈现出PTSD与MDD各自成簇、簇间通过二者重叠症状一一睡眠问题连接的相对独立的网络结构，反映二者表征了创伤后不同的心理病理过程;(2) PTSD与MDD症状纵向网络中，PTSD症状对MDD有着压倒性的强预测作用，表明二者共病中可能存在PTSD为“前因”，MDD为“后果”的关系;(3)不同症状在PTSD与MDD共病中具有不同的潜在干预效果:“对创伤的心理反应”可能是有效的治疗靶点，“对未来的负性信念”可能是有效的预防靶点。 第二部分对于创伤在PTSD和MDD症状共生模式中作用的研究结果表明: (1)创伤分别通过闯入症状簇(闯入性想法、对创伤的心理反应和生理反应等)和悲伤情绪独立地激活PTSD和MDD症状;C2)创伤可能通过作用于PTSD的“易激惹”与MDD的“低自我价值感”这一桥连接将PTSD与MDD关联起来; (3)高创伤暴露水平情境下可能需要特别关注“情感疏离”，低创伤暴露水平情境下可能需要特别关注“兴趣缺失”;(4)相较于非人际创伤类型，人际创伤类型中，“易激惹”和“低自我价值感”与“自杀意念”的关联明显增强。 总体上，本系列研究的发现支持了PTSD与MDD表征创伤后两个独立心理构念的观点，部分支持了创伤后PTSD为MDD前因的“失志”模型;识别出了“对创伤的心理反应”在 PTSD与MDD共病中的核心作用及潜在治疗型干预效果，以及睡眠问题这一重叠症状在创伤后PTSD与MDD共病发生以及MDD发展中的重要驱动性作用;也发现了创伤对于PTSD与MDD共病的影响不仅有简单的剂量效应，也直接作用于PTSD与MDD之间桥连接的潜在心理病理学路径;以及人际创伤类型中“易激惹”和“低自我价值感”与“自杀意念”的强关联。基于这些发现，提出了“创伤一PTSD=MDD”可能的共病理论整合模型，为理解PTSD与MDD共病的潜在心理病理机制、制定精确有效的早期筛查和干预措施提供了重要的信息。 |
| 语种 | 中文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/46602]  |
| 专题 | 心理研究所_健康与遗传心理学研究室 |
| 推荐引用方式 GB/T 7714 | 陈琛. 创伤后应激障碍与重性抑郁障碍症状的共生模式与机制:基于心理病理学网络视角[D]. 中国科学院心理研究所. 中国科学院大学. 2023. |
入库方式： OAI收割
来源：心理研究所
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