A twin registry study of the relationship between posttraumatic stress disorder and nicotine dependence in men
A twin registry study of the relationship between posttraumatic stress disorder and nicotine dependence in men
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DOI：
10.1001/archpsyc.62.11.1258
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发表时间：
2005-11-01
影响因子：
--
通讯作者：
Tsuang, M
中科院分区：
文献类型：
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作者：
Koenen, KC;Hitsman, B;Tsuang, M
背景：最近的研究表明，创伤后应激障碍（PTSD）和尼古丁依赖（ND）之间有很强的联系。然而，该协会的解释仍不清楚。目的：为了测试竞争的解释PTSD和ND.Design之间的关联，设置和参与者：越南时代双胞胎注册表，一个国家的6744名成员的数据分析。主要结果：采用DSM-III-R诊断访谈表，对1991- 1992年在越南战争时期服役的所有男性-男性双胞胎进行调查。结果：与未暴露个体（40.5%）相比，创伤暴露个体（52.0%）和创伤后应激障碍个体（71.7%）的ND患病率升高。这种关联对于ND和创伤无PTSD（比值比，1.31; 95%置信区间[CI]，1.18-1.45）和PTSD（比值比，2.34; 95% CI，1.92-2.84）是显著的，并且不能完全用共同的风险因素来解释。共享的遗传效应解释了63%的PTSD-ND关联;其余的协方差由个体特异性环境效应解释。使用具有时间依赖性协变量的生存分析，ND与创伤暴露男性中PTSD风险大幅增加相关（风险比，1.98; 95%CI，1.61-2.42）。创伤（危害比，1.49; 95%CI，1.35-1.64）和创伤后应激障碍（危害比，1.36; 95%CI，1.14-1.61）是不太强烈，但显着相关的风险增加后，控制共享的风险factors.Conclusions：大多数的PTSD-ND协会是由共享的遗传效应解释。然而，有一个实质性的，强大的PTSD-ND协会没有解释的共同风险因素。支持对这种关联的多种解释;然而，最强的关联与先前存在的ND增加PTSD发作的风险一致。这些数据表明，有ND病史的男性退伍军人患PTSD的风险可能会增加。PTSD-ND并发症的生物学机制有待进一步研究。
Context: Recent studies indicate a strong association between posttraumatic stress disorder (PTSD) and nicotine dependence (ND). However, the explanation for the association remains unclear.Objective: To test competing explanations for the association between PTSD and ND.Design, Setting, and Participants: Analysis of data on 6744 members of the Vietnam Era Twin Registry, a national. registry of all male-male twin pairs who served in the military during the Vietnam era interviewed in 1991-1992.Main Outcome Measures: Risk of PTSD and ND using the Diagnostic Interview Schedule for the DSM-III-R.Results: The prevalence of ND was elevated among trauma-exposed individuals (52.0%) and those with PTSD (71.7%) compared with unexposed individuals (40.5%). This association was significant for ND and for trauma without PTSD (odds ratio, 1.31; 95% confidence interval [CI], 1.18-1.45) and for PTSD (odds ratio, 2.34; 95% CI, 1.92-2.84) and was not entirely explained by shared risk factors. Shared genetic effects explained 63% of the PTSD-ND association; the remaining covariance was explained by individual-specific environmental effects. Using survival analysis with time-dependent covariates, ND was associated with a substantially increased risk of PTSD among trauma-exposed men (hazard ratio, 1.98; 95% CI, 1.61-2.42). Trauma (hazard ratio, 1.49; 95% CI, 1.35-1.64) and PTSD (hazard ratio, 1.36; 95% CI, 1.14-1.61) were less strongly but significantly associated with increased risk of ND onset after controlling for shared risk factors.Conclusions: Most of the PTSD-ND association is explained by shared genetic effects. However, there is a substantial, robust PTSD-ND association not explained by shared risk factors. Multiple explanations for the association were supported; however, the strongest association was consistent with preexisting ND increasing the risk of PTSD onset. These data suggest that male veterans with a history of ND may be at increased risk for PTSD. Further research on the biological mechanisms underlying PTSD-ND comorbidity is needed.