van den Berk-Clark Carissa, Balan Sundari, Shroff Manan V, Widner Greg, Price Rumi Kato
a Department of Psychiatry , Washington University School of Medicine , St. Louis , Missouri , USA.
b VA St. Louis Health Care System , St. Louis , Missouri , USA.
Subst Use Misuse. 2016;51(5):625-36. doi: 10.3109/10826084.2015.1133644. Epub 2016 Mar 23.
Prior research suggests that both posttraumatic stress disorder (PTSD) and alcohol abuse affect behavioral healthcare utilization among combat-exposed military populations. However, their interactive effect is not well documented, especially after experiencing psychological trauma.
This study examined the role of hazardous alcohol use (i.e. repeated patterns of drinking which lead to harmful consequences) on behavioral healthcare utilization among service members stratified by past-year combat exposure.
This study utilized a sample of National Guard service members who participated in an in-depth survey 2-4 months after returning from Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn deployments (2011-2013) (n = 467). We examine the marginal effect (the change in the probability) of hazardous alcohol use on utilization while controlling for trauma exposure, PTSD and other potential covariates.
In the unadjusted logistic model, hazardous alcohol use reduced the probability of behavioral healthcare utilization by 77% among service members who had been exposed to combat within the past year. In the adjusted model, which controlled for socio-demographics (age, gender, and race), health status (PTSD symptoms, depression and physical health), and measures of stigma (perception of services as embarrassing or harmful to one's career or social networks), hazardous alcohol use further reduced the utilization probability by 302%. CONCLUSION/IMPORTANCE: Although these findings require replication, they appear to demonstrate that when combat-exposed service members engaged in hazardous alcohol use at postdeployment, they were much less likely to utilize behavioral healthcare to manage their posttraumatic stress symptoms during this period.
先前的研究表明，创伤后应激障碍（PTSD）和酒精滥用都会影响接触过战斗的军人对行为健康服务的利用。然而，它们的交互作用尚无充分记录，尤其是在经历心理创伤之后。
本研究调查了危险饮酒（即导致有害后果的反复饮酒模式）在按过去一年战斗接触情况分层的军人中对行为健康服务利用的作用。
本研究使用了一个国民警卫队军人样本，他们在从持久自由行动、伊拉克自由行动或新黎明行动部署返回后2至4个月参加了一项深入调查（2011 - 2013年）（n = 467）。我们在控制创伤暴露、创伤后应激障碍和其他潜在协变量的同时，研究危险饮酒对服务利用的边际效应（概率变化）。
在未调整的逻辑模型中，危险饮酒使过去一年接触过战斗的军人利用行为健康服务的概率降低了77%。在调整后的模型中，该模型控制了社会人口统计学因素（年龄、性别和种族）、健康状况（创伤后应激障碍症状、抑郁和身体健康）以及耻辱感指标（认为服务令人尴尬或对个人职业或社交网络有害），危险饮酒进一步使利用概率降低了302%。结论/重要性：尽管这些发现需要重复验证，但它们似乎表明，当接触过战斗的军人在部署后进行危险饮酒时，他们在此期间利用行为健康服务来管理创伤后应激症状的可能性要小得多。
