Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia.
Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia.
J Stud Alcohol Drugs. 2023 May;84(3):378-388. doi: 10.15288/jsad.22-00209. Epub 2022 Dec 28.
Two predominant phenotypic models of causality exist to explain the high co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD): the self-medication and susceptibility models. Population-based longitudinal studies that simultaneously examine both models are needed. Thus, the goal of the present study is to test these models using the Swedish National Registries.
Registries were used to conduct longitudinal Cox proportional hazard models ( ≈ 1.5 million) and cross-lagged panel models ( ≈ 3.8 million) with follow-up periods of ~23 years.
Covarying for cohort and socioeconomic status, Cox proportional hazards model results found strong support for the self-medication model. Results showed that PTSD predicted increased risk for AUD among both men (HR = 4.58 [4.42, 4.74]) and women (HR = 4.14 [3.99, 4.30]), significantly more so for men (interaction HR = 1.11 [1.05, 1.16]). Support was also found for the susceptibility model, although the effects were lower in magnitude than those for the self-medication model. AUD increased risk for PTSD among men (HR = 2.53 [2.47, 2.60]) and women (HR = 2.06 [2.01, 2.12]), and significantly more so for men (interaction term HR = 1.23 [1.18, 1.28]). Cross-lagged model results of simultaneously testing both models found support for bidirectionality. The PTSD-to-AUD paths and the AUD-to-PTSD paths were of modest effect for men and women.
The results from both complementary statistical approaches demonstrate that the models of comorbidity are not mutually exclusive. Although the Cox model results evidenced more support for the self-medication pathway, the cross-lagged model results suggest that the prospective relationships between these disorders are nuanced across development.
有两种主要的因果表现模型可用于解释创伤后应激障碍（PTSD）和酒精使用障碍（AUD）的高度共病性：自我治疗和易感性模型。需要进行基于人群的纵向研究来同时检验这两种模型。因此，本研究的目的是使用瑞典国家登记处来检验这些模型。
使用登记处进行纵向 Cox 比例风险模型（≈150 万）和交叉滞后面板模型（≈380 万），随访期约为 23 年。
在协变量为队列和社会经济地位的情况下，Cox 比例风险模型的结果强烈支持自我治疗模型。结果表明，PTSD 预测了 AUD 在男性（HR=4.58[4.42，4.74]）和女性（HR=4.14[3.99，4.30]）中的风险增加，对男性的影响更为显著（交互 HR=1.11[1.05，1.16]）。易感性模型也得到了支持，尽管其影响程度低于自我治疗模型。AUD 增加了男性（HR=2.53[2.47，2.60]）和女性（HR=2.06[2.01，2.12]）患 PTSD 的风险，对男性的影响更为显著（交互项 HR=1.23[1.18，1.28]）。同时检验两种模型的交叉滞后模型结果支持双向性。对于男性和女性，PTSD 到 AUD 的路径和 AUD 到 PTSD 的路径都有适度的影响。
这两种互补的统计方法的结果表明，共病模型并不是相互排斥的。虽然 Cox 模型的结果更支持自我治疗途径，但交叉滞后模型的结果表明，这些障碍之间的前瞻性关系在整个发展过程中是复杂的。
