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May AC, Hendrickson RC, Pagulayan KF, Schindler AG. An observational cohort study of alcohol use and cognitive difficulties among post-9/11 veterans with and without TBI and PTSD. Drug Alcohol Depend 2024; 263:112419. [PMID: 39173220 DOI: 10.1016/j.drugalcdep.2024.112419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and alcohol use are highly prevalent among military Veterans and independently associated with cognitive difficulties; less is known about the combined effects. This study aimed to investigate the association between alcohol use patterns and cognitive diagnoses in Veterans with TBI and/or PTSD. METHODS Using electronic health record data,193,663 Veterans were classified into three alcohol use trajectory groups (consistently low, initially high transitioning to low, initially moderate transitioning to high) based on self-reported Alcohol Use Disorders Identification Test-C (AUDIT-C) scores. Cox proportional hazards models were used to examine the association between alcohol use patterns, TBI, PTSD, and the risk of cognitive diagnosis, while adjusting for demographic factors and comorbidities. RESULTS Veterans with initially high transitioning to low (HR = 1.21, 95 % CI: 1.11-1.31) and initially moderate transitioning to high (HR = 1.42, 95 % CI: 1.33-1.51) alcohol use patterns had a significantly greater risk of cognitive diagnosis compared to those with consistently low alcohol use when accounting for TBI, PTSD, and comorbidities. TBI (HR = 5.40, 95 % CI: 5.06-5.76) and PTSD (HR = 2.42, 95 % CI: 2.25-2.61) were also independently associated with an elevated risk of cognitive diagnosis. CONCLUSIONS Findings suggest that Higher levels of alcohol consumption, even if decreasing over time, may confer an increased risk of cognitive diagnosis for Veterans with TBI and/or PTSD. Long-term alcohol use patterns should be considered in clinical assessments and interventions to identify individuals at greater risk for experiencing cognitive difficulties.
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Affiliation(s)
- April C May
- Sierra Pacific Mental Illness Research and Education Clinical Center (MIRECC), Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Rebecca C Hendrickson
- Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, WA, USA
| | - Kathleen F Pagulayan
- Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA; Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA 98195, USA
| | - Abigail G Schindler
- Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, WA, USA; Veterans Affairs Northwest Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA 98195, USA.
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2
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Walton TO, Graupensperger S, Walker DD, Kaysen D. Alcohol use disorder as a moderator of the relationship between posttraumatic stress disorder and suicidality among military personnel. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1096-1106. [PMID: 38796793 DOI: 10.1111/acer.15313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/02/2024] [Accepted: 03/11/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD), posttraumatic stress disorder (PTSD), and suicide are substantial public health concerns among military service members, yet the nature of their relationships is not well understood. Here, we tested the hypothesis that AUD moderates the relationship between PTSD symptom severity and suicidal ideation. METHODS This secondary analysis uses data collected at baseline for a randomized clinical trial. The sample consists of 160 active-duty service members from three service branches (Army, Air Force, and Navy). All participants met diagnostic criteria for PTSD and were not engaged in evidence-based PTSD treatment at the time of enrollment. Zero-inflated Poisson generalized linear regression models were used to test the associations of PTSD and AUD symptom severity with the presence and severity of suicidal ideation. RESULTS Findings suggest that AUD symptom severity moderates (i.e., amplifies) the relationship between PTSD symptoms and severity of suicidal ideation among military personnel with untreated PTSD. Among service members with mild or absent AUD, we found no significant association between PTSD symptoms and the severity of suicidal ideation. However, when AUD severity was average (i.e., sample mean) or high (mean + 1SD), PTSD symptoms were significantly positively associated with the severity of suicidal ideation. CONCLUSIONS This study highlights the importance of assessing AUD and PTSD as a part of suicide risk evaluations of veterans. The results also provide strong support for the maintenance and further development in the military health system of treatment programs that simultaneously address AUD and PTSD comorbidity.
