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.

项目摘要 创伤后应激障碍（PTSD）和身体疼痛在退伍军人中高度共同发生。将近一个- 9/11事件后，一半的美国退伍军人报告身体疼痛，近四分之一的人报告PTSD。PTSD发生率 在身体疼痛的人中甚至更高，反之亦然。患有创伤后应激障碍和身体疾病的退伍军人 疼痛可能是有问题的大麻使用的特别风险，因为这两种情况都与自我 药物和大麻使用障碍。关于大麻使用是否会改善PTSD的研究好坏参半 症状和身体疼痛或使其恶化。因此，了解合作伙伴之间的动态关联， 发生PTSD症状，身体疼痛和大麻使用是至关重要的。一些理论模型已经被 研究旨在解释创伤后应激障碍和身体疼痛之间的联系， 大麻使用问题相互维护模型假设了一种双向关系， 症状使身体疼痛加剧，反之亦然。因此，随着创伤后应激障碍症状和身体疼痛的升级， 大麻滥用问题也可能增加。共享漏洞模型暗示了 心理因素如焦虑敏感性（即，恐惧焦虑症状的倾向）的发展 创伤后应激障碍和身体疼痛的维持，以及焦虑敏感性也可能增加自我- 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， 被方法论问题所破坏。也就是说，大多数相关研究评估了在以下时间测量的症状： 每季度（即，3个月）的间隔，然而，创伤后应激障碍症状，身体疼痛和大麻的使用都是众所周知的， 每天波动。因此，先前的工作可能会受到回顾性回忆偏差的影响， 共同发生的生物学变化。参与者每天报告症状的研究（每日日记 研究）可以更精确地评估关联的强度和方向， 在多大程度上，理论模型，包括相互维护，共同的脆弱性，和自我药疗， 描述这些关联。拟议的论文研究将利用现有的每日日记研究 （1 R21 DA 051802 - 01 A1）PTSD症状和9/11后退伍军人（N=75）中有问题的大麻使用。 分析将利用密集的纵向方法（即，动态结构方程模型），以测试 创伤后应激障碍症状和身体疼痛之间的双向关联， 大麻的使用，以及焦虑敏感性的调节作用。定性访谈将使用一个 退伍军人的子样本（N=20），他们筛查PTSD，报告身体疼痛加剧， 大麻滥用的问题采访将探讨退伍军人的生活经验，共同发生的生物学 和有问题的大麻使用，并将采用叙事生活史的方法来了解一个人的关键 作为一个服务成员和退伍军人的经验涉及到他们的生物学和使用。