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 在退伍军人中，创伤后应激障碍（PTSD）和身体疼痛是高度同时发生的。将近一个 9/11后美国退伍军人的一半报告身体疼痛，几乎四分之一的报告PTSD。 PTSD的比率 在身体疼痛的人中，甚至更高。具有同时发生的PTSD和身体的退伍军人 疼痛可能特别有问题使用大麻的风险，因为这两种情况都与自我相关 药物和大麻使用障碍。关于大麻使用是否改善PTSD的研究混杂 症状和身体疼痛或使其恶化。这，了解共同的动态关联 发生PTSD症状，身体疼痛和大麻使用至关重要。几种理论模型已经 开发出来解释PTSD与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。相互维护模型构成了双向关系，其中PTSD 症状使身体疼痛恶化，反之亦然。随着PTSD症状和身体疼痛的升级， 有问题的大麻使用也可能会增加。共享漏洞模型实现了易感性的 心理因素，例如焦虑敏感性（即担心焦虑症状的趋势） 以及维持PTSD和身体疼痛以及焦虑敏感性的维持也可能增加自我的风险 药物和大麻问题。但是，关于这些关联的先前研究结果是混合的， 通过方法论问题损害。即，大多数相关研究都评估了在 季度（即3个月）间隔，但是PTSD症状，身体疼痛和大麻的使用都是已知的 每天波动。因此，先前的工作可能会受到回顾性召回偏见的影响，并且可能无法准确捕获 同时出现的症状变化。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以及 理论模型，包括相互维护，共享脆弱性和自我药物的范围， 描述这些关联。拟议的论文研究将利用现有的日记研究 （1R21DA051802-01A1）PTSD症状和9/11后退伍军人（n = 75）中使用有问题的大麻。 分析将利用密集的纵向方法（即动态结构方程模型）来测试 PTSD症状与身体疼痛之间的双向关联，它们与 大麻使用以及焦虑敏感性的调节作用。定性采访将与 筛选PTSD的退伍军人的子样本（n = 20），报告身体疼痛的增加，并且水平不同 有问题的大麻使用。访谈将探讨退伍军人的同时症状的实时经验 和有问题的大麻使用，并将采用叙事生活历史方法来了解一个人的关键 作为服务成员和退伍军人症状和使用的经验。