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Affiliation(s)
- Thomas O Walton
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Scott Graupensperger
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Denise D Walker
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
- National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, California, USA
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3
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Yancey JR, Carson CN, McGlade EC, Yurgelun-Todd DA. A Literature Review of Mental Health Symptom Outcomes in U.S. Veterans and Servicemembers Following Combat Exposure and Military Sexual Trauma. TRAUMA, VIOLENCE & ABUSE 2024; 25:1431-1447. [PMID: 37313717 DOI: 10.1177/15248380231178764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Combat exposure (CE) and military sexual trauma (MST) are among the most common types of traumatic experiences faced by veterans and active duty servicemembers and, as such, have both garnered increased research focus over the past decades. However, there has not yet been a critical review of the literature to examine the distinct clinical presentations associated with different trauma types. This is particularly important, as understanding distinct clinical profiles could help researchers and clinicians refine treatment approaches based on trauma type. To address this question, we conducted a search of the available literature in PsycINFO and PubMed prior to October 2022. We identified 43 articles evaluating the distinct and overlapping clinical symptoms of CE and MST. Study findings were conceptually organized by psychiatric condition. In general, there was substantial variability in study methodology including sample size, composition, and operationalizations of CE and MST. Despite this variability, notable patterns emerged across studies. Specifically, MST and CE uniquely predicted posttraumatic stress disorder symptoms, MST was more related to depressive symptoms and suicidality than CE, and CE appeared to be more related to alcohol use and other externalizing behaviors. Gender also played a significant role in the relationship between CE, MST, and clinical variables across studies. This review suggests that individuals with a history of MST and CE likely have distinct clinical presentations and more research into these presentations could better inform assessment and treatment. Important methodological gaps in the literature are also discussed.
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Affiliation(s)
- James R Yancey
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chelsea N Carson
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin C McGlade
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Deborah A Yurgelun-Todd
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
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4
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Reinhardt KM, McCaughey VK, Vento SA, Street AE. In Their Own Words: Women Veterans Identify the Personal Consequences of Military Sexual Trauma Victimization. Violence Against Women 2024; 30:722-742. [PMID: 36617939 DOI: 10.1177/10778012221147909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This qualitative study provides a platform for women veterans to inform our perspective of their experienced impacts following military sexual trauma (MST). We engaged 23 women veterans in semistructured interviews and used a grounded theory-informed thematic analytic approach, to interpret women's experiences. Women described negative impacts of their MST experiences across psychological, behavioral, and occupational domains. Less frequently, women discussed experiences of posttraumatic growth. These results aid our understanding of the complexities of women's posttrauma experiences and suggest that holistic intervention frameworks focused on a range of potential intervention targets are warranted in helping women veterans recover from MST.
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Affiliation(s)
| | - Virginia K McCaughey
- Suffolk University and National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
| | | | - Amy E Street
- National Center for PTSD at VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
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5
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Whiteford S, Quigley M, Dighton G, Wood K, Kitchiner N, Armour C, Dymond S. Anxiety, distress tolerance, and the relationship between complex posttraumatic stress disorder symptoms and alcohol use in veterans. J Clin Psychol 2024; 80:158-169. [PMID: 37860949 DOI: 10.1002/jclp.23604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/07/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Little is known about whether distress tolerance and anxiety mediate the relationship between comorbid complex posttraumatic stress disorder (CPTSD) and alcohol use among military veterans. Here, we investigated the contribution of distress tolerance and anxiety on the strength of the CPTSD and alcohol use association. We hypothesized that the impact of a two-factor model of CPTSD derived from subscale scores on the International Trauma Questionnaire (ITQ)-namely ITQ PTSD and ITQ Disturbances in Self Organization (DSO; e.g., issues with affective regulation/self-belief and shame)-on alcohol use severity would be mediated by anxiety but not by distress tolerance. METHODS Participants included 403 community-dwelling United Kingdom (UK) veterans (91.64% male, Mage = 51.15 years, SD = 12.48) recruited as part of a larger, online study. RESULTS Findings indicated that the influence of CPTSD symptoms on alcohol use severity was mediated by anxiety, not by distress tolerance, with greater relative impact due to ITQ DSO status than ITQ PTSD status. CONCLUSIONS We identified the mediational influence of anxiety and distress tolerance on the association between CPTSD subscales and alcohol use in UK veterans. Interventions for anxiety may be adapted for reducing problematic alcohol use and the impact of CPTSD symptoms in veterans with comorbid PTSD and alcohol use disorder.
