Childhood Trauma Predicts Less Remission from PTSD among Patients with Co-Occurring Alcohol Use Disorder and PTSD.

Paul Brunault,Robert Courtois,Wissam El-Hage,Servane Barrault,Marie Grall-Bronnec,Hussein El Ayoubi,Kevin Lebigre,Nicolas Ballon,Grégoire Baudin,Coraline Hingray,Fatima Idbrik,Damien Maugé,Philippe Adam

doi:10.3390/jcm9072054

Abstract

Post-traumatic stress disorder (PTSD) is highly prevalent among patients hospitalized for an alcohol use disorder (AUD). Hospitalization can improve PTSD and AUD outcomes in some but not all patients, but we lack data on the baseline predictors of PTSD non-remission. This study aimed to determine the baseline risk factors for non-remitted PTSD in patients hospitalized for an AUD. Of 298 AUD inpatients recruited in a rehabilitation center (Le Courbat, France), we included 91 AUD inpatients with a co-occurring PTSD and a longitudinal assessment at baseline (T1) and before discharge (T2: 8 weeks later). Patients were assessed for PTSD diagnosis/severity (PCL-5=PTSD Checklist for DSM-5), different types of trauma including childhood trauma (LEC-5=Life Events Checklist for DSM-5/CTQ-SF=Childhood Trauma Questionnaire, Short-Form), and AUD diagnosis/severity (clinical interview/AUDIT=Alcohol Use Disorders Identification Test). Rate of PTSD remission between T1 and T2 was 74.1%. Non-remitted PTSD at T2 was associated with a history of childhood trauma (physical, emotional or sexual abuse, physical negligence), but not with other types of trauma experienced, nor baseline PTSD or AUD severity. Among patients hospitalized for an AUD with co-occurring PTSD, PTSD remission was more strongly related to the existence of childhood trauma than to AUD or PTSD severity at admission. These patients should be systematically screened for childhood trauma in order to tailor evidence-based interventions.

Highlights

Alcohol use disorders (AUD), which are characterized by compulsive alcohol use and loss of control over alcohol intake [1], are a major public health problem worldwide [2]
The main objective of this study was to determine how many patients hospitalized for an alcohol use disorder (AUD) and with a comorbid Post-traumatic stress disorder (PTSD) remitted from their PTSD at the end of their hospitalization, and to identify the risk factors for non-remission
The questionnaires were designed and completed online using Sphinx mobile iQ 2 software during a systematic visit with the person in charge of the data collection (P.A.). Out of these 303 patients, 298 had fully exploitable questionnaires at Table 1. At baseline (T1) (five patients had missing data for at least one questionnaire including the AUDIT (Alcohol Use Disorders Identification Test), PCL-5 (PTSD Checklist for DSM-5, i.e., Diagnostic and Statistical Manual for Mental Disorders, 5th edition), Life Event Checklist for DSM-5 (LEC-5) (Life Events Checklist for DSM-5), and CTQ-SF (Childhood Trauma Questionnaire, Short-Form); there was no significant difference between these five patients and the 298 others in terms of age, gender, AUDIT total score, number of traumatic events experiences, or CTQ sub-scores), including 149 patients who had a PTSD according to the LEC-5 and the PCL-5

Summary

Introduction

Alcohol use disorders (AUD), which are characterized by compulsive alcohol use and loss of control over alcohol intake [1], are a major public health problem worldwide [2]. One of the most prevalent psychiatric disorders associated with AUD is post-traumatic stress disorder (PTSD); while the prevalence of PTSD ranges from 4.8% to 8% in the overall population [5,6], it is much higher in people with AUD and is estimated to be between 20% and 39% [7,8]. For these patients, a PTSD diagnosis is associated with a poorer AUD outcome, as well as a higher rate of hospitalization and a more severe social impairment [5,9,10]. Based on the hypothesis that PTSD could be a causal risk or maintenance factor for AUD (i.e., improvement in PTSD associated with lower alcohol dependence) [11], identification of the factors associated with poor PTSD outcomes using a longitudinal approach could improve our ability to identify the patients who would benefit from tailor-made interventions, and improve AUD outcome [11]

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