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

项目总结 创伤后应激障碍(PTSD)和身体疼痛在退伍军人中高度共存。将近一个- 一半的9/11后的美国退伍军人报告身体疼痛，近四分之一的人报告创伤后应激障碍。创伤后应激障碍发生率 在那些有身体疼痛的人中甚至更高，反之亦然。退伍军人合并创伤后应激障碍和躯体疾病 疼痛可能是使用有问题的大麻的特别风险，因为这两种情况都与自我 药物和大麻使用障碍。关于使用大麻是否会改善创伤后应激障碍的研究褒贬不一 症状和身体疼痛，或者使它们变得更糟。因此，了解合作与合作之间的动态关联 出现创伤后应激障碍症状、身体疼痛和吸食大麻是至关重要的。已经建立了几个理论模型 旨在解释创伤后应激障碍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 症状会使身体疼痛加剧，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， 有问题的大麻使用也可能增加。共享漏洞模型隐含了 发展中的心理因素，如焦虑敏感性(即对焦虑症状的恐惧倾向) 而维持创伤后应激障碍和躯体疼痛，以及焦虑敏感也可能增加自我 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。 受到方法论问题的影响。也就是说，大多数相关研究都评估了在 每季度(即3个月)间隔一次，然而创伤后应激障碍症状、身体疼痛和大麻使用都是已知的 每天都在波动。因此，以前的工作可能会受到追溯性回忆偏见的影响，并且可能无法准确地捕获 共同出现的症状的变化。参与者每天报告症状的研究(每日日记 研究)可以允许更准确地评估关联的强度和方向以及 理论模型在多大程度上，包括相互维护、共享脆弱性和自我治疗， 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。 (1R21DA051802-01A1)9/11事件后退伍军人(N=75)的创伤后应激障碍症状和有问题的大麻使用情况。 分析将利用密集的纵向方法(即动态结构方程模型)来测试 创伤后应激障碍症状和躯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。定性访谈将与 退伍军人样本(N=20)，他们筛查创伤后应激障碍，报告有高度的身体疼痛，并有不同程度的疼痛 有问题的大麻使用。采访将探索退伍军人共生症状的真实经历 和有问题的大麻的使用，并将使用叙事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他们的症状和使用有关。

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.