Current literature lacks longitudinal understandings of the association between childhood sexual/physical violence, alcohol use, depressive symptoms, and indiscriminant sexual behaviors among young women, as well as the racial/ethnic differences in these associations. Therefore, using the 1994-2008 National Longitudinal Study of Adolescent Health, this study examined a) heterogeneous growth trajectories of problem alcohol use during the transition from adolescents to young adulthood and the impact of childhood sexual/physical violence on drinking trajectories, b) the long-term impact of childhood sexual/physical violence on alcohol use and depressive symptoms, and c) the structural associations between childhood sexual/physical violence and indiscriminant sexual behaviors by examining alcohol use and depressive symptoms as mediators between White and African-American women. First, with 1,702 women, LCGM was used to identify trajectories of problem alcohol use using the first three waves. Four trajectories of problem alcohol use emerged: stable abstainers; decliners (moderate-low); incliners (low-moderate); and rapid incliners (low-high). From the bivariate level analyses, in reference to stable abstainers, White women who experienced childhood sexual/physical violence were more likely to be rapid incliners (low-high). Second, with 1,756 women, autoregressive cross-lagged path models were performed to test longitudinal associations between childhood sexual/physical violence, problem alcohol use, and depressive symptoms of White and African-American women. Both groups demonstrated significant association between childhood sexual/physical violence and subsequent development of depressive symptoms, while only White women demonstrated significant association with subsequent problem alcohol use. Third, with 1,388 women, SEM and multigroup SEM were used to test pathways between childhood sexual/physical violence and indiscriminant sexual behaviors for White and African-American women. SEM indicates that problem alcohol use and depressive symptoms mediated the proposed relationship. Multigroup SEM indicates that, for White women, both problem alcohol use and depressive symptoms mediated the association between childhood sexual/physical violence and indiscriminant sexual behaviors, while only depressive symptoms mediated the proposed association for African-American women. These findings highlight the importance of designing and providing effective prevention and treatment programs for women who experienced childhood sexual/physical violence to interrupt subsequent problem alcohol use, depressive symptoms, and indiscriminant sexual behaviors. / text

本研究主要目的在探討不同治療階段中創傷後成長與因應策略之關係。由於過去創傷後成長與因應策略之間的研究，均是將創傷後成長視為個體因應後的結果，而忽略創傷後成長的經驗對個體的影響，因此本研究透過雙面神模式的理論，以更多元的角度來檢視「創傷後成長」，並將追蹤三個時間點，根據不同治療階段進一步提出三個假設模式，並採用交叉延宕分析（Cross-lagged analyses）來檢驗。 研究方法採立意取樣，以中部某教學醫學之乳房中心的乳癌患者為對象，共262 人，蒐集患者之「基本資料」、「創傷後成長」及「因應策略」，並在術後三個月、術後六個月及術後一年進行問卷調查。資料分析以探索性因素分析將因應策略分為三個因素：「自我導向因應」、「社會導向因應」及「逃避因應」，並與創傷後成長進行交叉延宕分析。 研究主要發現如下：（一）診斷時年齡愈小及教育程度愈高者，可以預測術後三個月較高的「自我導向因應」、「社會導向因應」及「創傷後成長」；（二）術後三個月到六個月之間，「自我導向因應」與「創傷後成長」呈現互惠關係，即術後三個月較高的「自我導向因應」可以預測術後六個月較高的「創傷後成長」，而術後三個月較高的「創傷後成長」也可以預測術後六個月較高的「自我導向因應」；（三）術後六個月的「創傷後成長」可以預測術後一年的「社會導向因應」，即在術後六個月時「創傷後成長」愈高，可以預測後續較高的「社會導向因應」；（四）三個時間點中，「逃避因應」均無法預測「創傷後成長」，「創傷後成長」亦無法預測「逃避因應」。 最後將根據研究結果提出其貢獻與實務運用，並依據研究限制提出相關建議，以供臨床工作者與未來研究學者參考。 / This study is aimed to investigate the relationships between coping strategies and Posttraumatic Growth (PTG) on three different timing of the breast cancer treatment. According to Janus-Faced Model, PTG is assumed as both a coping effort and a coping result. In order to investigate the possible relationships between coping strategies and PTG, three hypothetic models were proposed and tested by cross-lagged analyses. By purposive sampling, 262 participants were recruited from the breast center unit at a hospital in central Taiwan. Demographic and disease-related information were gathered after surgery. The Posttraumatic Growth Inventory (PTGI) and the Brief Coping Orientations to Problems Experienced scale (Brief COPE) were assessed 3, 6 and 12 months later. The Brief COPE included 3 factors: self-sufficient coping, socially-supported coping and avoidant coping. Each was assumed to associate with PTG differently. Results of the current study were as follows: 1. Younger patients or women of higher education level reported more PTG, self-sufficient coping and socially-supported coping at T1. 2. The reciprocal relation was found between self-sufficient coping and PTG within 6 months postsurgery, which indicated the positive effect of T1 self-sufficient coping on T2 PTG, as well as the reciprocal effects of T1 PTG on T2 self-sufficient coping. 3. Higher level of PTG at T2 predicted more socially-supported coping at T3. 4. Within 1 year postsurgery, there were no significant cross-lagged effects between avoidant coping and PTG, but only autoregressive correlations within constructs over time. Implications of these findings are discussed, along with potential directions for future research.