title: Does trauma exposure predict prescription drug problems beyond the contribution of post-traumatic stress disorder and depression? An analysis of the Mind Your Heart cohort study.
abstract: It is not clear from prior studies whether trauma exposure predicts substance use problems independent of psychiatric comorbidities. Most prior studies were cross-sectional in nature, and none focused on prescription drug problems. To address this gap in the literature, the current article is a secondary analysis of veterans from the Mind Your Heart prospective cohort study. The primary research question is whether trauma exposure predicts prescription drug problems even after controlling for major psychiatric symptoms, such as post-traumatic stress disorder and depression. Multinomial logistic regression was used to assess whether the 10-item lifetime Brief Trauma Questionnaire (e.g., serious car accidents, war traumas, life-threatening illness, natural disasters, physical, or sexual abuse) predicts prescription drug problems as determined by a self-report categorical question (three answer choices) over a 4-year follow-up time period (n = 661 [100%] at year 1; 83.4% at year 2; 85.9% at year 3; and 78.2% at year 4). Trauma exposure was positively associated with prescription drug problems in unadjusted and age-, sex-, and race-adjusted analyses at follow-up. After accounting for post-traumatic stress disorder (PTSD Checklist-17 Civilian Version) and depression (Patient Health Questionnaire-9) symptoms, trauma exposure was no longer associated with prescription drug problems at all time points (relative risk ratios range 0.91-1.47). These results were robust to different missing data strategies. Trauma exposure was not associated with prescription drug problems over a 4-year follow-up in a prospective cohort study of veterans. Future directions include detailed measures of prescription drug problems and recruitment from community sites.
authors.affiliation: a Department of Psychiatry , University of California , San Francisco , California , USA.|b Department of Epidemiology and Biostatistics , University of California , San Francisco , California , USA.|c San Francisco Veterans Affairs Medical Center , San Francisco , California , USA.|d Zuckerberg San Francisco General Hospital and Trauma Center , San Francisco , California , USA.
authors.forename: Raj K
authors.identifier: http://orcid.org/0000-0001-7582-5718
authors.initials: RK
authors.lastname: Kalapatapu
authors.affiliation: a Department of Psychiatry , University of California , San Francisco , California , USA.|c San Francisco Veterans Affairs Medical Center , San Francisco , California , USA.
authors.forename: Tatiana P
authors.initials: TP
authors.lastname: Dannenbaum
authors.affiliation: a Department of Psychiatry , University of California , San Francisco , California , USA.|d Zuckerberg San Francisco General Hospital and Trauma Center , San Francisco , California , USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Harbison
authors.affiliation: c San Francisco Veterans Affairs Medical Center , San Francisco , California , USA.|e Department of Medicine , University of California , San Francisco , California , USA.
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003863:Depression / Q000523:psychology*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000073222:Patient Health Questionnaire; D055553:Prescription Drugs; D012044:Regression Analysis; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D014728:Veterans
chemical_list: D055553:Prescription Drugs
keywords: Trauma; depression; post-traumatic stress disorder; prescription drug; substance use; veteran