Korte Kristina J, Bountress Kaitlin E, Tomko Rachel L, Killeen Therese, Moran-Santa Maria Megan, Back Sudie E
Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29401, USA.
J Clin Med. 2017 Jan 13;6(1):9. doi: 10.3390/jcm6010009.
Posttraumatic stress disorder (PTSD) represents one of the most common mental health disorders, particularly among veterans, and is associated with significant distress and impairment. This highly debilitating disorder is further complicated by common comorbid psychiatric disorders, such as substance use disorders (SUD). Individuals with PTSD and co-occurring SUD also commonly present with secondary symptoms, such as elevated depression. Little is known, however, about how these secondary symptoms are related to treatment outcome. The aim of the present study, therefore, was to examine (1) the effects of treatment of comorbid PTSD/SUD on depressive symptoms; and (2) whether this effect was mediated by changes in PTSD severity or changes in SUD severity. Participants were 81 U.S. military veterans (90.1% male) with PTSD and SUD enrolled in a randomized controlled trial examining the efficacy of an integrated, exposure-based treatment (; = 54) versus relapse prevention ( = 27). Results revealed significantly lower depressive symptoms at post-treatment in the COPE group, as compared to the relapse prevention group. Examination of the mechanisms associated with change in depression revealed that reduction in PTSD severity, but not substance use severity, mediated the association between the treatment group and post-treatment depression. The findings underscore the importance of treating PTSD symptoms in order to help reduce co-occurring symptoms of depression in individuals with PTSD/SUD. Clinical implications and avenues for future research are discussed.
创伤后应激障碍（PTSD）是最常见的心理健康障碍之一，在退伍军人中尤为常见，且与严重的痛苦和功能损害相关。这种极具致残性的障碍因常见的共病精神障碍（如物质使用障碍，SUD）而进一步复杂化。患有PTSD和并发SUD的个体通常还伴有继发性症状，如抑郁情绪升高。然而，对于这些继发性症状与治疗结果之间的关系知之甚少。因此，本研究的目的是探讨：（1）共病PTSD/SUD的治疗对抑郁症状的影响；（2）这种影响是否由PTSD严重程度的变化或SUD严重程度的变化介导。研究参与者为81名患有PTSD和SUD的美国退伍军人（90.1%为男性），他们参与了一项随机对照试验，该试验比较了一种综合的、基于暴露的治疗方法（n = 54）与预防复发治疗方法（n = 27）的疗效。结果显示，与预防复发组相比，COPE组在治疗后抑郁症状显著减轻。对与抑郁变化相关机制的研究表明，PTSD严重程度的降低而非物质使用严重程度的降低介导了治疗组与治疗后抑郁之间的关联。这些发现强调了治疗PTSD症状对于帮助减轻PTSD/SUD个体并发抑郁症状的重要性。本文还讨论了临床意义和未来研究的方向。
