Posttraumatic Stress Disorder Substance Research Articles

Coping strategy utilization among posttraumatic stress disorder symptom severity and substance use co-occurrence typologies: A latent class analysis.

There is a lack of research on primary prevention of posttraumatic stress disorder (PTSD) symptoms and substance use among trauma-exposed populations. To guide the development of more effective prevention efforts, the current study sought to identify underlying coping mechanisms that impact PTSD-substance use co-occurrence. A person-centered analytic approach (latent class analysis) examined PTSD-substance use co-occurrence typologies (classes) and identified theoretically adaptive (e.g., active coping) and maladaptive (e.g., denial) coping strategies that differentiated between classes among a sample of 1,270 trauma-exposed participants (Mage = 20.71, 73.5% female, 45.7% White). Latent class analysis identified five distinct typologies, reflective of extant epidemiological and etiological work. Generally, behavioral disengagement and self-blame coping increased the likelihood of being in more severe PTSD-illicit substance use (e.g., cocaine) comorbidity classes. Positive reframing and planning differentiated between low and moderate illicit substance typologies with moderate PTSD severity. Venting, acceptance, and self-distraction differentiated between asymptomatic and moderate PTSD severity typologies with low illicit substance use. Findings identify general coping strategies associated with increased likelihood of being in more severe comorbidity typologies, as well as several unique coping strategies associated with risk of transitioning between low/moderate PTSD and illicit substance use classes. Relevant interventions (e.g., trauma psychoeducation, guilt-reduction therapy, psychological first aid) that may be targets for future prevention-oriented work are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mental health and social support among public safety personnel.

Social support may be a protective factor for the mental health of public safety personnel (PSP), who are frequently exposed to potentially psychologically traumatic events and report substantial post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) symptoms. Research examining perceived social support and its association with PTSD and MDD in different PSP categories (e.g. firefighters, paramedics) is limited. To examine differences in perceived social support across PSP and determine whether perceived social support is associated with differences in rates of MDD and PTSD. We asked Canadian PSP, including correctional workers and officers, public safety communications officials, firefighters, paramedics, municipal and provincial police officers, and Royal Canadian Mounted Police (RCMP) officers, to complete an online anonymous survey that assessed socio-demographic information (e.g. occupation, sex, marital status, service years), social supports and symptoms of mental disorders, including PTSD and MDD. Analyses included ANOVA and logistic regression models. Perceived social support differed by PSP occupation. RCMP officers reported lower social support than all other PSP except paramedics. For most PSP categories, PSP who reported greater social support were less likely to screen positive for PTSD (adjusted odds ratios [AORs]: 0.90-0.93). Across all PSP categories, greater perceived social support was associated with a decreased likelihood of screening positive for MDD (AORs: 0.85-0.91). Perceived social support differs across some PSP categories and predicts PTSD and MDD diagnostic status. Studies involving diagnostic clinical interviews, longitudinal designs and social support interventions are needed to replicate and extend our results.

Mediators of Initial Acute and Later Posttraumatic Stress in Youth in a PICU*

Youth in a PICU and their parents may experience initial symptoms of acute stress disorder and later symptoms of posttraumatic stress disorder. The objective of this study was to examine potential mediators of these conditions, including youth anxiety, depression, negative affect, and hospital fear, as well as parent anxiety and depression This study involved a short longitudinal design that encompassed initial assessments in a PICU setting and later assessments 4-7 weeks after discharge. Youth and their parents completed dependent measures in the hospital and at follow-up at the youth's home or an outpatient clinic setting. Fifty youth aged 9-17 yrs were admitted to a PICU for respiratory illness/asthma (30.0%), trauma (26.0%), surgery and after surgery recovery (20.0%), infections/viral illness (8.0%), neurologic disorder (6.0%), or other (10.0%). Parents (n = 50) were also assessed. None. Measures were utilized for youth anxiety, acute stress, depression, negative affect, posttraumatic stress, and hospital fear, as well as parent anxiety, acute stress, depression, and posttraumatic stress. Some youth (26%) and parents (24%) had substantial posttraumatic stress disorder symptoms develop. Youth acute stress disorder symptoms in the PICU predicted later youth posttraumatic stress disorder symptoms, parent acute stress disorder symptoms in the PICU predicted later parent posttraumatic stress disorder symptoms, and youth acute stress disorder symptoms in the PICU predicted later parent posttraumatic stress disorder symptoms. Youth anxiety, negative affect, and hospital fear mediated initial youth acute stress disorder symptoms and later youth posttraumatic stress disorder symptoms. Youth in a pediatric intensive care unit are at increased risk for posttraumatic stress disorder and should be screened for acute stress disorder.

