Risk Pathways Among Traumatic Stress, Posttraumatic Stress Disorder Symptoms, and Alcohol and Drug Problems: A Test of Four Hypotheses
Risk Pathways Among Traumatic Stress, Posttraumatic Stress Disorder Symptoms, and Alcohol and Drug Problems: A Test of Four Hypotheses
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DOI：
10.1037/a0035878
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发表时间：
2014-09-01
影响因子：
3.4
通讯作者：
Chassin, Laurie
中科院分区：
文献类型：
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作者：
Haller, Moira;Chassin, Laurie
本研究利用了社区样本的纵向数据（n = 377; 166例创伤暴露; 54%男性; 73%非西班牙裔高加索人; 22%西班牙裔; 5%其他种族），以测试创伤前物质使用问题是否会增加创伤暴露的风险（高风险假设）或创伤后应激障碍（PTSD）症状PTSD症状与酒精/药物问题之间的关联是否归因于共同的风险因素（共同的脆弱性假说）。在路径分析框架中进行Logistic和负二项回归。结果提供了最有力的支持自我药疗假说，如创伤后应激障碍症状预测较高水平的酒精和药物问题，以上的创伤前家庭危险因素的影响，创伤前物质使用问题，创伤暴露，和人口统计学变量。结果部分支持了高风险假设，例如青少年物质使用问题增加了攻击性暴力暴露的风险，但不影响创伤暴露的总体风险。易感性假说没有得到支持。最后，共同脆弱性假设几乎没有得到支持。无论是创伤暴露还是先前存在的家庭逆境都不能解释PTSD症状和后来的物质使用问题之间的联系。相反，创伤后应激障碍症状介导了创伤前家庭逆境对后来酒精和药物问题的影响，从而支持自我药疗假说。这些发现为更好地理解创伤应激、PTSD症状和物质使用问题之间的影响方向做出了重要贡献。
The present study utilized longitudinal data from a community sample (n = 377; 166 trauma-exposed; 54% males; 73% non-Hispanic Caucasian; 22% Hispanic; 5% other ethnicity) to test whether pretrauma substance use problems increase risk for trauma exposure (high-risk hypothesis) or posttraumatic stress disorder (PTSD) symptoms (susceptibility hypothesis), whether PTSD symptoms increase risk for later alcohol/drug problems (self-medication hypothesis), and whether the association between PTSD symptoms and alcohol/drug problems is attributable to shared risk factors (shared vulnerability hypothesis). Logistic and negative binomial regressions were performed in a path analysis framework. Results provided the strongest support for the self-medication hypothesis, such that PTSD symptoms predicted higher levels of later alcohol and drug problems, over and above the influences of pretrauma family risk factors, pretrauma substance use problems, trauma exposure, and demographic variables. Results partially supported the high-risk hypothesis, such that adolescent substance use problems increased risk for assaultive violence exposure but did not influence overall risk for trauma exposure. There was no support for the susceptibility hypothesis. Finally, there was little support for the shared vulnerability hypothesis. Neither trauma exposure nor preexisting family adversity accounted for the link between PTSD symptoms and later substance use problems. Rather, PTSD symptoms mediated the effect of pretrauma family adversity on later alcohol and drug problems, thereby supporting the self-medication hypothesis. These findings make important contributions to better understanding the directions of influence among traumatic stress, PTSD symptoms, and substance use problems.