Associations of alcohol and cannabis use with change in posttraumatic stress disorder and depression symptoms over time in recently trauma-exposed individuals

Cecilia A Hinojosa¹, Amanda Liew¹, Xinming An², Jennifer S Stevens¹, Archana Basu³, Sanne J H van Rooij¹, Stacey L House⁴, Francesca L Beaudoin⁵, Donglin Zeng⁶, Thomas C Neylan⁷, Gari D Clifford^{8

9}, Tanja Jovanovic¹⁰, Sarah D Linnstaedt², Laura T Germine^{11

12

13}, Scott L Rauch^{11

13

14}, John P Haran¹⁵, Alan B Storrow¹⁶, Christopher Lewandowski¹⁷, Paul I Musey¹⁸, Phyllis L Hendry¹⁹, Sophia Sheikh¹⁹, Christopher W Jones²⁰, Brittany E Punches^{21

22}, Michael C Kurz^{23

24

25}, Robert A Swor²⁶, Lauren A Hudak²⁷, Jose L Pascual^{28

29}, Mark J Seamon^{29

30}, Elizabeth M Datner^{31

32}, Anna M Chang³³, Claire Pearson³⁴, David A Peak³⁵, Roland C Merchant³⁶, Robert M Domeier³⁷, Niels K Rathlev³⁸, Paulina Sergot³⁹, Leon D Sanchez^{36

40}, Steven E Bruce⁴¹, Mark W Miller^{42

43}, Robert H Pietrzak^{44

45}, Jutta Joormann⁴⁶, Diego A Pizzagalli^{13

47}, John F Sheridan^{48

49}, Steven E Harte^{50

51}, James M Elliott^{52

53

54}, Ronald C Kessler⁵⁵, Karestan C Koenen³, Samuel A McLean^{56

57}, Kerry J Ressler^{13

47}, Negar Fani¹

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
² Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
⁴ Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
⁵ Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA.
⁶ Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
⁷ Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA.
⁸ Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA.
⁹ Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
¹⁰ Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.
¹¹ Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA.
¹² The Many Brains Project, Belmont, MA, USA.
¹³ Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
¹⁴ Department of Psychiatry, McLean Hospital, Belmont, MA, USA.
¹⁵ Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
¹⁶ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁷ Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, USA.
¹⁸ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁹ Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA.
²⁰ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
²¹ Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA.
²² Ohio State University College of Nursing, Columbus, OH, USA.
²³ Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA.
²⁴ Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA.
²⁵ Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA.
²⁶ Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
²⁷ Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
²⁸ Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
²⁹ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³⁰ Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA.
³¹ Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, USA.
³² Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
³³ Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA.
³⁴ Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA.
³⁵ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
³⁶ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
³⁷ Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA.
³⁸ Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
³⁹ Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA.
⁴⁰ Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
⁴¹ Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA.
⁴² Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
⁴³ Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
⁴⁴ Clinical Neurosciences Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA.
⁴⁵ Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
⁴⁶ Department of Psychology, Yale University, New Haven, CT, USA.
⁴⁷ Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
⁴⁸ Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, USA.
⁴⁹ Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA.
⁵⁰ Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
⁵¹ Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA.
⁵² Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia.
⁵³ Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, St. Leonards NSW, New South Wales, Australia.
⁵⁴ Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁵⁵ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁵⁶ Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵⁷ Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 37309917
PMCID: PMC10716364
DOI: 10.1017/S0033291723001642

Associations of alcohol and cannabis use with change in posttraumatic stress disorder and depression symptoms over time in recently trauma-exposed individuals

Cecilia A Hinojosa et al. Psychol Med. 2024 Jan.

. 2024 Jan;54(2):338-349.

doi: 10.1017/S0033291723001642. Epub 2023 Jun 13.

Authors

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
² Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
⁴ Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
⁵ Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA.
⁶ Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
⁷ Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA.
⁸ Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA.
⁹ Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
¹⁰ Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.
¹¹ Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA.
¹² The Many Brains Project, Belmont, MA, USA.
¹³ Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
¹⁴ Department of Psychiatry, McLean Hospital, Belmont, MA, USA.
¹⁵ Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
¹⁶ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁷ Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, USA.
¹⁸ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁹ Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA.
²⁰ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
²¹ Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA.
²² Ohio State University College of Nursing, Columbus, OH, USA.
²³ Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA.
²⁴ Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA.
²⁵ Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA.
²⁶ Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
²⁷ Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
²⁸ Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
²⁹ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³⁰ Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA.
³¹ Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, USA.
³² Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
³³ Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA.
³⁴ Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA.
³⁵ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
³⁶ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
³⁷ Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA.
³⁸ Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
³⁹ Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA.
⁴⁰ Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
⁴¹ Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA.
⁴² Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
⁴³ Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
⁴⁴ Clinical Neurosciences Division, National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA.
⁴⁵ Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
⁴⁶ Department of Psychology, Yale University, New Haven, CT, USA.
⁴⁷ Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
⁴⁸ Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, USA.
⁴⁹ Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA.
⁵⁰ Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
⁵¹ Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA.
⁵² Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia.
⁵³ Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, St. Leonards NSW, New South Wales, Australia.
⁵⁴ Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁵⁵ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁵⁶ Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵⁷ Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 37309917
PMCID: PMC10716364
DOI: 10.1017/S0033291723001642

Abstract

Background: Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians.

Methods: In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance.

Results: Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12.

Conclusions: Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.

Keywords: alcohol use; cannabis use; depression; posttraumatic stress disorder.

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Figures

**Figure 1.**
Observed individual (A, B) and mean (C, D) latent trajectories for both alcohol and cannabis use. Individual trajectories determined by measurements at 4 timepoints are represented by the thin lines, while the thick lines are the average trajectories for each designated group. Each class was identified through the chosen latent growth mixture model, based on Bayesian Information Criterion (BIC) values and class membership percentages.

**Figure 2.**
Repeated measures ANOVA examining interactions between levels of use and measures for PTSD (PCL) and depression (PROMIS). Analyses included 3 timepoints – baseline, week 8 and 12. Error bars represent 95% confidence interval; *Denotes significant interaction.

See this image and copyright information in PMC

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Associations of alcohol and cannabis use with change in posttraumatic stress disorder and depression symptoms over time in recently trauma-exposed individuals

Affiliations

Associations of alcohol and cannabis use with change in posttraumatic stress disorder and depression symptoms over time in recently trauma-exposed individuals

Authors

Affiliations

Abstract

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous