Rashin Jima'i, Yanayin Mutum, Shekaru na Farko da Cutar Duration zuwa Zaman Lafiya (ciki har da jaraba da jima'i). (2018)

Shafin Farko. 2018 Oct 16; 9: 497. Doi: 10.3389 / fpsyt.2018.00497.

Valero-Solís S1, Granero R2,3, Fernández-Aranda F2,4,5, Steward T2,4, Mestre-Bach G2,4, Mallorquí-Bagué N2,4, Martín-Romera V6, Aymam N4, Gómez-Peña M4, Del Pino-Gutiérrez A7, Baño M4, Moragas L4, Menchón JM4,5,8, Jiménez-Murcia S2,4,5.

Abstract

Bayani da manufar: Inara yawan yaduwar dabi'a a duk duniya ya haifar da ci gaba a cikin binciken ilimin ilimin halittu game da takamaiman gudummawar abubuwan haɗari / kariya ga waɗannan rikice-rikice. Makasudin wannan binciken shine don kimanta matsayin dangin jima'i na marasa lafiya, shekarun rikicewar rikicewa da rashin kwanciyar hankali akan yanayin asibiti na jarabar ɗabi'a.

Hanyar: Misalinmu sun haɗa da marasa lafiya masu neman magani da aka gano da matsalar caca (GD, n = 3,174), labarun caca ta yanar gizo (IGD, n = 45), saye mai sayarwa (CB, n = 113), da kuma jaraba da jima'i (SA, n = 34).

results: Misalin ƙungiyoyi tsakanin masu canji masu zaman kansu da kuma sakamakon ya kasance da alaka da halayen halayyar halin kirki: (a) ga GD-maza a farkon farkon cuta ya danganta da rashin ƙarfi na GD, yayin da GD-mata da farko sun haɗu da neman sabon abu ; (b) ga mazaunin IGD-maza, farkon farkon dangantaka da tsangwama rikitarwa, mummunan halin kwakwalwa, da kuma mummunar cutar da kauce wa matakai; (c) ga CB-mata, farkon farkon ya danganci matsayi mai girma da girman kai da matsanancin matsayi, da kuma tsawon lokacin tsinkaya mafi girma da tarawa; ga CB-men, farkon farkon da tsawon lokaci da aka haɗu da matsakaicin matsanancin lalacewar-rashin kaucewa, kai tsaye, kai tsaye, da hadin kai; da (d) ga mazaunin Sa-maza, marigayi na farko da tsawon tsawon lokacin da aka haɗu da rashin ƙarfi.

Tattaunawa da Karshe: Wadannan binciken suna da matukar dacewa don karewa da rigakafi da shirye-shiryen maganin rigakafi daban daban.

KEYWORDS: shekaru; haɓaka halin kirki; sayen dan kasuwa; matsalar caca; Cibiyar caca ta internet; jima'i jima'i

PMID: 30386263

PMCID: PMC6198171

DOI: 10.3389 / fpsyt.2018.00497

Gabatarwa

Abubuwan da suka shafi halayyar mutum sun haɗa da ƙungiyoyi daban-daban na yanayin da ake nunawa da tilasta yin aiki a cikin ɗan gajeren lokaci mai ladabi, wanda ba shi da halayyar abu wanda zai iya haifar da ci gaba duk da sanin illa mai tsanani (-). A yayin wadannan matsalolin, mutane sun rasa iko a kan halayya ko matsala, tare da rashin matsala a cikin iyali, aiki da zamantakewa na rayuwarsu (, ). A farkon farkon yanayin, babban matakan impulsivity suna nufin samun ladabi (ƙarfafawa), amma a lokacin yanayin, yanayin haɓaka ya zama mai karfi kuma yana nufin ragewa mummunar jiha (ƙarfafawa)). A cikin wannan binciken, an riga an jaddada cewa ƙaddamarwa da ƙwarewar ƙwaƙwalwa zai iya kwatanta farfado da alamun bayyanar cututtuka da kuma fasalin fasalin fasalin a duk waɗannan yanayi, ƙwararru, har ma da amsa ga magani ().

Mafi yawan nau'ikan maganganun halayyar halayyar cin hanci ne (GD), sayen mai sayarwa (CB), jarabar jima'i (SA) da kuma labarun labaran yanar gizo (IGD). A cikin sabon version na DSM-5, GD ya haɗa shi a cikin sabon tsarin bincike wanda ake kira "Matakan da ke ciki da kuma Addictive," yayin da yiwuwar hada da wasu addinan hali (irin su CB, SA, da IGD) an tattauna da kuma cire su saboda rashin tabbaci.

Abubuwan da ake yi wa mazajen jima'i suna nuna bambanci dangane da raƙuman ruwa: maza suna bada rahotanni mafi girma a cikin GD, IGD, da SA, yayin da mata ke nuna yawan ƙananan kudaden CB (). Dangane da shekarun haihuwa, waɗannan cututtuka suna faruwa a duk lokacin rayuwa, amma matakai biyu suna da matukar haɓaka mai girma: matashi / tsufa da tsufa ().

Nazarin bincike akan gudunmawar shekarun da aka fara nunawa cewa marasa lafiya da farko sun kasance ƙungiyoyi tare da matsanancin dabi'un hali na zamantakewa da kuma impulsivity, yayin da marasa lafiya daga baya sun zama wani ɗan ƙaramin matsayi tare da matsananciyar damuwa ga damuwa da damuwa, wanda ke yin caca a matsayin maladaptative inji don canza yanayin halayen su (, ). Farawa na farko na GD (idan aka kwatanta da farkon lokacin) kuma ana ganin ana haɗuwa da ƙananan kwakwalwa na rikici, yawan ƙwayar cuta ta jiki B, matsayi mafi girma a cikin halin kirki wanda yake neman ƙananan kullun a cikin kai tsaye (, ).

