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Substance use behaviors as a mediator between posttraumatic stress disorder and physical health in trauma-exposed college students

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Abstract

Introduction

Research within the field of traumatic stress has documented a strong link between posttraumatic stress disorder (PTSD) and adverse physical health outcomes, although the mechanisms contributing to this relationship are unclear.

Method

The current study examined substance use behaviors as one such mediator in a mixed civilian trauma population. Participants were 136 undergraduates exposed to a variety of civilian traumas. They completed measures assessing trauma exposure, substance use behaviors, and physical health outcomes.

Results

Moderate correlations were found between PTSD symptom severity, substance use, and adverse health outcomes. Mediational analyses indicated that substance use behaviors, especially alcohol and drug use, mediated the relationship between PTSD and health outcomes.

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References

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. Revised.

    Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychology research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Article  PubMed  Google Scholar 

  • Beckham, J. C., Moore, S. D., Feldman, M. E., & Hertzberg, M. A. (1998). Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder. The American Journal of Psychiatry, 155, 1565–1569.

    PubMed  Google Scholar 

  • Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., et al. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.

    Google Scholar 

  • Boscarino, J. A. (1997). Diseases among men 20 years after exposure to severe stress: Implications for clinical research and medical care. Psychosomatic Medicine, 59, 605–614.

    PubMed  Google Scholar 

  • Brener, N. D., McMahon, P. M., Warren, C. W., & Douglas, K. A. (1999). Forced sexual intercourse and associated health-risk behaviors among female college students in the United States. Journal of Consulting and Clinical Psychology, 67, 252–259.

    Article  PubMed  Google Scholar 

  • Chilcoat, H. D., & Breslau, N. (1998). Posttraumatic stress disorder and drug disorders: Testing causal pathways. Archives of General Psychiatry, 55, 913–917.

    Google Scholar 

  • Ciechanowski, P. S., Walker, E. A., Russo, J. E., Newman, E., & Katon, W. J. (2004). Adult health status of women HMO members with posttraumatic stress disorder symptoms. General Hospital Psychiatry, 26, 261–268.

    Article  PubMed  Google Scholar 

  • Cohen, S., & Williamson, G. M. (1991). Stress and infectious disease in humans. Psychological Bulletin, 109, 5–24.

    Article  PubMed  Google Scholar 

  • Cook, J. M., Elhai, J. D., Cassidy, E. L., Ruzek, J. I., Ram, G. D., & Sheikh, J. I. (2005). Assessment of trauma exposure and post-traumatic stress in long-term care veterans: Preliminary data on psychometrics and post-traumatic stress disorder prevalence. Military Medicine, 170, 862–866.

    PubMed  Google Scholar 

  • Engel, C. C. (2004). Somatization and multiple idiopathic physical symptoms: Relationship to traumatic events and posttraumatic stress disorder. In P. P. Schnurr & B. L. Green (Eds.), Trauma and health: Physical health consequences of exposure to extreme stress (pp. 191–215). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Fagerstrom, K., & Schneider, N. G. (1989). Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire. Journal of Behavioral Medicine, 12, 159–182.

    Article  PubMed  Google Scholar 

  • Friedman, M. J., & McEwen, B. S. (2004). Posttraumatic stress disorder, allostatic load, and medical illness. In P. P. Schnurr & B. L. Green (Eds.), Trauma and health: Physical health consequences of exposure to extreme stress (pp. 157–188). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Friedman, M. J., & Schnurr, P. P. (1995). The relationship between trauma, post-traumatic stress disorder, and physical health. In M. J. Friedman & A. Y. Deutch (Eds.), Neurobiological and clinical consequences of stress: From normal adaptation to post-traumatic stress disorder (pp. 507–524). Philadelphia, PA: Lippincott-Raven.

    Google Scholar 

  • Gavin, D. R., Ross, H. E., & Skinner, H. A. (1989). Diagnostic validity of the Drug Abuse Screening Test in the assessment of DSM-III drug disorders. British Journal of Addiction, 84, 301–307.

    Google Scholar 

  • Herman, J. (1997). Trauma and recovery: The aftermath of violence-from domestic abuse to political terror. New York, NY: Basic Books.

    Google Scholar 

  • Kramer, M. C., Kiernan, M., Essex, M., & Kupfre, D. (2008). How and why criteria defining moderators and mediators differ between the Baron and Kenny and MacArthur approaches. Health Psychology, 27, S101–S108.

  • Lang, A. J., Laffaye, C., Satz, L. E., Dresselhaus, T. R., & Stein, M. B. (2003). Sensitivity and specificity of the PTSD checklist in detecting PTSD in female veterans in primary care. Journal of Traumatic Stress, 16, 257–264.

    Article  PubMed  Google Scholar 

  • Marshall, G. N. (2004). Posttraumatic stress disorder checklist: Factor structure and English–Spanish measurement invariance. Journal of Traumatic Stress, 17, 223–230.

    Article  PubMed  Google Scholar 

  • McDevitt-Murphy, M. E., Weathers, F. W., Flood, A. M., Eakin, D., & Benson, T. (2007). The utility of the PAI and the MMPI-2 for discriminating PTSD, depression, and social phobia in trauma-exposed college students. Assessment, 14, 181–196.

    Article  PubMed  Google Scholar 

  • McFarlane, A. C., Atchison, M., Rafalowicz, E., & Papay, P. (1994). Physical symptoms in post-traumatic stress disorder. Journal of Psychosomatic Research, 38, 715–726.