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Affiliation(s)
- Seb Whiteford
- School of Psychology, Swansea University, Swansea, UK
| | | | - Glen Dighton
- School of Psychology, Swansea University, Swansea, UK
| | - Katie Wood
- School of Psychology, Swansea University, Swansea, UK
| | - Neil Kitchiner
- Veterans NHS Wales, Cardiff and Vale University Health Board, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Cherie Armour
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, UK
| | - Simon Dymond
- School of Psychology, Swansea University, Swansea, UK
- Department of Psychology, Reykjavík University, Reykjavík, Iceland
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6
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Saraiya TC, Back SE, Jarnecke AM, Blakey SM, Bauer AG, Brown DG, Ruglass LM, Killeen T, Hien DA. Sex and Gender Differences in Co-Occurring Alcohol Use Disorder and PTSD. CURRENT ADDICTION REPORTS 2023; 10:617-627. [PMID: 39026610 PMCID: PMC11257080 DOI: 10.1007/s40429-023-00511-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 07/20/2024]
Abstract
Purpose of Review Research demonstrates a strong association between alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD). However, less is known about sex- and gender-based differences among individuals with AUD + PTSD. This narrative review examines recent literature in this area and aims to be a reference for future research endeavors. Recent Findings Extant literature shows that intertwining biological systems increase females' risk of developing PTSD and experiencing more adverse effects from AUD compared to males. Sex-based physiological differences further interact with gendered sociocultural environments to influence the risk of AUD + PTSD. Emerging research suggests potential gender-specific pathways between PTSD, coping, and AUD which may inform prevention and treatment. However, barriers to care are often gender-specific and tailored approaches are needed to improve reach and uptake. Summary Additional research is needed to examine intersectional and contextual factors that synergistically influence sex/gender differences in AUD + PTSD, particularly beyond cisgender identities, and mechanisms of action.
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Affiliation(s)
- Tanya C. Saraiya
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
- Ralph H. Johnson Veterans Affairs Healthcare System, Charleston, SC, USA
| | - Amber M. Jarnecke
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | | | - Alexandria G. Bauer
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
| | - Delisa G. Brown
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | - Lesia M. Ruglass
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
- Department of Psychology, City College of New York, New York, NY, USA
| | - Therese Killeen
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | - Denise A. Hien
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
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7
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Edwards AC, Ohlsson H, Barr PB, Sundquist J, Kendler KS, Sundquist K. Military service and risk of subsequent drug use disorders among Swedish men. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1039-1048. [PMID: 36680575 PMCID: PMC10916707 DOI: 10.1007/s00127-023-02426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE Environmental factors contribute substantially to risk for drug use disorders (DUD). The current study applies multiple methods to empirically test whether military service is associated with subsequent DUD, as previous findings are inconsistent. METHODS Longitudinal Swedish national registry data on a cohort of male conscripts born 1972-1987 (maximum N = 485,900) were used to test the association between military service and subsequent registration for DUD. Cox proportional hazard models were used in preliminary analyses, followed by three methods that enable causal inference: propensity score models, co-relative models, and instrumental variable analysis. RESULTS Across all methods, military service was causally associated with lower risk of DUD. Hazard ratios ranged from HR = 0.43 (95% confidence intervals [CI] 0.37; 0.50) in the instrumental variable analysis to 0.77 (0.75; 0.79) in the multivariate propensity score matching analysis. This effect diminished across time. In the model including a propensity score, HRs remained below 1 across the observation period, while confidence intervals included 1 after ~ 11 years in the co-relative analysis and after ~ 21 years in the instrumental variable analysis. CONCLUSIONS In this cohort of Swedish men, complementary methods indicate that military service conferred substantial but time-limited protection against subsequent DUD. The observed effect could be due to reduced opportunity for substance use during service, social cohesion experienced during and after service, and/or socioeconomic advantages among veterans. Additional research is necessary to clarify these protective mechanisms and determine how other environmental contexts can provide similar benefits.
