Department of Psychiatry, University of Manitoba, Winnipeg, Canada.
Depress Anxiety. 2010 Aug;27(8):731-6. doi: 10.1002/da.20677.
Self-medication has been proposed as an explanation for the high rates of comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders; however, knowledge of self-medication in PTSD is scarce. We describe the prevalence and correlates of self-medication in PTSD in the general population.
Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (N=34,653; response rate: 70.2%), a nationally representative survey of mental illness in community-dwelling adults. Self-medication was assessed separately for alcohol and drugs. Prevalence rates were determined for self-medication among individuals with DSM-IV PTSD. Regression analyses determined associations between self-medication and a variety of correlates, including sociodemographic factors, comorbid mental disorders, suicide attempts, and quality of life.
Approximately 20% of individuals with PTSD used substances in an attempt to relieve their symptoms. Men were significantly more likely than women to engage in self-medication behavior. In adjusted models, using illicit drugs or misusing prescription medications to control PTSD symptoms was associated with a substantially higher likelihood of dysthymia and borderline personality disorder. After controlling for mental disorder comorbidity, self-medication was independently associated with higher odds of suicide attempts (adjusted odds ratio=2.46; 95% confidence interval 1.53-3.97) and lower mental health-related quality of life.
Self-medication is a common behavior among people with PTSD in the community, yet has potentially hazardous consequences. Health care practitioners should assess reasons for substance use among people with PTSD to identify a subgroup with higher psychiatric morbidity.
自我用药被认为是创伤后应激障碍（PTSD）和物质使用障碍之间高共病率的一个解释；然而，对 PTSD 中的自我用药知之甚少。我们描述了一般人群中 PTSD 中自我用药的流行率和相关因素。
数据来自全国酒精和相关条件流行病学调查第 2 波（N=34653；响应率：70.2%），这是一项针对社区居住成年人精神疾病的全国代表性调查。分别评估了酒精和药物的自我用药情况。确定了 DSM-IV PTSD 个体中自我用药的患病率。回归分析确定了自我用药与各种相关因素之间的关联，包括社会人口统计学因素、共病精神障碍、自杀企图和生活质量。
大约 20%的 PTSD 患者使用物质试图缓解症状。男性比女性更有可能从事自我用药行为。在调整后的模型中，使用非法药物或滥用处方药物来控制 PTSD 症状与心境恶劣和边缘型人格障碍的可能性显著增加相关。在控制精神障碍共病后，自我用药与自杀企图的可能性更高独立相关（调整后的优势比=2.46；95%置信区间 1.53-3.97），心理健康相关生活质量较低。
自我用药是社区中 PTSD 患者的常见行为，但具有潜在的危险后果。医疗保健从业者应评估 PTSD 患者使用物质的原因，以确定一个具有更高精神疾病发病率的亚组。
