Testing Phenotypic Models of Posttraumatic Stress Disorder and Alcohol Use Disorder Comorbidity Using Longitudinal Registry Data
(2023) In Journal of Studies on Alcohol and Drugs 84(3). p.378-388- Abstract
Objective: Two predominant phenotypic models of causality exist to explain the high co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD): the self-medication and susceptibility models. Population-based longitudinal studies that simultaneously examine both models are needed. Thus, the goal of the pres-ent study is to test these models using the Swedish National Registries. Method: Registries were used to conduct longitudinal Cox proportional hazard models (n ≈ 1.5 million) and cross-lagged panel models (N ≈ 3.8 million) with follow-up periods of ~23 years. Results: Covarying for cohort and socioeconomic status, Cox proportional hazards model results found strong support for the self-medication model.... (More)
Objective: Two predominant phenotypic models of causality exist to explain the high co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD): the self-medication and susceptibility models. Population-based longitudinal studies that simultaneously examine both models are needed. Thus, the goal of the pres-ent study is to test these models using the Swedish National Registries. Method: Registries were used to conduct longitudinal Cox proportional hazard models (n ≈ 1.5 million) and cross-lagged panel models (N ≈ 3.8 million) with follow-up periods of ~23 years. Results: Covarying for cohort and socioeconomic status, Cox proportional hazards model results found strong support for the self-medication model. Results showed that PTSD predicted increased risk for AUD among both men (HR = 4.58 [4.42, 4.74]) and women (HR = 4.14 [3.99, 4.30]), significantly more so for men (interaction HR = 1.11 [1.05, 1.16]). Support was also found for the susceptibility model, although the effects were lower in magnitude than those for the self-medication model. AUD increased risk for PTSD among men (HR = 2.53 [2.47, 2.60]) and women (HR = 2.06 [2.01, 2.12]), and significantly more so for men (interaction term HR = 1.23 [1.18, 1.28]). Cross-lagged model results of simultaneously testing both models found support for bidirectionality. The PTSD-to-AUD paths and the AUD-to-PTSD paths were of modest effect for men and women. Conclusions: The results from both complementary statistical approaches demonstrate that the models of comorbidity are not mutually exclusive. Although the Cox model results evidenced more support for the self-medication pathway, the cross-lagged model results suggest that the prospective relationships between these disorders are nuanced across development. (J. Stud. Alcohol Drugs, 84, 378–388, 2023).
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- author
- Amstadter, Ananda B. ; Lönn, Sara L. LU ; Sundquist, Jan LU ; Kendler, Kenneth S. and Sundquist, Kristina LU
- organization
- publishing date
- 2023-05
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Studies on Alcohol and Drugs
- volume
- 84
- issue
- 3
- pages
- 378 - 388
- publisher
- Alcohol Research Documentation, Inc.
- external identifiers
-
- pmid:36971747
- scopus:85165520137
- ISSN
- 1937-1888
- DOI
- 10.15288/jsad.22-00209
- language
- English
- LU publication?
- yes
- additional info
- Funding Information: This project was supported by National Institutes of Health Grant R01AA023534 and by the Swedish Research Council (2020-01175). *Correspondence may be sent to Ananda B. Amstadter at the Virginia Institute for Psychiatric and Behavioral Genetics of VCU, Box 980126, Richmond, VA 23298-0126, or via email at: ananda.amstadter@vcuhealth. org. Publisher Copyright: © 2023, Alcohol Research Documentation Inc.. All rights reserved.
- id
- 0322291d-78dd-4b16-89aa-b5d66083ddf5
- date added to LUP
- 2023-08-28 10:35:42
- date last changed
- 2024-04-20 02:01:53
@article{0322291d-78dd-4b16-89aa-b5d66083ddf5, abstract = {{<p>Objective: Two predominant phenotypic models of causality exist to explain the high co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD): the self-medication and susceptibility models. Population-based longitudinal studies that simultaneously examine both models are needed. Thus, the goal of the pres-ent study is to test these models using the Swedish National Registries. Method: Registries were used to conduct longitudinal Cox proportional hazard models (n ≈ 1.5 million) and cross-lagged panel models (N ≈ 3.8 million) with follow-up periods of ~23 years. Results: Covarying for cohort and socioeconomic status, Cox proportional hazards model results found strong support for the self-medication model. Results showed that PTSD predicted increased risk for AUD among both men (HR = 4.58 [4.42, 4.74]) and women (HR = 4.14 [3.99, 4.30]), significantly more so for men (interaction HR = 1.11 [1.05, 1.16]). Support was also found for the susceptibility model, although the effects were lower in magnitude than those for the self-medication model. AUD increased risk for PTSD among men (HR = 2.53 [2.47, 2.60]) and women (HR = 2.06 [2.01, 2.12]), and significantly more so for men (interaction term HR = 1.23 [1.18, 1.28]). Cross-lagged model results of simultaneously testing both models found support for bidirectionality. The PTSD-to-AUD paths and the AUD-to-PTSD paths were of modest effect for men and women. Conclusions: The results from both complementary statistical approaches demonstrate that the models of comorbidity are not mutually exclusive. Although the Cox model results evidenced more support for the self-medication pathway, the cross-lagged model results suggest that the prospective relationships between these disorders are nuanced across development. (J. Stud. Alcohol Drugs, 84, 378–388, 2023).</p>}}, author = {{Amstadter, Ananda B. and Lönn, Sara L. and Sundquist, Jan and Kendler, Kenneth S. and Sundquist, Kristina}}, issn = {{1937-1888}}, language = {{eng}}, number = {{3}}, pages = {{378--388}}, publisher = {{Alcohol Research Documentation, Inc.}}, series = {{Journal of Studies on Alcohol and Drugs}}, title = {{Testing Phenotypic Models of Posttraumatic Stress Disorder and Alcohol Use Disorder Comorbidity Using Longitudinal Registry Data}}, url = {{http://dx.doi.org/10.15288/jsad.22-00209}}, doi = {{10.15288/jsad.22-00209}}, volume = {{84}}, year = {{2023}}, }