Game da CB, rashin daidaituwa da rashin daidaitattun sakamakon da aka samo, an samo asali daga 1 zuwa 20% dangane da asalin samfurori, ma'anoni,-). Bayanai na annoba na yanzu ga CB sun nuna cewa marasa lafiya masu neman magani tare da CB suna sha wahala daga magungunan ƙwayoyi, tare da barasa maras kyau da / ko wasu magungunan kwayoyi, rashin cin nama, rikitaccen yanayi, damuwa,). An rarraba bambance-bambancen jinsin jima'i da dama ga CB: haɗarin, yaduwa, da kuma saurin farawa da kuma yawan yin amfani da ita ya fi girma ga mata ().

Nazarin da aka fi sani da IGD ya nuna cewa tsakanin 3.7 da 13.0% na yawan jama'a na girma sun haɗu da ka'idoji don amfani da intanet na wucin gadi (, ), kuma cewa IGD ya fi yawan samari a samari (). Kasuwancin IGD sun haɗa da halayen halayen rikice-rikice da rashin hanzari, ƙwanƙwasawa mai girma da yawa, tsinkaya ga rashin amincewa da zamantakewar al'umma da matakai masu girma a rikice-rikice na rikice-rikice, haɓari-kaucewa da rikice-rikice na interpersonal (-).

A ƙarshe, binciken da aka yi a kan SA ta tabbatar da cewa yawancin maza yana da kyau mafi girma idan aka kwatanta da mata (-). Matsayi mafi girma na zamantakewar zamantakewa, matsayi mai yawa a yanayin dabi'ar mutum da kuma neman ƙananan ƙananan abubuwa don kauce wa haɓakawa shine haɗari ga SA (, ). Wasu nazarin ilimin ilimin halittu sun nuna cewa SA tana da alaƙa da dabi'un hali na mutunci, rashin tsoro, mutunci na mutunci, rashin cin hanci,).

Gaskiyar cewa GD kawai a halin yanzu an haɗa shi a cikin DSM-5 ya samo asali ne daga rashin amincewa game da la'akari da halin kwaikwayon dabi'a kamar matsalar rashin hankali (). Wannan na iya bayyana wani ɓangare na wannan mummunan yanayin dangane da sauran tsangwama. Har ila yau, yana da ƙalubalanci don ƙayyade yanayin da ba a yarda da shi ba kamar yadda cuta yake kuma kada ku jefa kayan aiki na asali (). Samun bayanan bincike na waɗannan jaraba zasu bada izinin sanin ilimin halitta, rigakafi da kuma maganin sauran halayyar hali (). Hakazalika, hada da wasu ƙwarewar hali na iya haifar da tasiri akan ayyukan kiwon lafiya da aka ba su kuma zai iya taimaka wajen rage rashin lafiyar marasa lafiya don neman magani ().

manufofi

Don mafi kyawun iliminmu, ƙididdiga masu yawa na ƙididdiga sun ƙididdige takamaiman gudummawar jima'i, farawa da kuma tsawon lokacin cin mutunci a cikin samfurori daban-daban da suka shafi asibiti ciki har da ƙananan ƙwayoyin maganin hali. Sabili da haka, manufar wannan binciken shine don tantance ainihin nauyin waɗannan ƙwayoyin cuta a yanayin asibiti na magani don neman marasa lafiya da aka gano tare da GD, IGD, CB, da SA.

Hanyar

Wanda su ka Halarta

Samfurin da aka haɗa n = 3,366 jima-jimawa marasa lafiya wadanda suka halarci asibiti na musamman a cikin halayyar hali a Barcelona, ​​Spain. An dauki ma'aikata tsakanin Janairu-2005 da Setember-2016. Abubuwan haɓakawa sun haɗa da ka'idodin bincike na GD, IGD, CB, ko SA a matsayin ainihin dalilin yin shawarwari da kasancewar shekaru 18. Hanyoyin warwarewa sun kasance suna da nakasa ta rashin fahimta ko kuma mummunar cututtuka na tunanin mutum (irin su schizophrenia ko wasu cututtuka na psychotic ko rashin lafiya).

Yawan mahalarta ba tare da sun kasance ba saboda rashin haɓakawar halayen iri-iri daban-daban sun kasance ƙasa (n = 5, mai haƙuri 1 wanda ya ruwaito GD + CB, 1 wanda ya gabatar da GD + SA, 2 da CB + SA, da 1 tare da SA + IGD). A gefe guda, tun da samfurori na IGD da SA sun haɗa da mata kadan (n ≤ 2), an cire mahalarta mata daga waɗannan rukuni guda biyu don kauce wa tsaiko a cikin sakamakon sakamakon ƙananan mata a cikin waɗannan takaddun biyu.

Matakan

Binciken da aka gano game da wasan caca kamar yadda DSM Criteria ()

Wannan tambayar na 19-abu ya ba da izinin nazarin DSM-5 () ma'aunin bincike don GD. Daidaitawar haɓakawa tare da ƙananan caca na waje a cikin asali na ainihi yana da kyau (r = 0.77 don samfurin wakilci da r = 0.75 don kungiyoyin caca;). Tsarin ciki cikin daidaituwa na Mutanen Espanya da aka yi amfani da shi a cikin wannan binciken shine α = 0.81 don yawancin jama'a kuma α = 0.77 don samfurin caca samfurori (). A cikin wannan binciken, ana nazarin adadin DSM-5 ma'auni ga GD, kuma daidaito na ciki α = 0.804 a cikin samfurin.

Ka'idojin bincike don sayen karfi ()

Wadannan ka'idodin, waɗanda aka karbi karɓa a cikin al'umma masu bincike, an yi amfani dashi don tabbatar da kasancewar CB a cikin samfurin. Jerin tambayoyin ya bincika "sayen halaye, halayen dangantaka, tunani mai mahimmanci, da damuwa da sayen siyayya" ().

