Gidzgier Piotr A, Bari Melav, López-Atanes Mayte, Lotzin Annett, Grundmann Johanna, Hiller Philipp, Schneider Barbara, Schäfer Ingo
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Front Psychiatry. 2023 Jan 12;13:1047274. doi: 10.3389/fpsyt.2022.1047274. eCollection 2022.
BACKGROUND: Posttraumatic disorders are among the most frequent co-occurring diagnoses in patients with substance use disorders (SUD). Individuals with this dual diagnosis often present with special treatment needs, especially after childhood traumatic experiences (CT). Along with posttraumatic stress disorder (PTSD) and dissociative symptoms, suicidal behaviors belong to the clinical challenges in this group of patients and may influence the course and outcome of SUD treatment. Therefore, a better understanding of the relationships between different forms of CT, psychopathology and suicidal behaviors seems to be important to tailor adequate concepts of care. MATERIALS AND METHODS: We examined 343 female patients with SUD and Posttraumatic stress disorder (PTSD). All patients completed the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale-Taxon (DES-T) and the Structured Clinical Interview Axis I Disorders (SCID-I). To determine relationships between different symptoms with potential importance for concepts of treatment, we conducted analyses of moderated mediation for different models. We examined the direct and indirect effects of associations between the type of CT, dissociation and suicidal behavior, as well as the moderation effect of PTSD. RESULTS: All participants met DSM-criteria for either full PTSD (75.2%) or subsyndromal PTSD (24.8%). Almost all (94.5%) received at least one substance dependence diagnosis and the remaining 5.5% met substance abuse criteria. Most participants (93.3%) reported at least one type of childhood trauma. In all models, dissociation was a risk factor for suicidal ideation (SI) and for suicide attempts (SA). In both, participants with subsyndromal PTSD and participants with full PTSD, dissociation mediated the relationship between childhood sexual abuse and SI as well as SA. Moreover, we report direct effects between different childhood traumas and SI and SA. Furthermore, emotional abuse was a significant predictor of dissociation. DISCUSSION: In our sample of female patients with SUD and co-occurring PTSD, dissociation significantly increased suicidal behavior and served as a mediator of the relationship between childhood sexual abuse and suicidal behavior. Our findings underline the need to include interventions to address dissociative symptoms and other more complex consequences of childhood trauma into concepts of care for patients with SUD.
背景：创伤后障碍是物质使用障碍（SUD）患者中最常见的共病诊断之一。患有这种双重诊断的个体通常有特殊的治疗需求，尤其是在经历童年创伤经历（CT）之后。除了创伤后应激障碍（PTSD）和分离症状外，自杀行为也是这类患者面临的临床挑战之一，并且可能影响SUD治疗的进程和结果。因此，更好地理解不同形式的CT、精神病理学和自杀行为之间的关系，对于制定适当的护理方案似乎很重要。 材料与方法：我们研究了343名患有SUD和创伤后应激障碍（PTSD）的女性患者。所有患者均完成了儿童创伤问卷（CTQ）、分离体验量表分类版（DES-T）和结构化临床访谈轴I障碍（SCID-I）。为了确定对治疗方案可能具有重要意义的不同症状之间的关系，我们对不同模型进行了调节中介分析。我们研究了CT类型、分离与自杀行为之间关联的直接和间接影响，以及PTSD的调节作用。 结果：所有参与者均符合完全PTSD（75.2%）或亚综合征PTSD（24.8%）的DSM标准。几乎所有（94.5%）参与者至少有一项物质依赖诊断，其余5.5%符合物质滥用标准。大多数参与者（93.3%）报告至少有一种童年创伤类型。在所有模型中，分离都是自杀意念（SI）和自杀未遂（SA）的危险因素。在患有亚综合征PTSD的参与者和患有完全PTSD的参与者中，分离都介导了童年性虐待与SI以及SA之间的关系。此外，我们报告了不同童年创伤与SI和SA之间的直接影响。此外，情感虐待是分离的一个重要预测因素。 讨论：在我们的患有SUD和共病PTSD的女性患者样本中，分离显著增加了自杀行为，并作为童年性虐待与自杀行为之间关系的中介。我们的研究结果强调，有必要将解决分离症状和童年创伤的其他更复杂后果的干预措施纳入SUD患者的护理方案中。
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