Cross Dorthie, Crow Thomas, Powers Abigail, Bradley Bekh
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA.
Atlanta VA Medical Center, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA.
Child Abuse Negl. 2015 Jun;44:26-35. doi: 10.1016/j.chiabu.2015.01.007. Epub 2015 Feb 11.
Previous studies demonstrate that PTSD mediates the relationship between childhood trauma and alcohol and substance use disorders and that PTSD and alcohol/substance use comorbidity is greater in men than in women. We sought to replicate and extend these findings in a predominantly low-income, African-American sample recruited from a public hospital. We administered measures of childhood trauma, PTSD symptoms, problematic alcohol use, and problematic substance use to 803 men and 2084 women. We examined rates of comorbidity in men and women. Next, two bootstrap analyses were used to test whether PTSD is a mediator between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use. Finally, two bootstrap analyses were used to test whether gender would moderate the indirect effect of PTSD in both the alcohol and substance use models. Results showed that although men and women reported similar overall PTSD symptom frequency, men were more likely than women to report PTSD comorbid with alcohol and/or substance use problems. In addition, PTSD partially mediated the relationship between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use. The indirect effects of PTSD on the relationship between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use were greater in men. This study demonstrates the important interplay of gender, childhood trauma, PTSD, and alcohol and substance use. Mental health providers should consider childhood trauma histories and diagnostic comorbidities when treatment planning.
先前的研究表明，创伤后应激障碍（PTSD）介导了童年创伤与酒精及物质使用障碍之间的关系，且男性中PTSD与酒精/物质使用共病的情况比女性更为严重。我们试图在从一家公立医院招募的、以低收入非裔美国人为主的样本中重复并扩展这些研究结果。我们对803名男性和2084名女性进行了童年创伤、PTSD症状、问题性酒精使用和问题性物质使用的测量。我们检查了男性和女性的共病率。接下来，使用两次自抽样分析来检验PTSD是否是童年创伤与问题性酒精使用之间以及童年创伤与问题性物质使用之间的中介变量。最后，使用两次自抽样分析来检验性别是否会调节PTSD在酒精和物质使用模型中的间接效应。结果显示，尽管男性和女性报告的PTSD总体症状频率相似，但男性比女性更有可能报告PTSD与酒精和/或物质使用问题共病。此外，PTSD部分介导了童年创伤与问题性酒精使用之间以及童年创伤与问题性物质使用之间的关系。PTSD对童年创伤与问题性酒精使用之间以及童年创伤与问题性物质使用之间关系的间接效应在男性中更大。这项研究证明了性别、童年创伤、PTSD以及酒精和物质使用之间重要的相互作用。心理健康服务提供者在制定治疗计划时应考虑童年创伤史和诊断共病情况。
