Posttraumatic stress disorder and alcohol dependence: Epidemiology and order of onset.
OBJECTIVE
Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) frequently co-occur; however, epidemiologic studies of temporal associations between PTSD and AD are limited. The aims of this study were (a) to investigate the bidirectional associations between PTSD and AD and (b) to examine demographic and clinical correlates of order-of-onset among individuals with PTSD and AD.


METHODS
Participants were 11,103 adults (60.6% women; Mage = 48.7 years, SD = 15.9) from the National Epidemiologic Survey on Alcohol and Related Conditions who endorsed lifetime alcohol consumption and DSM-IV PTSD Criterion A trauma exposure (American Psychiatric Association, 2000). Cox proportional hazards models with time-dependent covariates were used to evaluate bidirectional associations between PTSD and AD. Sex differences were assessed using stratified analyses.


RESULTS
After adjusting for demographic, trauma, and alcohol characteristics, PTSD was associated with greater likelihood of subsequent AD (hazard ratio [HR] = 1.359, 95% CI = 1.357-1.362), and AD was associated with greater likelihood of subsequent PTSD (HR = 1.274, 95% CI = 1.271-1.277). Bidirectional associations between PTSD and AD were stronger for women compared with men. Among individuals with PTSD and AD, initial onset of PTSD was associated with younger age of first potentially traumatic event. Initial onset of AD was associated with earlier initiation of alcohol use, earlier onset of heavy alcohol use, family history of alcohol problems, and history of generalized anxiety disorder and social anxiety disorder for women but not men. Initial AD was associated with lifetime panic disorder for men and women.


CONCLUSIONS
Etiology of PTSD and AD is heterogeneous, and order of onset may reflect differing risk pathways. (PsycINFO Database Record
Department of Pediatrics, University of Virginia.
Erin C
EC
Berenz
Department of Psychiatry, Virginia Commonwealth University.
Roxann
R
Roberson-Nay
Department of Psychology and Neuroscience, Baylor University.
Shawn J
SJ
Latendresse
Department of Epidemiology and Community Health, Virginia Commonwealth University.
Briana
B
Mezuk
Department of Psychiatry, Virginia Commonwealth University.
Charles O
CO
Gardner
Department of Psychiatry, Virginia Commonwealth University.
Ananda B
AB
Amstadter
Timothy P
TP
York
D017668:Age of Onset; D000437:Alcoholism / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D013997:Time Factors