Post-traumatic stress and future substance use outcomes: leveraging antecedent factors to stratify risk.
Journal: Frontiers in psychiatry
Volume: 15
Issue:
Year of Publication:
Affiliated Institutions:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, New York City, NY, United States.
Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States.
Department of Epidemiology, Brown University, Providence, RI, United States.
Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States.
Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, United States.
Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States.
Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States.
Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States.
Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States.
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, United States.
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States.
Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, United States.
Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, United States.
Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, United States.
Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States.
Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, United States.
Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, United States.
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States.
Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, United States.
Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States.
Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, United States.
Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center, Houston, TX, United States.
Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, United States.
Department of Psychology, Yale University, New Haven, CT, United States.
Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States.
Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States.
Abstract summary
Post-traumatic stress disorder (PTSD) and substance use (tobacco, alcohol, and cannabis) are highly comorbid. Many factors affect this relationship, including sociodemographic and psychosocial characteristics, other prior traumas, and physical health. However, few prior studies have investigated this prospectively, examining new substance use and the extent to which a wide range of factors may modify the relationship to PTSD.The Advancing Understanding of RecOvery afteR traumA (AURORA) study is a prospective cohort of adults presenting at emergency departments (N = 2,943). Participants self-reported PTSD symptoms and the frequency and quantity of tobacco, alcohol, and cannabis use at six total timepoints. We assessed the associations of PTSD and future substance use, lagged by one timepoint, using the Poisson generalized estimating equations. We also stratified by incident and prevalent substance use and generated causal forests to identify the most important effect modifiers of this relationship out of 128 potential variables.At baseline, 37.3% (N = 1,099) of participants reported likely PTSD. PTSD was associated with tobacco frequency (incidence rate ratio (IRR): 1.003, 95% CI: 1.00, 1.01, p = 0.02) and quantity (IRR: 1.01, 95% CI: 1.001, 1.01, p = 0.01), and alcohol frequency (IRR: 1.002, 95% CI: 1.00, 1.004, p = 0.03) and quantity (IRR: 1.003, 95% CI: 1.001, 1.01, p = 0.001), but not with cannabis use. There were slight differences in incident compared to prevalent tobacco frequency and quantity of use; prevalent tobacco frequency and quantity were associated with PTSD symptoms, while incident tobacco frequency and quantity were not. Using causal forests, lifetime worst use of cigarettes, overall self-rated physical health, and prior childhood trauma were major moderators of the relationship between PTSD symptoms and the three substances investigated.PTSD symptoms were highly associated with tobacco and alcohol use, while the association with prospective cannabis use is not clear. Findings suggest that understanding the different risk stratification that occurs can aid in tailoring interventions to populations at greatest risk to best mitigate the comorbidity between PTSD symptoms and future substance use outcomes. We demonstrate that this is particularly salient for tobacco use and, to some extent, alcohol use, while cannabis is less likely to be impacted by PTSD symptoms across the strata.
Authors & Co-authors:
Garrison-Desany
Meyers
Linnstaedt
House
Beaudoin
An
Zeng
Neylan
Clifford
Jovanovic
Germine
Bollen
Rauch
Haran
Storrow
Lewandowski
Musey
Hendry
Sheikh
Jones
Punches
Swor
Gentile
Hudak
Pascual
Seamon
Harris
Pearson
Peak
Domeier
Rathlev
O'Neil
Sergot
Sanchez
Bruce
Joormann
Harte
McLean
Koenen
Denckla
Study Outcome
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