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Affiliation(s)
- Alexis C Edwards
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Box 980126, RichmondRichmond, VA, 23298-0126, USA.
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Peter B Barr
- Department of Psychiatry and Behavioral Sciences, State University of New York-Downstate, Brooklyn, NY, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth S Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Box 980126, RichmondRichmond, VA, 23298-0126, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Vest BM, Weiss-Laxer NS, Homish DL, Homish GG. Lifetime trauma exposure profiles and alcohol use over time among U.S. Reserve and National Guard soldiers. J Trauma Stress 2022; 35:1642-1655. [PMID: 35901312 PMCID: PMC10440733 DOI: 10.1002/jts.22867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 12/24/2022]
Abstract
Although trauma exposure is a recognized risk factor for alcohol use, research on military populations has emphasized combat exposure, with minimal consideration of exposure to other potentially traumatic events (PTEs). We aimed to (a) identify, characterize, and quantify subgroups of service members based on PTE patterns; (b) examine associations between trauma exposure subgroups and alcohol use; and (c) examine these associations longitudinally. Data were drawn from Operation: SAFETY, a longitudinal study of health and well-being among U.S. Army Reserve/National Guard soldiers (N = 478). Exposure to 15 PTEs, including childhood maltreatment, noninterpersonal events (e.g., natural disasters, accidents), interpersonal trauma, and military-related exposures, was assessed at baseline. Latent profile analysis was conducted to characterize mutually exclusive trauma profiles; profile membership was used to longitudinally predict alcohol use in generalized estimating equation models. Four exposure profiles were identified: intimate partner violence (IPV)/combat trauma (8.4%, n = 40), combat trauma (24.7%, n = 118), childhood trauma (8.4%, n = 40), and low trauma (58.6%, n = 280). In adjusted models, compared to the low trauma profile, IPV/combat profile membership was longitudinally associated with alcohol problems, OR = 2.44, p =.005. Membership in other trauma profiles was not associated with alcohol use. Within the IPV/combat profile, men had a higher risk of frequent heavy drinking than women. Results suggest a need to comprehensively screen for lifetime PTE exposure, particularly IPV, in military populations. Given the high prevalence of nonmilitary PTEs, an inclusive, trauma-informed approach to health care and service provision is warranted.
