Vázquez Alejandro L, Flores Cynthia M Navarro, Feinberg Daniel K, Gonzalez Juan Carlos, Young John, Stewart Regan W, Orengo-Aguayo Rosaura E
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA.
J Trauma Stress. 2024 Apr;37(2):267-279. doi: 10.1002/jts.23008. Epub 2024 Jan 10.
Youth exposed to natural disasters are at risk of developing trauma-related symptoms as well as engaging in substance use. Although previous research has established associations between disaster-related stressors and substance use in youth, less has focused on how symptoms of posttraumatic stress disorder (PTSD) may underpin this association. The current study used network analysis to identify specific PTSD symptoms associated with substance use following a natural disaster. Participants were 91,732 youths (Grades 3-12) from across Puerto Rico who completed a needs assessment 5-9 months after Hurricane Maria made landfall in September 2017. We examined associations between PTSD symptoms and substance use, identified clusters of symptoms and bridges between them, and explored age- and binary gender-related differences in associations between specific PTSD symptoms and substance use. Analyses identified two symptom communities: (a) arousal and reactivity, negative alterations in cognition and mood, and substance use, and (b) avoidance and intrusion. Broader findings suggested that substance use was most strongly associated with PTSD-related irritability and angry outbursts among youths. Surrounding nodes explained only 4.1% of the variance in substance use, but this was higher among youths who reported not having a supportive adult, R = 8.5; friend, R = 7.9; or teacher/counselor, R = 7.7, in their life. The bridge symptoms of sleep disruption and physiological reactivity were identified as potentially critical intervention targets for disrupting PTSD symptom networks after a natural disaster. Implications for triaged mental health care following natural disasters and directions for future research are discussed.
经历自然灾害的青少年有出现创伤相关症状以及使用药物的风险。尽管先前的研究已证实灾害相关应激源与青少年药物使用之间存在关联，但较少关注创伤后应激障碍（PTSD）症状如何支撑这种关联。本研究使用网络分析来识别与自然灾害后药物使用相关的特定PTSD症状。参与者是来自波多黎各各地的91732名青少年（3至12年级），他们在2017年9月飓风“玛丽亚”登陆后的5至9个月完成了一项需求评估。我们研究了PTSD症状与药物使用之间的关联，识别了症状群及其之间的桥梁，并探讨了特定PTSD症状与药物使用之间关联的年龄和二元性别差异。分析确定了两个症状群落：（a）觉醒与反应性、认知和情绪的消极改变以及药物使用，以及（b）回避与侵入。更广泛的研究结果表明，药物使用与青少年中与PTSD相关的易怒和愤怒爆发关联最为紧密。周围节点仅解释了药物使用差异的4.1%，但在报告生活中没有支持性成年人（R = 8.5）、朋友（R = 7.9）或教师/辅导员（R = 7.7）的青少年中这一比例更高。睡眠中断和生理反应性的桥梁症状被确定为自然灾害后破坏PTSD症状网络的潜在关键干预靶点。讨论了自然灾害后分类心理健康护理的意义以及未来研究的方向。
