Daily and dynamic fluctuations in PTSD symptoms, physical pain, and cannabis use among veterans

退伍军人创伤后应激障碍症状、身体疼痛和大麻使用的每日和动态波动

• 批准号: 10664875
• 负责人: Shaddy Saba
• 金额: $ 4.39万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10664875
• 关键词: Afghanistan; American; Anxiety; Cannabis; Complex; Conceptions; Data; Development; Equation; Etiology; Evidence based intervention; Frequencies; Fright; Interview; Iraq; Knowledge; Link; Maintenance; Measures; Methodology; Methods; Modeling; Pain; Participant; Pathway interactions; Persons; Post-Traumatic Stress Disorders; Prevention; Psychological Factors; Reporting; Research; Risk; Role; Self Medication; Severities; Symptoms; Testing; Theoretical model; Treatment outcome; Veterans; Work; anxiety sensitivity; anxiety symptoms; diaries; experience; improved; life history; marijuana use; marijuana use disorder; military veteran; neglect; novel; pain sensitivity; post 9/11; psychologic; service member

PROJECT SUMMARY Posttraumatic stress disorder (PTSD) and physical pain are highly co-occurring among veterans. Nearly one- half of post-9/11 American veterans report physical pain, and nearly one-quarter report PTSD. Rates of PTSD are even higher among those with physical pain and vice versa. Veterans with co-occurring PTSD and physical pain may be at particular risk of problematic cannabis use, as both conditions are associated with self- medication and cannabis use disorder. Research is mixed on whether cannabis use improves PTSD symptoms and physical pain or makes them worse. Thus, understanding dynamic associations between co- occurring PTSD symptoms, physical pain, and cannabis use is vital. Several theoretical models have been developed to explain links between PTSD and physical pain and may carry implications for understanding problematic cannabis use. The mutual maintenance model posits a bidirectional relationship where PTSD symptoms make physical pain worse and vice versa. Thus, as PTSD symptoms and physical pain escalate, problematic cannabis use may increase as well. The shared vulnerability model implicates predisposing psychological factors such as anxiety sensitivity (i.e., a tendency to fear anxiety symptoms) in the development and maintenance of both PTSD and physical pain, and anxiety sensitivity may also increase risk of self- medication and cannabis problems. However, results of prior research on these associations are mixed and marred by methodological issues. Namely, most relevant studies have assessed symptoms measured at quarterly (i.e., 3-month) intervals, however PTSD symptoms, physical pain, and cannabis use are all known to fluctuate daily. Therefore, prior work may be subject to retrospective recall bias and may not accurately capture changes in co-occurring symptomology. Studies in which participants report symptoms daily (daily diary studies) may allow for a more precise assessment of the strength and direction of associations as well as the extent to which theoretical models, including mutual maintenance, shared vulnerability, and self-medication, describe these associations. The proposed dissertation study will leverage an existing daily diary study (1R21DA051802-01A1) of PTSD symptoms and problematic cannabis use among post-9/11 veterans (N=75). Analyses will utilize intensive longitudinal methods (i.e., dynamic structural equation models) to test the bidirectional associations between PTSD symptoms and physical pain, their dynamic associations with cannabis use, and the moderating role of anxiety sensitivity. Qualitative interviews will be used with a subsample of veterans (N=20) who screen for PTSD, report heightened physical pain, and have varying levels of problematic cannabis use. Interviews will explore veterans’ lived experience of co-occurring symptomology and problematic cannabis use and will employ narrative life history methods to understand how one’s key experiences as a service member and veteran relate to their symptomology and use.

项目概要 创伤后应激障碍（PTSD）和身体疼痛在退伍军人中高度并发。近一—— 9/11 事件后的美国退伍军人中有一半表示身体疼痛，近四分之一表示患有创伤后应激障碍 (PTSD)。创伤后应激障碍 (PTSD) 发生率 在那些有身体疼痛的人中这一比例甚至更高，反之亦然。患有创伤后应激障碍 (PTSD) 和身体疾病同时发生的退伍军人 疼痛可能是有问题的大麻使用带来的特别风险，因为这两种情况都与自我控制有关。 药物和大麻使用障碍。关于使用大麻是否可以改善创伤后应激障碍（PTSD）的研究结果不一 症状和身体疼痛或使情况变得更糟。因此，了解合作之间的动态关联 发生创伤后应激障碍（PTSD）症状、身体疼痛和吸食大麻至关重要。提出了多种理论模型 旨在解释 PTSD 和身体疼痛之间的联系，并可能对理解产生影响 有问题的大麻使用。相互维护模型假设了一种双向关系，其中 PTSD 症状使身体疼痛加剧，反之亦然。因此，随着 PTSD 症状和身体疼痛的加剧， 有问题的大麻使用也可能增加。共享脆弱性模型暗示了易感性 发育过程中的心理因素，例如焦虑敏感性（即害怕焦虑症状的倾向） 创伤后应激障碍（PTSD）和身体疼痛以及焦虑敏感性的持续存在也可能增加自我伤害的风险。 药物和大麻问题。然而，先前对这些关联的研究结果好坏参半， 因方法论问题而受到损害。也就是说，大多数相关研究都评估了测量的症状 每季度（即 3 个月）间隔一次，但是 PTSD 症状、身体疼痛和吸食大麻都已知 每日波动。因此，之前的工作可能会受到回顾性回忆偏差的影响，并且可能无法准确地捕捉到 共存症状的变化。参与者每天报告症状的研究（每日日记 研究）可以更精确地评​​估协会的强度和方向以及 理论模型，包括相互维护、共同脆弱性和自我治疗，在多大程度上 描述这些关联。拟议的论文研究将利用现有的日常日记研究 (1R21DA051802-01A1) 9/11 后退伍军人 (N=75) 的 PTSD 症状和大麻使用问题。 分析将利用强化纵向方法（即动态结构方程模型）来测试 PTSD 症状和身体疼痛之间的双向关联，它们与 大麻的使用以及焦虑敏感性的调节作用。将采用定性访谈 筛查 PTSD、报告身体疼痛加剧且具有不同程度的退伍军人子样本 (N=20) 有问题的大麻使用。访谈将探讨退伍军人对同时出现的症状的生活经历 和有问题的大麻使用，并将采用叙述生活史的方法来了解一个人的关键 作为服役人员和退伍军人的经历与其症状和使用有关。