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Affiliation(s)
| | | | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo
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9
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Morishima R, Usami S, Ando S, Kiyono T, Morita M, Fujikawa S, Araki T, Kasai K. Trajectory and course of problematic alcohol use after the Great East Japan Earthquake: Eight-year follow-up of the Higashi-Matsushima cohort study. Alcohol Clin Exp Res 2022; 46:570-580. [PMID: 35102561 DOI: 10.1111/acer.14787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Problematic alcohol use (PAU) after natural disasters is an unignorable public health issue. However, the long-term trajectory and course of PAU after an earthquake disaster remain unknown. METHODS The Higashi-Matsushima cohort study was conducted between 2012 (time 1) and 2019 (time 8) in areas affected by the Great East Japan Earthquake in 2011. In the annual health checks, participants responded to self-report questionnaires on PAU, traumatic experiences (e.g., house damage), resources (e.g., social support), and other covariates (e.g., gender, psychological distress). The trajectory and course of PAU were estimated by latent growth model and latent class analyses. Risk factors for the long-term course of PAU were calculated by multinomial logistic regression analysis with multiple imputation. The analytical sample comprised 8929 residents who participated in at least one survey across the eight time points. RESULTS The trajectory of PAU showed a sustained trend (slope <0.001). Three potential courses of PAU (No PAU course: 84.3%, Subthreshold PAU course: 12.4%, and Persistent PAU course: 3.4%) were estimated. The long-term course of PAU, especially the persistent PAU course, was predicted by house damage (OR = 1.43, 95% CI 1.06 to 1.92), less social support (OR = 0.71, 95% CI 0.53 to 0.96), gender (male) (OR = 16.86, 95% CI 9.42 to 30.20), and psychological distress (OR = 1.15, 95% CI 1.09 to 1.20). CONCLUSIONS Long-term support is needed after an earthquake disaster, especially for residents who in early phases of the disaster suffer from PAU, males, and those in vulnerable situations resulting from conditions such as severe house damage, low social support, or high psychological distress.
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Affiliation(s)
- Ryo Morishima
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Health Care Science Institute, Tokyo, Japan
| | - Satoshi Usami
- Graduate School of Education, University of Tokyo, Tokyo, Japan
| | - Shuntaro Ando
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Tomoki Kiyono
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masaya Morita
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinya Fujikawa
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Araki
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Psychiatry, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,International Research Center for Neurointelligence (WPI-IRCN) at University of Tokyo Institutes for Advanced Study (UTIAS), Tokyo, Japan
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10
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McGlinchey E, Ross J, Murphy D, Shorter GW, Armour C. Disentangling the Symptom-Level Nuances in Comorbid Posttraumatic Stress Disorder and Problematic Alcohol Use in Northern Irish Military Veterans: A Network Analysis. J Trauma Stress 2022; 35:32-41. [PMID: 33743187 DOI: 10.1002/jts.22666] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 01/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use are highly prevalent among military veteran populations. Several theories have been proposed to account for the comorbidity between PTSD and problematic alcohol use, but research examining the symptom-level associations between the two is limited. The current study used network analysis to examine the associations between PTSD and problematic alcohol use. Data were collected through a cross-sectional survey of veterans of the United Kingdom Armed Forces living in Northern Ireland. The sample comprised 511 (91.2% male) veterans with a history of trauma exposure and current alcohol use. A network consisting of PTSD symptoms from the PTSD Checklist for DSM-5 (PCL-5) and items from the Alcohol Use Disorders Identification Test (AUDIT) was constructed, and the bridge centrality of all items was estimated to identify items with the highest number of associations and the strongest associations between the two constructs. The PTSD symptom "reckless behavior" (2.43) had the highest bridge centrality values and thus the strongest connections and most connections to the alcohol use items. For the alcohol use items, "not being able to stop drinking" (2.31) and "number of drinks" (1.24) demonstrated the strongest bridge connections to the PTSD items. These results highlight the role of specific PTSD symptoms involved in the interaction between PTSD and problematic alcohol use.
