VA San Diego Healthcare System, San Diego, CA, 92161, USA; Department of Psychiatry, University of California, San Diego, CA, 92093, USA.
VA San Diego Healthcare System, San Diego, CA, 92161, USA; Department of Psychiatry, University of California, San Diego, CA, 92093, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, 92161, USA; National Center for PTSD, White River Junction, VT, 05009, USA.
Drug Alcohol Depend. 2019 Jan 1;194:6-12. doi: 10.1016/j.drugalcdep.2018.09.011. Epub 2018 Oct 24.
Comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are associated with greater clinical and functional impairments than either disorder alone, including higher rates of suicidality and reduced functioning and quality of life. Although PTSD/AUD is associated with more severe risk factors relative to either disorder alone, it is unclear whether PTSD/AUD and its related impairments are also associated with lower levels of protective factors.
We examined two composite factors of protective qualities derived from exploratory factor analyses-social connectedness (i.e., structural social support, perceived social support, secure attachment style) and protective psychosocial characteristics (i.e., resilience, purpose in life, dispositional optimism and gratitude, and community integration), in a nationally representative sample of U.S. Veterans (using data from the National Health and Resilience in Veterans Study) with PTSD alone, AUD alone, and comorbid PTSD/AUD.
Veterans with PTSD and PTSD/AUD scored significantly lower than those with AUD alone but did not differ from each other on measures of social connectedness and protective psychosocial characteristics (ps < .001). Both factors partially mediated the relationship between diagnostic status (PTSD or PTSD/AUD vs. AUD alone) and suicidal ideation (ORs = 0.58-0.62), as well as between diagnostic status and functioning/quality of life (psychosocial protective characteristics, β = 0.39; social connectedness, β = 0.16). Only protective psychosocial characteristics (OR = 0.54) emerged as a partial mediator between diagnostic status and lifetime suicide attempts.
U.S. Veterans with PTSD and PTSD/AUD score lower on measures of protective factors than Veterans with AUD. These factors may be important targets for prevention and treatment efforts.
与单独存在创伤后应激障碍（PTSD）或酒精使用障碍（AUD）相比，共病 PTSD 和 AUD 与更大的临床和功能障碍相关，包括更高的自杀率以及功能和生活质量下降。尽管 PTSD/AUD 与单独存在的任何一种障碍相比，与更严重的风险因素相关，但尚不清楚 PTSD/AUD 及其相关障碍是否也与较低水平的保护因素相关。
我们使用来自美国退伍军人国家健康和韧性研究的数据，在一个全国代表性的美国退伍军人样本中（N=1109），对两种源自探索性因素分析的保护因素综合因素进行了检验：社会联系（即结构性社会支持、感知社会支持、安全依恋风格）和保护心理社会特征（即韧性、生活目标、性格乐观和感激、社区融合）。该样本包含仅患有 PTSD、仅患有 AUD 以及共病 PTSD/AUD 的退伍军人。
患有 PTSD 和 PTSD/AUD 的退伍军人在社会联系和保护心理社会特征方面的得分显著低于仅患有 AUD 的退伍军人（p<0.001），但他们之间在这些方面没有差异。两个因素部分中介了诊断状态（PTSD 或 PTSD/AUD 与仅 AUD）与自杀意念（ORs=0.58-0.62）以及诊断状态与功能/生活质量（心理社会保护特征，β=0.39；社会联系，β=0.16）之间的关系。只有保护心理社会特征（OR=0.54）在诊断状态和终生自杀企图之间表现为部分中介。
与仅患有 AUD 的退伍军人相比，患有 PTSD 和 PTSD/AUD 的美国退伍军人在保护因素的测量中得分较低。这些因素可能是预防和治疗工作的重要目标。
