title: Stress exposure and the risk for the onset of alcohol use disorders and nicotine dependence in deployed military personnel: the role of prior internalizing disorders.
abstract: OBJECTIVE
  This prospective study aimed to investigate whether prior internalizing disorders (PIDs) moderate the relationship between stress exposure (SE) and the onset of alcohol use disorders (AUDs) and nicotine dependence (ND) in deployed military personnel.
  
  
  METHODS
  358 male soldiers were examined directly before and 12months after return from deployment using standardized interviews. Combat experiences, concerns about family disruptions, and difficult living and working environment were assessed as different aspects of SE. PID diagnoses (mood disorders (PMDs), anxiety disorders (PADs)) and substance use disorders were defined according to the DSM-IV-TR.
  
  
  RESULTS
  PMDs were related to a stronger association between concerns about family disruptions and the risk of AUD onset (OR=7.7, 95% CI 1.8-32.8, p=0.006). The number of PID diagnoses (OR per diagnosis: 1.7, 95% CI 1.0-2.8, p=0.036) and PADs (OR: 2.6, 95% CI 1.1-6.3, p=0.038) were further related to a stronger association between difficult living and working environment and the risk of AUD onset. With regard to ND, PMDs were related to a weaker association between difficult living and working environment and the risk of ND onset (OR=0.4, 95% CI 0.2-0.8, p=0.013).
  
  
  CONCLUSIONS
  PIDs might be related to an increased risk for the onset of AUDs but not ND following SE. This effect is probably restricted to specific constellations of PADs, PMDs, comorbid PIDs and specific aspects of SE. These critical constellations of PIDs and SE might be a promising target for future research and could contribute to the development of preventive measures to reduce the risk of AUDs following SE.
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany. Electronic address: Sebastian.Trautmann1@tu-dresden.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Trautmann
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Schönfeld
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Behrendt
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Heinrich
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Höfler
authors.affiliation: Centre for Psychiatry and Posttraumatic Stress, Federal Armed Forces Hospital Berlin, Berlin, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Siegel
authors.affiliation: Centre for Psychiatry and Posttraumatic Stress, Federal Armed Forces Hospital Berlin, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Zimmermann
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000523:psychology*; D001008:Anxiety Disorders / Q000150:complications; D005858:Germany; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D019964:Mood Disorders / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*; D014029:Tobacco Use Disorder / Q000523:psychology*
keywords: Alcohol; Internalizing disorders; Moderator; Nicotine; Stress; Substance use disorders