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Affiliation(s)
- Emily McGlinchey
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Jana Ross
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Dominic Murphy
- Research Department, Combat Stress, Leatherhead, United Kingdom.,King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Gillian W Shorter
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Cherie Armour
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
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11
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Cucciare MA, Mengeling MA, Han X, Kennedy K, Torner J, Sadler AG. Experiencing Sexual Assault and/or Stalking-Related Behavior is Associated with Binge Drinking and Substance Use Consequences in Deployed U.S. Servicewomen. Womens Health Issues 2022; 32:402-410. [PMID: 34991954 DOI: 10.1016/j.whi.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/23/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Being deployed is a risk factor for poor postdeployment mental health outcomes in U.S. servicewomen, including harmful drinking. However, to our knowledge, no studies have examined deployment-related sexual assault and exposure to stalking-related behavior in relation to binge drinking and substance use consequences in this population. METHODS A community sample of post-9/11 servicewomen from the Midwest, including both veterans and those actively serving (N = 991), completed computer-assisted telephone interviews after deployment. Logistic regression models examined associations between deployment-related sexual assault (attempted or completed) and stalking-related behavior (e.g., being left unwanted things, having property vandalized), and the likelihood of reporting binge drinking and substance use consequences after controlling for covariates. RESULTS U.S. servicewomen experiencing deployment-related sexual assault and/or stalking-related behavior were more likely to report binge drinking in the past 4 weeks and at least one negative consequence of substance use in the past year. Also, 21.56% of the sample reported experiencing any deployment-related sexual assault and/or stalking-related behavior, 17.34% reported any stalking-related behavior and no sexual assault, 2.42% reported both sexual assault and stalking-related behavior, and 1.80% reported sexual assault and no stalking-related behavior. The most commonly endorsed behaviors were being followed or spied on (9.09%), receiving unsolicited correspondence (8.34%-8.74%), and having someone show up at places you were (6.90%). CONCLUSIONS U.S. servicewomen experiencing sexual assault and/or stalking-related behavior during deployment may be at higher risk for binge drinking and experiencing negative consequence of substance use when compared with their peers not reporting these stressors.
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Affiliation(s)
- Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arizona; VA South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas.
| | - Michelle A Mengeling
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa; VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arizona; VA South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas
| | - Kristina Kennedy
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arizona
| | - James Torner
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Anne G Sadler
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
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12
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The buffering role of higher romantic relationship satisfaction on the association of hazardous drinking with PTSD and depression symptoms among female military service members/veterans. Addict Behav 2021; 123:107081. [PMID: 34418870 DOI: 10.1016/j.addbeh.2021.107081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 01/03/2023]
Abstract
Studies show that more positive relationship satisfaction can mitigate the effects of posttraumatic stress disorder (PTSD) and depression severity on hazardous drinking in military samples. However, past studies were not circumscribed to female service members/veterans (SM/V), who represent the fastest growing demographic in the military. Moreover, studies did not examine moderators of specific symptom clusters of PTSD and depression with hazardous drinking. Indeed, recent studies have shown that the more depressive and cognitive clusters are associated with greater dysfunction. The current study extended this literature in a convenience sample of 584 female SM/V who completed self-report measures of hazardous drinking, PTSD, depression, and relationship satisfaction. PTSD or depression severity, relationship satisfaction, and their interaction, were examined as correlates of hazardous drinking after accounting for relationship, demographic, and military characteristics. For both overall PTSD and depression severity, higher relationship satisfaction weakened their association with hazardous drinking. Such results were consistent when global scores were replaced with PTSD-related negative alterations in cognitions and mood and somatic depression symptom clusters, but not for PTSD-related dysphoric arousal, anhedonia, or non-somatic depression symptom clusters. Findings suggest that to lessen the association of PTSD or depressive symptoms with problematic drinking, interventions aimed at improving relationship satisfaction may be worth considering among women in relationships. Moreover, symptom cluster analyses show that the cognitive and depressive components of PTSD, as well as the physical symptoms of depression, are most problematic, pinpointing specific areas of function on which to intervene.