Ka'idojin bincike na IGD bisa ga Griffiths da Hunt (, )

Don tantance tantancewar cutar ta IGD da kuma tabbatar da matakin dogara da cutar, masana masanan sun gudanar da tattaunawar fuska da fuska game da sikelin da Griffiths da Hunt suka tsara (, ). Wannan tattaunawar ta tantance al'amurran da suka shafi matsala, haɗarin da aka haifar da aikin yau da kullum saboda yin amfani da labaran da aka yi amfani da su akan labaran yanar gizo, kasancewar haƙuri da matsalolin gudanarwa, tare da yawan adadin DSM-5 [bisa ga Sashi III, ()].

Ka'idojin bincike na jima'i bisa ga DSM-IV-TR ()

Don tantance SA, an yi amfani da batirin abubuwa, wanda ya danganci bayanin da aka tsara a DSM-IV-TR () a cikin Harkokin Jima'i Ba Shaƙataccen Sashe ba (302.9). A cikin bincikenmu, an ba da wannan nauyin nauyin nau'i na musamman: "damuwa game da irin yadda ake maimaita jima'i tare da wasu masoya waɗanda mutane ke jin dadin su kawai a matsayin abin da za a yi amfani dashi."

Ƙwaƙwalwar lalata da halayyar halayyar kayan aiki (TCI-R) ()

Wannan abin tambaya ne mai nauyin 240 wanda yayi la'akari da nauyin mutum guda bakwai: nau'in yanayi (bincike mai ban sha'awa, lalacewar haɓaka, farfadowa da juriya) da nauyin halayen mutum uku (jagoranci kai tsaye, hadin kai, da karfin kai). Ana auna dukkan abubuwa a kan wani nau'in 5-ma'auni. An yi amfani da fassarar Mutanen Espanya mai amfani (). Sikeli a cikin Sifan ɗin da aka bita ya nuna daidaito na ciki (darajar Cronbach pha ƙimar 0.87). A cikin binciken, ƙididdigar daidaito sun kasance daga mai kyau (α = 0.70 don sabon neman neman ƙarami) zuwa kyakkyawa mai kyau (α = 0.859 don ƙaramar ƙasa).

Sakamakon binciken lamuni-sake dubawa ()

Wannan tambayoyin yana nazari kan matsalolin halayyar kwakwalwa da kuma cututtuka. Wannan tambayoyin ya ƙunshi abubuwa 90 da matakan tara na farko alama alama: haɗuwa, haɗuwa-tilastawa, ƙwarewar mutunci, rashin tausayi, damuwa, haɓaka, ƙyamar hoto, paranoid ideation, da psychoticism. Har ila yau, ya haɗa da alamun littattafai guda uku na duniya: (1) wani ma'auni mai zurfi na duniya (GSI), an tsara shi don auna yawan ƙananan halayyar mutum; (2) wata alama ce wadda ta nuna damuwa (PSDI), don auna yawan tsananin bayyanar cututtuka; da kuma (3) alama ce mai kyau tabbatacce (PST), wanda ke nuna alamun bayyanar da kansa. An yi amfani da fassarar Mutanen Espanya mai amfani (). Girman ingancin ingancin Mutanen Espanya ya sami kyawawan alamomin kwakwalwa, tare da mahimmancin daidaito na ciki na 0.75 (Cronbach's alpha). Wannan binciken yana nazarin ƙididdigar GSI ta duniya a matsayin ma'auni na yanayin halin ƙwaƙwalwar duniya (daidaito a cikin samfurinmu yana da kyau ga wannan sikelin, α = 0.981).

Sauran yanayin zamantakewar zamantakewar al'umma da na asibiti

An ƙididdige yawan yawan mutane, ɗakunan, da zamantakewar iyali / iyalan iyali ta yin amfani da yin hira da ɗakin gwagwarmaya mai kyau wanda aka kwatanta a wasu wurare (). Abubuwan da aka ƙididdiga sun haɗa da shekarun rashin lafiya a farkon, ƙididdigar basussuka saboda jaraba da matsayi na zamantakewar da aka auna ta hanyar index na Hollingshead (wani binciken da aka tsara don auna matsayin matsayin zamantakewa na mutane bisa ga ilmantarwa da darajar sana'a; ().

hanya

Masana kimiyya da masu ilimin psychiatrist, tare da fiye da shekaru 15 na gwagwarmaya a cikin yanayin rikici, sun gudanar da tambayoyi biyu na fuska da fuska don su tattara bayanai na asibiti da kuma tantance ganewar asibiti na kowane mai haƙuri. Dukkanin matakan da aka bincikar a cikin wannan binciken ya dace da kima a farkon, kafin a fara magani.

Nazarin lissafi

An gudanar da nazarin ilimin lissafi tare da Stata 15 don Windows. Abubuwan haɗin haɗin haɗin Pearson sun auna haɗin tsakanin shekarun farko da tsawon lokacin matsalar halayyar haɗari tare da ɗabi'a da bayanin asibiti. An ba da takamaiman gudummawar jima'i na marasa lafiya, farawa, da tsawon lokacin matsalar kan tsananin jaraba da yanayin halin ƙwaƙwalwa tare da mummunan rashi binomial da layin mahara iri-iri (don ƙididdigar basusuka da ƙimar SCL-90-R GSI). Waɗannan samfuran sun haɗa kuma sun gwada hulɗar jima'i-da-farawa da jima'i-da-lokaci: (a) don sigogin hulɗar da ta dace, an kiyasta sakamako guda don shekarun mahalarta zuwa ƙungiyoyi uku waɗanda aka ayyana game da rikice-rikice na 1 da 3 na shekarun farawa [farkon (farkon kafin shekaru 20), matsakaici (farawa tsakanin 20 da 35 shekaru) da kuma marigayi (farawa bayan shekaru 35)]; da (b) don sigogin hulɗar da ba ta dace ba, an kiyasta da fassara. Samfurori masu zaman kansu an samo su don kowane nau'in bincike (GD, CB, IGD, da SA). Ba a bincika gudummawar jima'i don IGD da SA ba, tunda babu mata da aka saka a cikin waɗannan samfuran saboda ƙarancin ƙarfin su a cikin ƙungiyoyi.