Cooccurrence of and remission from general anxiety, depression, and posttraumatic stress disorder symptoms after acute lung injury: a 2-year longitudinal study.

To evaluate the cooccurrence, and predictors of remission, of general anxiety, depression, and posttraumatic stress disorder symptoms during 2-year follow-up in survivors of acute lung injury treated in an ICU. Prospective cohort study, with follow-up at 3, 6, 12, and 24 months post-acute lung injury. Thirteen medical and surgical ICUs in four hospitals. Survivors among 520 patients with acute lung injury. The outcomes of interest were measured using the Hospital Anxiety and Depression Scale anxiety and depression subscales (scores ≥ 8 indicating substantial symptoms) and the Impact of Event Scale-Revised (scores ≥ 1.6 indicating substantial posttraumatic stress disorder symptoms). Of the 520 enrolled patients, 274 died before 3-month follow-up; 186 of 196 consenting survivors (95%) completed at least one Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised assessment during 2-year follow-up, and most completed multiple assessments. Across follow-up time points, the prevalence of suprathreshold general anxiety, depression, and posttraumatic stress disorder symptoms ranged from 38% to 44%, 26% to 33%, and 22% to 24%, respectively; more than half of the patients had suprathreshold symptoms in at least one domain during 2-year follow-up. The majority of survivors (59%) with any suprathreshold symptoms were above threshold for two or more types of symptoms (i.e., general anxiety, depression, and/or posttraumatic stress disorder). In fact, the most common pattern involved simultaneous general anxiety, depression, and posttraumatic stress disorder symptoms. Most patients with general anxiety, depression, or posttraumatic stress disorder symptoms during 2-year follow-up had suprathreshold symptoms at 24-month (last) follow-up. Higher Short-Form-36 physical functioning domain scores at the prior visit were associated with a greater likelihood of remission from general anxiety and posttraumatic stress disorder symptoms during follow-up. The majority of acute lung injury survivors had clinically significant general anxiety, depression, or posttraumatic stress disorder symptoms, and these symptoms tended to co-occur across domains. Better physical functioning during recovery predicted subsequent remission of general anxiety and posttraumatic stress disorder symptoms.

Psychiatric symptoms and acute care service utilization over the course of the year following medical-surgical ICU admission: a longitudinal investigation*.

To determine if the presence of in-hospital substantial acute stress symptoms, as well as substantial depressive or posttraumatic stress disorder symptoms at 3 months post-ICU, are associated with increased acute care service utilization over the course of the year following medical-surgical ICU admission. Longitudinal cohort study. Academic medical center. One hundred fifty patients who are 18 years old or older admitted to medical-surgical ICUs for over 24 hours. None. Participants were interviewed in-hospital to ascertain substantial acute stress symptoms using the Posttraumatic Stress Disorder Checklist-Civilian version. Substantial depressive and posttraumatic stress disorder symptoms were assessed using the Patient Health Questionnaire-9 and the Posttraumatic Stress Disorder Checklist-Civilian version, respectively, at 3 months post-ICU. The number of rehospitalizations and emergency department visits were ascertained at 3 and 12 months post-ICU using the Cornell Services Index. After adjusting for participant and clinical characteristics, in-hospital substantial acute stress symptoms were independently associated with greater risk of an additional hospitalization (relative risk, 3.00; 95% CI, 1.80-4.99) over the year post-ICU. Substantial posttraumatic stress disorder symptoms at 3 months post-ICU were independently associated with greater risk of an additional emergency department visit during the subsequent 9 months (relative risk, 2.29; 95% CI, 1.09-4.84) even after adjusting for both rehospitalizations and emergency department visits between the index hospitalization and 3 months post-ICU. Post-ICU psychiatric morbidity is associated with increased acute care service utilization during the year after a medical-surgical ICU admission. Early interventions for at-risk ICU survivors may improve long-term outcomes and reduce subsequent acute care utilization.