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Hahn CK, Jarnecke AM, Calhoun C, Melkonian A, Flanagan JC, Back SE. Sexual Harassment and Assault During Deployment: Associations with Treatment Outcomes Among Veterans with Co-occurring PTSD and SUD. MILITARY PSYCHOLOGY 2021; 34:12-22. [PMID: 35340543 PMCID: PMC8942369 DOI: 10.1080/08995605.2021.1964901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/03/2021] [Indexed: 01/03/2023]
Abstract
Sexual trauma is common and increases risk for posttraumatic stress disorder (PTSD), substance use disorders (SUD), and depression among veterans. Limited research has examined the impact of sexual harassment and assault during deployment on treatment outcomes among veterans with co-occurring PTSD and SUD. The current study examined frequency of exposure to sexual harassment and assault during deployment as a predictor of treatment outcomes among a primarily male sample of U.S military veterans diagnosed with current PTSD and SUD. A secondary analysis was performed using data from a randomized clinical trial examining the efficacy of Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) compared to Relapse Prevention (RP). Data from 69 veterans (91.3% male) who were deployed while in the service were analyzed using mixed models to determine whether frequency of exposure to sexual harassment and assault during deployment impacted changes in PTSD symptom severity, percent days using substances, and depressive symptoms during treatment. Over one-third of the sample (36.2%) reported exposure to sexual harassment and/or assault during deployment. Frequency of exposure to sexual harassment and assault during deployment was not a predictor of treatment outcome in any of the models, suggesting a similar response to treatment among those with varying frequency of exposure to sexual harassment and assault during deployment. Veterans with co-occurring PTSD and SUD who have been exposed to sexual harassment and assault during deployment may benefit from integrated trauma-focused treatments and treatments focused on decreasing SUD symptoms.
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Affiliation(s)
- Christine K. Hahn
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amber M. Jarnecke
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Casey Calhoun
- Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alex Melkonian
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Julianne C. Flanagan
- Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Sudie E. Back
- Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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14
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Gibson M, Williamson L, Henwood G, Chalmers D, Dell CA. Perceptions and Use of Alcohol and Medical Cannabis among Canadian Military Veterans Living with PTSD. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i1.200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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15
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Naifeh JA, Mash HBH, Stein MB, Vance MC, Aliaga PA, Fullerton CS, Dinh HM, Wynn GH, Kao TC, Sampson NA, Kessler RC, Ursano RJ. Sex Differences in US Army Suicide Attempts During the Wars in Iraq and Afghanistan. Med Care 2021; 59:S42-S50. [PMID: 33438882 PMCID: PMC7810153 DOI: 10.1097/mlr.0000000000001425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine sex differences in risk for administratively documented suicide attempt (SA) among US Army soldiers during the Iraq/Afghanistan wars. METHOD Using administrative person-month records of Regular Army enlisted soldiers from 2004 to 2009, we identified 9650 person-months with a first documented SA and an equal-probability control sample (n=153,528 person-months). Person-months were weighted to the population and pooled over time. After examining the association of sex with SA in a logistic regression analysis, predictors were examined separately among women and men. RESULTS Women (an estimated 13.7% of the population) accounted for 25.2% of SAs and were more likely than men to attempt suicide after adjusting for sociodemographic, service-related, and mental health diagnosis (MHDx) variables (odds ratio=1.6; 95% confidence interval, 1.5-1.7). Women with increased odds of SA in a given person-month were younger, non-Hispanic White, less educated, in their first term of enlistment, never or previously deployed (vs. currently deployed), and previously received a MHDx. The same variables predicted SA among men. Interactions indicated significant but generally small differences between women and men on 6 of the 8 predictors, the most pronounced being time in service, deployment status, and MHDx. Discrete-time survival models examining risk by time in service demonstrated that patterns for women and men were similar, and that women's initially higher risk diminished as time in service increased. CONCLUSIONS Predictors of documented SAs are similar for US Army women and men. Differences associated with time in service, deployment status, and MHDx require additional research. Future research should consider stressors that disproportionately affect women.
