Geriatric Research, Education and Clinical Center (GRECC) and Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Psychopharmacology (Berl). 2019 Jun;236(6):1729-1739. doi: 10.1007/s00213-018-5155-6. Epub 2019 Jan 7.
Tobacco use is highly prevalent among individuals with posttraumatic stress disorder (PTSD), depressive disorders, and pain. Research has revealed pairwise relationships among these conditions but has not examined more complex relationships that may influence symptom severity, chronicity, and treatment outcome.
To examine the clustering of current PTSD, depressive disorders, and clinically significant pain according to current tobacco use and dependence among post-9/11 deployed veterans.
Logistic regression was used to examine the clustering of these conditions in relationship to current tobacco use/dependence, while adjusting for age and total combat exposure, in 343 post-9/11 deployed veterans enrolled in the Translational Research Center for TBI and Stress Disorders (TRACTS) cohort (Mage = 32.1 + 8.3 years; 38% current tobacco use; 25% low and 12% moderate/high tobacco dependence).
A three-way clustering of PTSD, depressive disorder, and pain was more likely than any single or pairwise combination of these conditions in moderate/high tobacco-dependent veterans compared to tobacco non-users (adjusted ORs = 3.50 to 4.18). This multi-morbidity cluster also was associated with increased PTSD severity.
Moderate to high dependence on tobacco is associated with substantially increased clustering of PTSD, depression, and clinically significant pain in veterans. Research examining synergistic interactions among these conditions, biological vulnerabilities shared among them, and the direct impact of tobacco use on the pathophysiology of PTSD, depression, and pain is needed. The results of such work may spur development of more effective integrated treatments to reduce the negative impact of these multi-morbid conditions on veterans' wellbeing and long-term health.
在患有创伤后应激障碍（PTSD）、抑郁障碍和疼痛的个体中，吸烟行为非常普遍。研究已经揭示了这些病症之间的两两关系，但尚未研究可能影响症状严重程度、持续性和治疗结果的更复杂关系。
根据 9·11 后部署的退伍军人当前的吸烟和依赖情况，检查当前 PTSD、抑郁障碍和临床上显著疼痛的聚类情况。
使用逻辑回归来检查这些病症在与当前吸烟/依赖的关系中的聚类情况，同时调整年龄和总战斗暴露情况，在 343 名参加创伤性脑损伤和应激障碍转化研究中心（TRACTS）队列的 9·11 后部署的退伍军人中（平均年龄为 32.1 ± 8.3 岁；38%的当前吸烟；25%的低烟草依赖和 12%的中/高烟草依赖）。
与不吸烟的退伍军人相比，中/高烟草依赖的退伍军人中 PTSD、抑郁障碍和疼痛的三向聚类比任何单一病症或这些病症的两两组合更有可能（调整后的 OR 值为 3.50 至 4.18）。这种多病种聚类也与 PTSD 严重程度增加有关。
对烟草的中度至高度依赖与退伍军人中 PTSD、抑郁和临床上显著疼痛的聚类显著增加有关。需要研究这些病症之间的协同作用、它们之间共同存在的生物学脆弱性以及吸烟对 PTSD、抑郁和疼痛病理生理学的直接影响。这项工作的结果可能会激发更有效的综合治疗方法的开发，以减轻这些多病症对退伍军人的幸福感和长期健康的负面影响。