Ethics

An gudanar da wannan binciken ne bisa ga sabon littafin Helsinki. Cibiyar Nazarin Kasuwancin Bellvitge Jami'ar Asibitin (Barcelona, ​​Spain) ta amince da binciken, kuma an sanya takardar sanarwar da aka samu daga dukkan masu halartar taron.

results

Halaye na samfurin

Ƙananan rabin allo ​Table11 ya hada da bayanin yadda ake yin nazarin zamantakewa na zamantakewa. Yawancin shekarun zamani na samfurori na 42.5 (SD = 13.5, tare da kewayon tsakanin 18 da 75 shekarun haihuwa), yana nufin shekarun farko don jarabawan hali shine 29.9 shekarun (SD = 11.5) da ma'ana tsawon lokacin rashin lafiya shine shekaru 6.2 (SD = 5.9).

Table 1

Bayanin samfurin: zamantakewa na zamantakewar al'umma da na asibiti.

GD; n = 3,174 IGD; n = 45 CB; n = 113 SA; n = 34
n % n % n % n % χ2 p
GENDER
mãtan 283 8.9 0 0 85 75.2 0 0 502.6
maza 2891 91.1 45 100 28 24.8 34 100
ORIGIN
Spain 2934 92.4 39 86.7 111 98.2 33 97.1 8.65 0.034
Baƙi 240 7.6 6 13.3 2 1.8 1 2.9
ILIMI
primary 1905 60.0 24 53.3 43 38.1 9 26.5 85.40
Secondary 1092 34.4 20 44.4 46 40.7 16 47.1
Jami'ar 177 5.6 1 2.2 24 21.2 9 26.5
CIVIL STATUS
single 1212 38.2 41 91.1 43 38.1 9 26.5 57.43
Aure - abokin tarayya 1534 48.3 3 6.7 51 45.1 17 50.0
Saki - rabu 428 13.5 1 2.2 19 16.8 8 23.5
SOCIAL INDEX
high 46 1.4 1 2.2 4 3.5 2 5.9 53.27
Matsanancin matsakaici 138 4.3 0 0.0 18 15.9 4 11.8
Medium 339 10.7 6 13.3 14 12.4 4 11.8
Matsanancin ƙasa 967 30.5 12 26.7 32 28.3 14 41.2
low 1684 53.1 26 57.8 45 39.8 10 29.4
Ayyukan aiki
Ba a yi aiki ba 1414 44.5 36 80.0 53 46.9 15 44.1 22.69
aiki 1760 55.5 9 20.0 60 53.1 19 55.9
aBABI NA GASKIYA
A'a 374 11.8 2 4.4 13 11.5 2 5.9 3.43 0.330
A 2800 88.2 43 95.6 100 88.5 32 94.1
Ma'ana SD Ma'ana SD Ma'ana SD Ma'ana SD F P
AGE, SANTA DA RUWA
Shekaru (shekaru tsufa) 42.8 13.5 22.6 8.4 42.6 11.5 42.6 11.9 33.76
Cutar farko (shekarun da suka wuce) 29.9 11.5 19.3 8.1 32.9 12.0 33.7 13.0 16.82
Rigar lokaci (yrs) 6.2 6.0 3.3 2.5 6.8 5.8 6.0 5.7 3.90 0.009
SASHI: SCL-90R
GSI score 1.05 0.72 0.86 0.76 1.58 0.91 1.25 0.78 20.21
TAMBAYOYIN TAMBAYOYI: TCI-R
Neman sabon abu 108.9 14.3 103.7 13.1 114.9 14.4 110.8 14.3 7.85
Hanyar haɓaka 101.1 17.0 102.6 22.8 111.0 19.7 102.1 17.5 10.80
Sakamakon dogara 98.5 14.8 92.3 17.1 103.2 17.0 100.5 15.2 5.84 0.001
dagewa 108.5 20.1 93.6 20.8 106.8 18.8 103.6 21.1 8.20
Gudanar da kai 127.0 21.1 127.1 25.7 124.1 23.9 116.9 19.6 2.91 0.033
Cooperativeness 130.4 16.3 126.8 18.5 133.9 15.7 127.4 15.1 2.57 0.053
Matsayin kai 64.0 15.3 57.2 14.1 65.4 16.5 63.1 14.0 2.97 0.031

Note.

aShawarar da ta gabata ta hanyar matsalolin matsalolin maganin rikici.

GD: matsalar caca. IGD: Cibiyar wasan kwaikwayon intanet. CB: saye mai karfi. SA: jaraba da jima'i.

SD: daidaitattun daidaituwa. - Wannan ma'auni bai samuwa ga wannan rukuni ba.

Ƙashin ƙasa na Table ​Table11 yana nuna rarraba ƙwayoyin magungunan asibiti da kuma kwatanta tsakanin sassan binciken bincike. Ƙungiyar ta IGD sun haɗa da mafi ƙanƙanta masu halartar, tare da mafi ƙasƙanci a shekarun da suka kamu da rashin lafiya da kwanciyar hankali. Game da nauyin halayen mutum, CB ya amince da duk abin da ya fi girma a cikin sabon bincike, cutar da kaucewa, farfado da sakamako da kuma karfin kai, sannan GD ya biyo baya.

Ƙungiyoyi tsakanin shekarun farko da lokaci tare da matakan jima'i da mutuntaka

Table ​Table22 ya haɗa da matakan daidaitawa don tantance ƙungiyoyi tsakanin shekarun farko (shekaru da haihuwa) da kuma tsawon (shekaru) na kowane jarabawar hali tare da ma'auni na asibiti. Ga ƙungiyar GD, ƙungiyoyi biyu sun fito: a cikin samfurin samfurin namiji, an fara danganta da samfurin DSM-5 mafi girma, kuma a cikin samfurin samfurin mata, an fara jigilar farko da farko don neman ƙira.