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Affiliation(s)
- James A. Naifeh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Holly B. Herberman Mash
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla
- VA San Diego Healthcare System, San Diego, CA
| | - Mary C. Vance
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Pablo A. Aliaga
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Carol S. Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
| | - Hieu M. Dinh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Gary H. Wynn
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Robert J. Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
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16
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McCabe CT, Watrous JR, Galarneau MR. Health Behaviors Among Service Members Injured on Deployment: A Study From the Wounded Warrior Recovery Project. Mil Med 2021; 186:67-74. [PMID: 33005930 DOI: 10.1093/milmed/usaa242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/06/2020] [Accepted: 08/03/2020] [Indexed: 01/12/2023] Open
Abstract
ABSTRACT
Introduction
Service members (SMs) who are injured on deployment are at risk for myriad long-term health problems that may be ancillary to their physical injury, including high rates of depression and posttraumatic stress disorder, and poor health behaviors (e.g., problem drinking, cigarette and tobacco use, poor sleep quality, and sedentary lifestyle). As the specific health behaviors injured SMs engage in have been largely ignored, the primary aim of this study was to compare health behavior patterns among those with and without mental health problems in a large, representative sample of SMs injured on combat deployment.
Materials and Methods
Participants (N = 3,303) completed behavioral health assessments between September 2018 and April 2019 as part of the Wounded Warrior Recovery Project. Multivariate linear regressions and binary logistic regressions were used to evaluate differences between mental health screening status and health behavior outcomes, adjusting for injury severity, age, and years since injury.
Results
Overall, about half of participants screened positive for posttraumatic stress disorder and/or depression (49%). Participants reported high rates of alcohol use and problems, cigarette and tobacco use, inadequate sleep and poor sleep quality, and low levels of physical activity. With the exception of number of drinking days and likelihood of current tobacco use, participants who screened positive for a mental health disorder evidenced significantly worse health behavior outcomes.
Conclusions
The results provide a preliminary glance into the mental health and health behaviors of SMs roughly a decade after injury, and underscore the importance of examining the interplay between mental, physical, and behavioral health outcomes among wounded warriors to promote health and wellness.
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Affiliation(s)
- Cameron T McCabe
- Operational Readiness Directorate, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, San Diego, CA 92106, USA
| | - Jessica R Watrous
- Operational Readiness Directorate, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, San Diego, CA 92106, USA
| | - Michael R Galarneau
- Operational Readiness Directorate, Naval Health Research Center, San Diego, CA 92106, USA
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17
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O'Toole BI, Gorman P, Catts SV. Military Combat, Posttraumatic Stress Disorder, and the Course of Alcohol Use Disorders in a Cohort of Australian Vietnam War Veterans. J Trauma Stress 2020; 33:709-719. [PMID: 32939901 DOI: 10.1002/jts.22588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 01/19/2023]
Abstract
The present study examined the course of diagnosed alcohol use disorders (AUDs) in a cohort of Australian veterans of the Vietnam War (N = 388) who were assessed 22 and 36 years after returning home. Standardized interviews provided data on AUDs, posttraumatic stress disorder (PTSD), other psychiatric diagnoses, and combat exposure. Overall, 148 veterans (38.1%) had no history of alcohol-related diagnoses, 151 veterans (38.9%) had a past AUD diagnosis that was not current at the second assessment point, and 89 veterans (22.9%) had a current AUD diagnosis at the second assessment. Less education, lower intelligence test scores, and misconduct were individual risk factors for AUDs, as were first-interview diagnoses of PTSD, antisocial personality disorder, generalized anxiety, and dysthymia, but not depression; these variables were all nonsignificant after controlling for combat exposure and PTSD. Multinomial regression was used to assess the relative contributions of combat exposure and PTSD to the course of AUDs. Combat exposure and PTSD had different patterns of association with AUDs whereby combat exposure, but not PTSD, was associated with a history of AUDs, odds ratio (OR) = 1.02, but not with current AUDs, whereas PTSD, but not combat exposure, was associated with current AUDs, OR = 3.37. Current numbing and avoidance symptoms were associated with current AUDs, OR = 4.48. The results do not support a mutual maintenance model of PTSD and AUDs but are consistent with a self-medication model, which suggests treatment for PTSD may have beneficial effects on AUDs.
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Affiliation(s)
- Brian I O'Toole
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Patrick Gorman
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Stanley V Catts
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Department of Psychiatry, University of Queensland, Brisbane, Australia
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