University of Maryland, Baltimore County, Baltimore, MD, USA.
Maryland Treatment Centers, Baltimore, MD, USA.
Subst Use Addctn J. 2024 Oct;45(4):664-673. doi: 10.1177/29767342241248978. Epub 2024 May 8.
Aim 1 of this cross-sectional, observational study with people in residential treatment for substance use disorders (SUDs) was to document stress exposure. Aim 2 was to assess potential sociodemographic and health differences based on probable posttraumatic stress disorder (PTSD) status. Aim 3 was to assess relative contributions of Diagnostic and Statistical Manual (DSM)-congruent versus DSM-incongruent stressors (Criterion A vs non-Criterion A) to mental and physical health. We hypothesized that both types of stressors would significantly contribute to impairment across indicators and that DSM-congruent stressor exposure would be more strongly associated with impairment than DSM-incongruent exposure.
We assessed exposure to DSM-congruent traumatic stressors and DSM-incongruent life stressors, PTSD and depressive symptoms, emotion regulation difficulties, substance use recovery capital, and physical/mental health-related quality of life among 136 people in residential SUD treatment who were 64% men, 36% women; 49% white, 41% Black, 11% multiracial/another race; 18% lesbian, gay, or bisexual (LGB+); mean age = 39.82 (standard deviation = 12.24) years.
Participants reported experiencing a mean of 9.76 (SD = 6.11) DSM-congruent events. Those with probable PTSD were younger and more likely to be LGB+ than those without probable PTSD ( < .05). Experiencing higher numbers of DSM-congruent events was associated with more severe PTSD and depressive symptoms, emotion regulation difficulties, and lower physical health-related quality of life ( < .05). DSM-incongruent stressor exposure was not independently associated with any indicators. Recovery capital was not associated with either type of stress exposure.
Stressful event exposure among people in residential SUD treatment is very high. Those who are younger or LGB+ in residential SUD treatment may be at greater risk of developing PTSD. DSM-congruent stressors are more consistently associated with mental health indicators than are DSM-incongruent stressors. Prioritizing treatment targets and identifying implementable treatment strategies can be challenging with this complex population.
本横断面观察性研究的目的 1 是记录物质使用障碍（SUD）住院治疗人群的应激暴露情况。目的 2 是根据可能的创伤后应激障碍（PTSD）状况评估潜在的社会人口学和健康差异。目的 3 是评估符合 DSM 标准和不符合 DSM 标准的应激源（标准 A 与非标准 A）对精神和身体健康的相对贡献。我们假设这两种类型的应激源都会显著导致各指标的损伤，并且符合 DSM 标准的应激源暴露与损伤的相关性要强于不符合 DSM 标准的应激源暴露。
我们评估了 136 名住院 SUD 治疗人群的 DSM 一致的创伤性应激源和 DSM 不一致的生活应激源暴露情况、PTSD 和抑郁症状、情绪调节困难、物质使用恢复资本，以及与身体/心理健康相关的生活质量。参与者中男性占 64%，女性占 36%；白人占 49%，黑人占 41%，其他种族占 11%；同性恋、双性恋或双性恋者（LGB+）占 18%；平均年龄为 39.82 岁（标准差为 12.24 岁）。
参与者报告经历了平均 9.76 次（SD=6.11）DSM 一致的事件。有 PTSD 可能性的参与者比没有 PTSD 可能性的参与者年龄更小，且更有可能是 LGB+（ < .05）。经历更多的 DSM 一致的事件与更严重的 PTSD 和抑郁症状、情绪调节困难以及较低的与身体健康相关的生活质量相关（ < .05）。DSM 不一致的应激源暴露与任何指标都没有独立关联。恢复资本与任何一种应激源暴露都没有关联。
住院 SUD 治疗人群中的应激事件暴露非常高。住院 SUD 治疗中年龄较小或 LGB+的人群可能面临更大的 PTSD 发病风险。与 DSM 不一致的应激源相比，DSM 一致的应激源与心理健康指标更密切相关。对于这个复杂的人群，确定治疗目标和制定可实施的治疗策略可能具有挑战性。
