VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
J Psychiatr Res. 2021 May;137:342-350. doi: 10.1016/j.jpsychires.2021.02.061. Epub 2021 Mar 13.
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur. Integrated treatments are effective, but not all patients respond and predicting outcome remains difficult. In this study, latent class analysis (LCA) identified symptom-based subgroups of comorbid PTSD/AUD among 119 veterans with PTSD/AUD from a randomized controlled trial of integrated exposure therapy (I-PE) versus integrated coping skills therapy (I-CS). Multilevel models compared subgroups on PTSD severity and percentage of heavy drinking days at post-treatment and 3- and 6-month follow-up. LCA revealed three subgroups best fit the data: Moderate PTSD/Low AUD Impairment (21%), High PTSD/High AUD Impairment (48%), and Low PTSD/High AUD Impairment (31%). There was a three-way interaction between time, treatment condition, and subgroup in predicting PTSD outcomes (p < .05). For the Moderate PTSD/Low AUD Impairment class, outcomes at post-treatment and 3-months were similar (ds = 0.17, 0.55), however I-PE showed greater reductions at 6-months (d = 1.36). For the High PTSD/High AUD Impairment class, I-PE demonstrated better post-treatment (d = 0.83) but comparable follow-up (ds = -0.18, 0.49) outcomes. For the Low PTSD/High AUD Impairment class, I-PE demonstrated stronger outcomes at every timepoint (ds = 0.82-1.15). Heavy drinking days declined significantly through follow-up, with an effect of subgroup, but not treatment, on timing of response. This was the first study modeling how PTSD and AUD symptoms might cluster together in a treatment sample of veterans with PTSD/AUD. Symptom-based subgroups show promise in helping understand variability in treatment response among patients with PTSD/AUD and deserve further study.
创伤后应激障碍（PTSD）和酒精使用障碍（AUD）经常同时发生。综合治疗是有效的，但并非所有患者都有反应，预测结果仍然很困难。在这项研究中，通过对 PTSD/AUD 共病的 119 名退伍军人进行的一项随机对照试验，使用潜在类别分析（LCA）识别出了基于症状的 PTSD/AUD 共病亚组，该试验比较了综合暴露疗法（I-PE）与综合应对技能疗法（I-CS）。多水平模型比较了亚组在治疗后、3 个月和 6 个月随访时 PTSD 严重程度和大量饮酒天数的差异。LCA 发现有三个亚组最适合数据：中度 PTSD/低 AUD 损害（21%）、高 PTSD/高 AUD 损害（48%）和低 PTSD/高 AUD 损害（31%）。时间、治疗条件和亚组之间的三向交互作用预测了 PTSD 结果（p<0.05）。对于中度 PTSD/低 AUD 损害亚组，治疗后和 3 个月的结果相似（ds=0.17,0.55），但 I-PE 在 6 个月时显示出更大的改善（d=1.36）。对于高 PTSD/高 AUD 损害亚组，I-PE 在治疗后表现出更好的效果（d=0.83），但在随访时结果相似（ds=-0.18,0.49）。对于低 PTSD/高 AUD 损害亚组，I-PE 在每个时间点都表现出更强的效果（ds=0.82-1.15）。随着随访的进行，大量饮酒天数显著下降，亚组有影响，但治疗没有影响。这是第一项在 PTSD/AUD 治疗样本中对 PTSD 和 AUD 症状如何聚类进行建模的研究。基于症状的亚组在帮助理解 PTSD/AUD 患者治疗反应的变异性方面显示出了希望，值得进一步研究。