Table 2

Ƙungiyar tsakanin shekarun farko da tsawon lokaci na BA tare da dabi'u da kuma halin mutum.

GD IGD CB SA
Women n = 283 Men n = 2,891 Men n = 45 Women n = 85 Men n = 28 Men n = 34
Farawa Durat. Farawa Durat. Farawa Durat. Farawa Durat. Farawa Durat. Farawa Durat.
DSM-5 cikakkiyar ma'auni -0.24 0.10 -0.19 0.05 0.44 -0.05 - - - - - -
Tarin bashi -0.14 0.00 -0.01 0.04 - - -0.15 0.25 0.03 0.18 -0.59 0.50
SASHI: SCL-90R
GSI score -0.11 0.04 -0.04 0.10 0.25 0.11 -0.03 0.06 0.36 -0.11 -0.18 0.07
TAMBAYOYIN TAMBAYOYI: TCI-R
Neman sabon abu -0.18 0.15 -0.25 0.02 0.01 -0.05 -0.19 -0.04 -0.05 0.23 0.16 -0.14
Hanyar haɓaka -0.15 -0.06 0.07 0.07 0.26 0.08 -0.12 -0.12 0.34 -0.21 -0.08 0.07
Sakamakon dogara 0.02 0.06 0.04 -0.07 -0.10 -0.11 -0.27 0.07 -0.07 0.17 0.17 -0.06
dagewa -0.02 -0.06 -0.03 -0.07 -0.10 0.02 0.02 0.12 -0.01 0.27 -0.18 0.09
Gudanar da kai 0.06 -0.04 0.06 -0.09 -0.23 -0.15 0.07 0.09 -0.25 0.25 -0.03 0.14
Cooperativeness 0.01 0.00 0.09 -0.07 -0.13 -0.06 -0.05 0.13 -0.28 0.01 0.02 0.24
Matsayin kai 0.19 -0.03 0.16 0.05 0.35 0.22 0.29 0.08 0.19 0.31 0.01 0.08

Lura. GD, matsalar caca; IGD, matsalar labarun yanar gizo; CB, sayen dan kasuwa; SA, jima'i jima'i.

Lura. Bold: daidaitawa zuwa matsakaici (| r |> 0.24) zuwa kewayon mai kyau (| r |> 0.37). - Babu ga wannan rukunin.

Ga matan da aka gano tare da CB, ƙananan shekarun da suka shafi farko sun danganci matsayi mai girma da girman kai da matsanancin matsayi, kuma tsawon lokaci na matsalar ya danganta da haɓaka kudade mafi girma. Ga maza a cikin wannan ƙananan binciken (CB): (a) farkon shekarun farko an danganta su da ƙananan SCL-90R scores da matakan da za a kawar da cutar, da kuma jagorancin kai tsaye da haɗin kai; (b) tsawon lokaci na rashin lafiya wanda ya haɗu da matakan da ya fi girma a dabi'un hali na juriya, jagoran kai da kuma karfin kai.

Ga mutanen da suka hadu da ka'idoji na SA, yawancin lokaci ya danganta da mafi girman rashin jituwa.

Taimako jima'i, shekarun farko, da kuma tsawon lokaci zuwa rashin lafiya

Table ​Table33 ya ƙunshi nau'o'in nau'i-nau'i daban-daban waɗanda ke nuna irin gudunmawar da aka bayar na jima'i, tsawon shekaru da tsawon lokacin rashin lafiya akan matakan haɓaka hali. An raba samfurori daban-daban don kowace cuta (GD, CB, IGD, da SA) da kuma kowane ma'auni (yawan DSM-5 ma'auni, Ƙungiyoyi masu tasowa, da SCL-90R GSI). Alal misali, Model-1 yayi la'akari da gudunmawar masu zaman kansu masu zaman kansu na binciken (jima'i, shekarun da tsawon lokaci) a kan lambar ƙimar dogara na DSM-5 musamman don GD. Domin kowane rikici da marasa daidaitattun B-sigogi, kuskuren daidaitattun (SE), 95% haɓaka amincewar (95% CI na B), ya bambanta labaran (Wald-chisquare don ƙyama-binomial regression da T don rikodi na layi) kuma p-ananan rahotanni an ruwaito.

Table 3

Taimakon jima'i, farawa da kuma tsawon lokaci a kan daban-daban BA subtypes.