Substance use and PTSD among smokers with serious mental illness

Aims: Epidemiological studies indicate Posttraumatic Stress Disorder (PTSD) frequently co-occurs with substance use and abuse, particularly among women. This study examined the PTSDsubstance use relation in a sample of men and women smokers with serious mental illness. Methods: 733 adult smokers (51% male) aged 18–73, were recruited from 5 acute inpatient psychiatry units. The e-MINI measured PTSD. Past 30-day substance use and readiness to change were assessed for heavy alcohol use (ALC), stimulants (STIM), sedatives (SED), hallucinogens (HAL), opiates (OP), and marijuana (MJ). The SF-12 assessed physical and mental health functioning. Logistic regression analyses tested for women and men separately the relation of PTSD with substance use and readiness to change. Results: 44% of women and 36% of men had PTSD. Past 30 day use of ALC, STIM, SED, OP and MJ was high (women range: 21.5–39.6%, men range: 24.9–47.1%). HAL use was lower (women: 3.9%, men: 5.9%). On average, women used 1.6 (sd =1.2) and men used 1.7 (sd =1.2) substances, during the past 30 days. Adjusting for covariates, use of OP (OR=2.1, p= .01), SED (OR=1.8, p= .02), and MJ (OR=1.9, p= .01) predicted PTSD in women. Use of STIM (OR=1.8, p= .04) and MJ (OR=1.7, p= .04) predicted PTSD in men. Number of substances used predicted PTSD in women (OR=1.5, p< .01), but not men. PTSD was unrelated to motivation to quit ALC/drugs. PTSD and # of substances used were associated with poorermental health functioning, anda significant interaction indicated mental health functioning was the worst among those with both PTSD and greater substance use (b=2.1, p= .03). Conclusions: Among smokers with serious mental illness, recent heavy alcohol, illicit drug use, and PTSD were common, found to co-occur, and predictive of worse mental health functioning. Integrative treatments for PTSD and substance abuse, with attention to sex-specific drugs of abuse, appear warranted. Financial support: Funding: K23MH083684, K05DA01869, P50DA09253, TRDRP#23BT-0018, T32HL007034.

Posttraumatic Stress Disorder in Survivors of Acute Lung Injury

Survivors of acute lung injury (ALI) and other critical illnesses often experience substantial posttraumatic stress disorder (PTSD) symptoms. However, most questionnaires have not been validated against a PTSD diagnostic reference standard in this patient population. Hence, in the current study of survivors of ALI, we evaluated the Impact of Events Scale-Revised (IES-R), a questionnaire measure of PTSD symptoms, against the Clinician-Administered PTSD Scale (CAPS), the current state-of-the-art PTSD diagnostic reference standard, which also provides a quantitative assessment of PTSD symptoms.We evaluated the IES-R questionnaire vs the CAPS diagnostic interview in 60 of 77 consecutively recruited survivors of ALI from two prospective cohort studies of patients 1 to 5 years after ALI.The IES-R total score (range: 0.0-3.2) and the CAPS total severity score (range: 0-70) were strongly related (Pearson r=0.80, Spearman ρ=0.69). Using CAPS data, eight of the 60 patients (13%) had PTSD at the time of assessment, and an additional eight patients had partial PTSD (total prevalence, 27%). In a receiver operating characteristics curve analysis with CAPS PTSD or partial PTSD as criterion variables, the area under the curve ranged from 95% (95% CI, 88%-100%) to 97% (95% CI, 92%-100%). At an IES-R threshold of 1.6, with the same criterion variables, sensitivities ranged from 80% to 100%, specificities 85% to 91%, positive predictive values 50% to 75%, negative predictive values 93% to 100%, positive likelihood ratios 6.5 to 9.0, negative likelihood ratios 0.0 to 0.2, and efficiencies 87% to 90%.The IES-R appears to be an excellent brief PTSD symptom measure and screening tool in ALI survivors.

Substance abuse and post-traumatic stress disorder comorbidity

This article reviews the extant literature on substance abusers with and without a comorbid diagnosis of post-traumatic stress disorder (PTSD) and reveals the discontinuity between clinical lore and empirical research. Included is an overview of PTSD-substance abuse theoretical models and comorbidity prevalence rates, as well as an evaluation of the comparative data on treatment outcome and psychosocial factors, such as coping skills, for PTSD versus non-PTSD substance abusers. In addition, we discuss the controversy surrounding sequential versus simultaneous treatment approaches for such ‘dually-diagnosed’ patients. We conclude by identifying gaps in current knowledge about the nature and impact of PTSD on substance abuse treatment outcome and outlining needs for future research.