Rosic Tea, Au Vivian Y O, Worster Andrew, Marsh David C, Thabane Lehana, Samaan Zainab
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Ontario, Canada; and Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada.
BJPsych Open. 2021 Jul 22;7(4):e138. doi: 10.1192/bjo.2021.971.
Exposure to traumatic events is both a risk factor for substance use and an adverse outcome of substance use disorders. Identifying and managing post-traumatic stress disorder (PTSD) in patients with addiction requires attention.
To examine the lifetime prevalence of traumatic events and past-month prevalence of PSTD in patients treated for opioid use disorder, and explore the association between trauma, PTSD and treatment outcomes.
Participants ( = 674) receiving methadone treatment in 20 community clinics across Ontario, Canada, were administered the Mini-International Neuropsychiatric Interview to identify self-reported traumatic events and PTSD. Drug use was measured for 12 months by urine drug screens.
Eleven per cent of participants met past-month criteria for PTSD ( = 72), and 48% reported history of traumatic events with no current PTSD ( = 323). Participants with PTSD were more likely to be female (odds ratio 2.13, 95% CI 1.20-3.76) and less likely to be employed (odds ratio 0.31, 95% CI 0.16-0.61) or married (odds ratio 0.51, 95% CI 0.26-0.90) than those with no trauma history. Antidepressants (39 . 24%) and benzodiazepines (36 . 18%) were differentially prescribed to patients with and without PTSD. Length of time in treatment and opioid use were not associated with trauma; however, suicidal ideation was more common in PTSD (odds ratio 2.29, 95% CI 1.04-5.01).
Trauma and PTSD are prevalent among patients with opioid use disorder, and consideration of trauma symptoms and associated characteristics is warranted. Patients with and without comorbid PTSD differ clinically and psychosocially, highlighting the relevance of integrating addiction and mental health services for this population.
接触创伤性事件既是物质使用的危险因素，也是物质使用障碍的不良后果。识别和管理成瘾患者的创伤后应激障碍（PTSD）需要引起关注。
研究阿片类物质使用障碍患者创伤性事件的终生患病率和过去一个月PTSD的患病率，并探讨创伤、PTSD与治疗结果之间的关联。
在加拿大安大略省20家社区诊所接受美沙酮治疗的参与者（n = 674）接受了迷你国际神经精神访谈，以确定自我报告的创伤性事件和PTSD。通过尿液药物筛查测量12个月的药物使用情况。
11%的参与者符合过去一个月PTSD的标准（n = 72），48%报告有创伤性事件史但目前无PTSD（n = 323）。与无创伤史的参与者相比，患有PTSD的参与者更可能为女性（优势比2.13，95%CI 1.20 - 3.76），就业可能性较小（优势比0.31，95%CI 0.16 - 0.61）或已婚可能性较小（优势比0.51，95%CI 0.26 - 0.90）。有PTSD和无PTSD的患者接受抗抑郁药（39.24%）和苯二氮䓬类药物（36.18%）的处方存在差异。治疗时间长短和阿片类物质使用与创伤无关；然而，自杀意念在PTSD患者中更常见（优势比2.29，95%CI 1.04 - 5.01）。
创伤和PTSD在阿片类物质使用障碍患者中很普遍，有必要考虑创伤症状及相关特征。合并PTSD和未合并PTSD的患者在临床和心理社会方面存在差异，这凸显了为该人群整合成瘾和心理健康服务的相关性。