B SE 95% CI (B) cwannan hasashen p
GAMBLING DISORDER; n = 3,174
[Model-1] aCriterion: DSM-5 ma'auni
(Intercept) 2.126 0.095 1.94 2.31 505.20 0.001
Jima'i (0: mata; 1: namiji) -0.075 0.070 -0.21 0.06 1.16 0.282
Duration (shekaru) 0.002 0.003 0.00 0.01 0.44 0.508
Shekaru na farko (shekaru-shekaru) -0.005 0.002 -0.01 0.00 9.18 0.002
[Model-2] aCriterion: tara kuɗi
(Intercept) 10.068 0.256 9.57 10.57 1543.67 0.001
Duration (shekaru) 0.012 0.004 0.01 0.02 10.58 0.001
dJima'i (cikin farkon farkon) 0.579 0.304 -0.02 1.18 3.63 0.057
dJima'i (a cikin matsakaici na farko) 0.323 0.106 0.12 0.53 9.29 0.002
dJima'i (cikin marigayi farko) 0.950 0.108 0.74 1.16 77.35
Shekaru na farko (cikin mata) -0.027 0.007 -0.04 -0.01 16.28
Shekaru na farko (cikin maza) 0.023 0.002 0.02 0.03 106.92
Sadarwa: Yin jima'i da farawa 0.050 0.007 0.04 0.06 50.62 0.001
[Model-3] bCriterion: SCL-90R GSI
(Intercept) 1.703 0.158 1.39 2.01 10.74 0.001
Duration (shekaru) 0.011 0.002 0.01 0.02 5.08
dJima'i (cikin farkon farkon) -0.433 0.163 -0.75 -0.11 -2.65 0.008
dJima'i (a cikin matsakaici na farko) -0.634 0.074 -0.78 -0.49 -8.63
dJima'i (cikin marigayi farko) -0.422 0.073 -0.57 -0.28 -5.76
Shekaru na farko (cikin mata) -0.007 0.004 -0.02 0.00 -1.76 0.048
Shekaru na farko (cikin maza) -0.002 0.001 0.00 0.00 -1.46 0.143
Sadarwa: Yin jima'i da farawa 0.005 0.004 0.00 0.01 -1.82 0.068
KUMA KUMA; n = 113
[Model-4] aCriterion: tara kuɗi
(Intercept) 11.149 0.437 10.29 12.00 652.20 0.001
Jima'i (0: mata; 1: namiji) -0.497 0.246 -0.98 -0.01 4.07 0.044
Duration (shekaru) 0.064 0.019 0.03 0.10 11.39 0.001
Shekaru na farko (shekaru-shekaru) -0.022 0.012 -0.05 -0.00 3.64 0.050
[Model-5] bCriterion: SCL-90R GSI
(Intercept) 1.861 0.342 1.18 2.54 5.44 0.001
Duration (shekaru) -0.010 0.016 -0.04 0.02 -0.66 0.508
dJima'i (cikin farkon farkon) -0.430 0.572 -1.56 0.70 -0.75 0.453
dJima'i (a cikin matsakaici na farko) -0.735 0.284 -1.30 -0.17 -2.59 0.011
dJima'i (cikin marigayi farko) 0.043 0.318 -0.59 0.67 0.13 0.893
Shekaru na farko (cikin mata) -0.003 0.009 -0.02 0.01 -0.36 0.719
Shekaru na farko (cikin maza) 0.024 0.015 -0.01 0.05 1.61 0.112
Sadarwa: Yin jima'i da farawa -0.733 0.406 -1.54 0.07 -1.81 0.074
GAME DA KUMA GAME DA KARANTA; n = 45 (MUTANE MUTANE)
[Model-6] aCriterion: DSM-5 ma'auni
(Intercept) 0.752 0.540 -0.31 1.81 1.94 0.164
Duration (shekaru) 0.005 0.072 -0.14 0.15 0.01 0.940
Shekaru na farko (shekaru-shekaru) 0.020 0.021 -0.02 0.06 0.93 0.335
[Model-7] bCriterion: SCL-90R GSI
(Intercept) 0.231 0.372 -0.52 0.983 0.62 0.539
Duration (shekaru) 0.051 0.049 -0.05 0.150 1.05 0.298
Shekaru na farko (shekaru-shekaru) 0.023 0.014 -0.01 0.052 1.63 0.110
GARANTI KASHI; n = 34 (MUTANE MUTANE)
[Model-8] aCriterion: tara kuɗi
(Intercept) 14.942 1.237 12.52 17.37 145.88 0.001
Duration (shekaru) 0.151 0.193 -0.23 0.53 0.62 0.432
Shekaru na farko (shekaru-shekaru) -0.259 0.045 -0.35 -0.17 32.84
[Model-9] bCriterion: SCL-90R GSI
(Intercept) 1.651 0.449 0.74 2.57 3.68 0.001
Duration (shekaru) -0.005 0.025 -0.06 0.05 -0.18 0.856
Shekaru na farko (shekaru-shekaru) -0.011 0.011 -0.03 0.01 -1.01 0.321
aKuskuren-binomial bala'i.
bDaidaitaccen layi na layi.
cWald-chisquare domin ƙyama-binomial regression da T don yin amfani da layin layi.
dDangane da jima'i ta hanyar jima'i ta hanyar farawa, an samu nauyin jinsi daya akan jima'i cikin kungiyoyi uku da aka ƙayyade game da shekarun farko: farkon (farkon kafin 20 shekarun haihuwa), matsakaici (farkon tsakanin 20 da 35 shekarun haihuwa), kuma marigayi (da farko bayan 35 shekaru). Bold: muhimmin hangen nesa (0.05 matakin).

A cikin ƙungiyar GD, mafi yawan lambobin DSM-5 sun danganta da farkon shekarun farko (B = -0.005; p = 0.002), yayin da ba a sami gudummawar ilimin lissafi ba don jima'i na marasa lafiya ko tsawon lokacin rikicewar, kuma ba a sami hulɗa tsakanin jima'i da farawa da tsawon lokacin don wannan ma'aunin ba (Model-1 a ​​cikin Table ​Table3).3). Don wannan BA subtype, idan ana la'akari da ma'auni na ma'auni (Model-2 a Table ​Table3)3) an karu da wannan ma'auni ga marasa lafiya da tsawon lokaci, kuma an haɗu da haɗuwa da jima'i ta hanyar tsufa kamar yadda ya kamata: (a) Abubuwanda ke haifar da jima'i ya nuna cewa maza suna ci gaba da tara basusuka, kuma wannan bambanci ya karu tare da shekarun farko ; da kuma (b) ƙididdiga masu yawa na shekarun da suka fara nuna cewa, ga mata, da baya a farkon, mafi girma yawan kuɗi na tarawa yayin da maza, tsofaffi na farko, mafi girma da basusuka.

Ga ma'auni SCL-90-R GSI (Model-3 a Table ​Table3),3), mummunan yanayin kwakwalwa ya danganci tsawon lokaci na rashin lafiya, kuma jima'i ta jima'i yana da mahimmanci don bayyana wannan sakamako: (a) Abubuwanda ke haifar da jima'i ya nuna cewa mata suna rijista mafi girma na matakan kwakwalwa idan aka kwatanta da maza, amma girman girman su don bambance-bambance ya danganta ne a kan shekarun farkon rashin lafiya (an ƙaddamar da sakamako mafi girma na farko tsakanin 20 da 35); da kuma (b) farkon shekarun farko na rashin lafiya ne kawai bayanin hangen nesa na halin rashin lafiya ga mata, yayin da farkon wannan cuta bai dace ba wajen bayanin GSI ga maza.

Ga Babban Bankin CB, ana tara bashi saboda sayen (Model-4 a Table ​Table3)3) ya karu don mata tare da dogon lokaci da farkon shekarun farko. Babu dangantaka tsakanin jima'i da shekaru da tsawon lokaci. Misalin da aka gyara don matakin ƙwararru na duniya a CB (Model-5 a Table ​Table3)3) ya ci gaba da yin jima'i ta hanyar farawa, kuma sakamakon wannan rikici ya nuna cewa an yi wa mata rajista ga mata idan aka kwatanta da maza, amma ga marasa lafiya wadanda suka nuna shekarun shekarun da suka gabata (cutar 20 da 35).

Domin takardun IGD da SA, jima'i ba a haɗa su cikin tsarin ba tun da ba a hada mata a cikin wadannan kungiyoyi ba. Ga IGD, babu gudunmawar lissafi na tsawon lokacin kuma ya fara fitowa don bayyana yawan adadin DSM-5 (Model-6 a Table ​Table3)3) da kuma ka'idodin ilimin lissafin duniya (Model-7 a Table ​Table3).3). Ga maza a cikin kungiyar SA, yawan kuɗin da aka tara ya karu don marasa lafiya da ƙananan shekaru (Model-8 a Table ​Table3),3), yayin da lokacin da ba su kasance masu ba da gudummawa ga yanayin tunanin (Model-9 a Table ​Table33).

Tattaunawa da kuma yanke shawara

Wannan binciken ya tantance haɗin gwiwa tsakanin jima'i da jima'i, shekarun farko da kuma halin jima'i na halin kwaikwayo a kan kwayoyin phenotype (ciki har da mummunar rashin lafiya, hali na halin mutumtaka da halin mutum). Bambanci tsakanin GD, IGD, CB, da SA sun gwada, tare da manufar zubar da haske kan matsakaicin matsakaicin hali na rikici na hali.

Ƙungiyar jima'i, farawa da tsawon lokaci tare da tsanani, da kuma ka'idar kwakwalwa

Sakamakonmu yana nuna cewa, gabaɗaya, takamaiman tsarin alaƙar ya bambanta dangane da ƙwarewar halayyar ɗabi'a. A matsayin cikakke, aikinmu yana ba da sabon tabbaci game da ɓangaren abubuwa da yawa na ƙwarewar ɗabi'a, wanda gudummawar masu canji kamar shekarun farawa, tsawon lokacin cuta ko halayen mutum suna taka rawa ta banbanci gwargwadon ƙarancin bincike da marasa lafiya ' jima'i. Karatuttukan da suka gabata sun riga sun sami irin wannan sakamakon game da bambancin mutum a cikin ɗabi'ar ɗabi'a, lura da cewa dole ne a fahimta su azaman yanayin yanayin yanayin asibiti (, ).

Abubuwan da suka dace da shekarun farkon suma suna da dogaro da nau'in bincike da kuma jima'i na marasa lafiya. Wannan haɗin gwiwar yana da mahimmanci ga GD da CB: a) a cikin GD, farkon farawa yana haɗuwa da tsananin ƙarfi ga maza da b) a cikin CB, farkon farawa an haɗu da matakan girma na matsalar matsalar jaraba a cikin mata (waɗanda suka gabatar da mafi yawan wannan nau'in nau'in binciken idan aka kwatanta shi da maza, wanda yayi daidai da karatun tattara bayanan da aka gabatar a baya da kuma bayanan martabar latent, ).

Ƙungiyar jima'i, farawa da kuma tsawon lokaci da girman hali

Tsarin alaƙar tsakanin farawa da tsawon lokacin jarabar ɗabi'a tare da ɗabi'a kuma ya bambanta dangane da nau'in bincike da kuma mahalarta jima'i. A cikin GD, shekarun farkon da aka fara suna haɗuwa da neman sabon abu mafi girma ga maza, wanda yake da alaƙa da bincike na ilimin halitta a cikin samfuran maza waɗanda ke la'akari da shekarun farawa a matsayin hanyar sasantawa tsakanin matakan neman sabon abu tare da haɗin GD (kamar matsalar rashin lafiya da psychopathology ().

A CB, da farko an hade da matakan da suka dace da ladabi da kuma ƙananan raƙuman su a cikin matsakaicin matsayi a cikin mata, kuma tare da ƙananan ƙananan lahani don hana kaucewa da kuma matakan jagoran kai da haɗin kai a cikin maza. Wadannan sakamakon zasu iya nuna cewa matan da suka sadu da wannan yanayin zasu iya ƙaddara don neman ƙarin amincewa da kuma bayyana wasu matsalolin da suke fuskanta tare da matsalolin ko matsalolin matsalolin, yayin da maza za su kasance mafi maƙasudin manufa, tasiri da kuma amincewa. Bugu da kari, ga Babban Bankin CB, tsawon lokaci na rashin lafiya ya kasance tare da haɗuwa da haɓaka, haɓaka kai tsaye, da karfin kai, wanda ya dace daidai da lura a cikin binciken da suka wuce (, ). Bamu da rashin mata a kungiyar SA, ba zai yiwu a sanya ƙungiyoyi tsakanin yanayin mutum da jima'i a marasa lafiya tare da wannan buri. Zai zama da amfani ga nazarin gaba don haɗawa da samfurori daban-daban da daidaito. Duk da haka, mun gano cewa samfurinmu na SA ya amince da matakan da suka fi dacewa da sababbin kamfanonin GD, da mahimmanci, ƙananan matakan kai tsaye.

Ƙuntatawa da ƙarfin

Duk da ciwon babban samfurin samfurin (wanda ya ba da babban ilimin lissafi don yawancin bincike da kuma kwatanta), adadin marasa lafiya a wasu kungiyoyi sun kasance kadan. Haka kuma, sabili da dangantakar da ke tsakanin rikici da jima'i, rarraba maza da mata ba su da bambanci tsakanin kungiyoyi. Ya kamata a yi jayayya cewa samfurin ya hada da marasa lafiya da suka shiga jigilar magungunan kulawa da juna kuma sun haɗu da ka'idojin haɓaka / haɓaka, sabili da haka rarraba jinsi ya dace da yawancin waɗannan matsalolin da ke faruwa a ƙasarmu (), wanda ya ba da cikakkiyar matsayi na waje ga sakamakonmu.

A gefe guda, wannan aikin yana nufin sanin jinƙai na marasa lafiya, shekaru, da kuma tsawon lokacin cutar suna taimakawa musamman ga farfadowa na hali wanda ya yi rajistar mafi girma a fannin kiwon lafiya na musamman a kasar Spain, saboda haka an gwada kamfanoni daban-daban. Dole ne a tsara bincike na gaba a gaba don nazarin taimakon da wadannan masu canji a kan asibiti na marasa lafiya wadanda ke gabatar da jita-jita na yau da kullum.

Ƙididdiga biyu na bincike mu ne manyan samfurin samfurin da kuma hada kungiyoyi daban-daban wadanda suka hadu da ka'idodin bincike don BA. Wani ƙarfin da ya dace shi ne hada da bincike na ma'aunin tunani da yawa, wanda ke ɗauke da tsananin BA, cikakkiyar yanayin tunani da halin mutum.

abubuwan

Sakamakon wannan binciken yana ba da sabon tabbaci game da abubuwan da ke tattare da ɗimbin ɗabi'u, wanda gudummawar masu canji kamar shekarun farawa, tsawon lokacin cuta ko halayen mutum yakamata su taka rawar gani dangane da nau'in bincike da marasa lafiya ' jima'i. Sakamakonmu na iya zama da amfani ga karatun nan na gaba na gwada ƙirar haɗin kai don bayyana mahimman hanyoyin da ke haifar da farawa da haɓaka kowane ganewar ɗabi'a. Kamar yadda yake tare da mafi rikitarwa, hanyoyin fannoni daban-daban, ana buƙatar ci gaba da karatu a yankuna daban-daban: binciken ilimin ɗabi'a (misali nazarin ilimin jijiyoyin jiki don gane abin da takamaiman yankuna, cibiyoyin sadarwa, da ayyukan zartarwa / fahimi ke ƙunshe), da kuma nazarin asibiti (don gano cikakken Abubuwan haɓaka da halayen haɓaka kowane yanayin yanayin bincike). Daga qarshe, cikakken fahimta game da ilimin halittar jiki da kuma tsarin halayyar halayyar mutum, da kuma dalilan dake haifar da bambancin sa, zai bada damar inganta rigakafin da kokarin magani. Dole ne a ba da kulawa ta musamman ga gudummawar fasalin yanayin zamantakewar al'umma, kuma musamman game da jima'i wanda da alama yana da babbar gudummawa ga yanayin asibitin marasa lafiya dangane da sauran masu canji na waje. Ayyukan rigakafin lafiyar hankali da sabis na shiga tsakani za su sami fa'ida don gudanar da bincike na yau da kullun da kayan aikin kima tare da ƙarfin nuna bambanci ga kowane nau'in bincike, da kuma samar da ingantattun shirye-shiryen tsoma baki waɗanda ke iya gudanar da ƙayyadaddun abubuwan da suka dace. Wannan yana da mahimmanci musamman ga wasu nau'ikan jarabar ɗabi'a, wanda babu wasu kayan aikin aunawa kuma ƙayyadaddun tsare-tsaren farfadowa sun wanzu (kamar CB ko SA).

Takardun marubuta

SV-S, RG, FF-A, JM, da SJ-M sun tsara gwaji bisa ga sakamakon da suka gabata da kuma kwarewar NM-B, NA, MG-P, AdP-G, MB, da LM. SV-S, RG, VM-R, GM-B, TS, FF-A, da SJ-M suka gudanar da gwaji, suka bincikar bayanan, kuma suka rubuta wani sashi na farko na rubutun. SJ-M, TS, GM-B, RG, da kuma FF-A sake ingantaccen rubutun.

Rikici na sanarwa mai amfani

Mawallafa sun bayyana cewa an gudanar da binciken ne a cikin babu wata kasuwanci ko kudi da za a iya ɗauka a matsayin mai rikici na sha'awa.

Acknowledgments

An samu tallafin kudi ta hanyar Minista na Economía y Competitividad (kyautar PSI2011-28349 da PSI2015-68701-R). FIS PI14 / 00290, FIS PI17 / 01167, da 18MSP001-2017I067 sun sami taimako daga Minista de Sanidad, Servicios Sociales e Igualdad. CIBER Fisiología Obesidad y Nutrición (CIBERobn) da CIBER Salud Mental (CIBERSAM), duka biyu ne manufofin ISCIII. GMB yana tallafawa ta (2018 FI_B2 00174) mai ba da umurni, don tallafawa ta Ƙasashen Turai (ESF) "ESF", wanda ke tallafawa a nan gaba. Tare da goyon bayan Sakatariya na Jami'o'i da Binciken Ma'aikatar Kasuwanci da Ilimin Gwamnatin Catalonia. Muna gode wa shirin CERCA da Generalitat de Catalunya don tallafawa hukumomi. Muna kuma gode wa Fondo Europeo de Desarrollo Regional (FEDER) da kuma shirin su, "Una manera de hacer Europa" (hanya don gina Turai).

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