    Article  PubMed  Google Scholar 

  • McHorney, C. A., Ware, J. E., & Lu, F. J. R. (1994). The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32, 40–66.

    Article  PubMed  Google Scholar 

  • McHorney, C. A., Ware, J. E., & Raczek, A. E. (1993). The MOS 36-item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31, 247–263.

    Article  PubMed  Google Scholar 

  • Murphy, S. A., Lohan, J., Braun, T., Johnson, L. C., Cain, K. C., & Beaton, R. D. (1999). Parents’ health, health care utilization, and health behaviors following the violent deaths of their 12- to 28-year-old children: A prospective longitudinal analysis. Death Studies, 23, 589–616.

    Article  PubMed  Google Scholar 

  • Neighbors, C., Larimer, M. E., Geisner, I. M., & Knee, C. R. (2004). Feeling controlled and drinking motives among college students: Contingent self-esteem as a mediator. Self and Identity, 3, 207–224.

    Article  Google Scholar 

  • Neighbors, C., Lee, C. M., Lewis, M. A., Fossos, N., & Larimer, M. E. (2007). Are social norms the best predictor of outcomes among heavy-drinking college students? Journal of Studies on Alcohol and Drugs, 68, 556–565.

    PubMed  Google Scholar 

  • Newman, M. G., Clayton, L., Zuellig, A., Cashman, L., Arnow, B., Dea, R., et al. (2000). The relationship of childhood sexual abuse and depression with somatic symptoms and medical utilization. Psychological Medicine, 30, 1063–1077.

    Article  PubMed  Google Scholar 

  • Palmieri, P. A., Weathers, F. W., Difede, J., & King, D. W. (2007). Confirmatory factor analysis of the PTSD Checklist and the Clinician-Administered PTSD scale in disaster workers exposed to the World Trade Center ground zero. Journal of Abnormal Psychology, 116, 329–341.

    Article  PubMed  Google Scholar 

  • Potts, M. K. (1994). Long-term effects of trauma: Post-traumatic stress among civilian internees of the Japanese during World War II. Journal of Clinical Psychology, 50, 681–697.

    Article  PubMed  Google Scholar 

  • Rheingold, A. A., Acierno, R., & Resnick, H. (2004). Trauma, PTSD, and health risk behaviors. In P. P. Schnurr & B. L. Green (Eds.), Physical health consequences of exposure to extreme stress. Washington, DC: American Psychological Association.

    Google Scholar 

  • Rodgers, C. S., Norman, S. B., Thorp, S. R., Lang, A. J., & Lebeck, M. M. (2005). Trauma exposure, posttraumatic stress disorder and health behaviors: Impact on special populations. In T. A. Corales (Ed.), Focus on posttraumatic stress disorder research (pp. 203–224). Hauppauge, NY: Nova Science Publishers.

    Google Scholar 

  • Rudy, E. B., & Gray, V. R. (1986). Handbook of health assessment (2nd ed.). Norwalk, CT: Appleton-Century-Crofts.

    Google Scholar 

  • Ruehlman, L. S., Lanyon, R. I., & Karoly, P. (1998). Multidimensional health profile professional manual. Odessa, FL: Psychological Assessment Resources, Inc.

    Google Scholar 

  • Ruggiero, K. J., Del Ben, K., Scotti, J. R., & Rabalais, A. E. (2003). Psychometric properties of the PTSD checklist-civilian version. Journal of Traumatic Stress, 16, 495–502.

    Article  PubMed  Google Scholar 

  • Schnurr, P. P. (1996). Trauma, PTSD, and physical health. PTSD Research Quarterly, 7, 1–8.

    Google Scholar 

  • Schnurr, P. P., Friedman, M. J., Sengupta, A., Jankowski, M. K., & Holmes, T. (2000). PTSD and utilization of medical treatment services among male Vietnam veterans. Journal of Nervous and Mental Disease, 188, 496–504.

    Article  PubMed  Google Scholar 

  • Schnurr, P. P., & Green, B. L. (2004). Understanding relationships among trauma, post-traumatic stress disorder, and health outcomes. Advances in Mind-Body Medicine, 20, 18–29.

    PubMed  Google Scholar 

  • Schnurr, P. P., & Spiro, A. (1999). Combat exposure, posttraumatic stress disorder symptoms, and health behaviors as predictors of self-reported physical health in older veterans. The Journal of Nervous and Mental Disease, 187, 353–359.

    Article  PubMed  Google Scholar 

  • Sher, C. D., McCreary, D. R., Asmudson, G. J. G., & Resick, P. A. (2008). The structure of post-traumatic stress disorder symptoms in three female trauma samples: A comparison of interview and self-report measures. Journal of Anxiety Disorders, 22, 1137–1145.

    Article  Google Scholar 

  • Skinner, H. A. (1982). The drug abuse screening test. Addictive Behaviors, 7, 363–371.

    Article  PubMed  Google Scholar 

  • Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. In S. Leinhart (Ed.), Sociological methodology 1982 (pp. 290–312). San Francisco: Jossey-Bass.

    Google Scholar 

  • Southwick, S. M., Bremner, D., Krystal, J. H., & Charney, D. S. (1994). Psychobiologic research in post-traumatic stress disorder. Psychiatric Clinics of North America, 17, 251–264.

    PubMed  Google Scholar 

  • Stein, M., & Miller, A. H. (1993). Stress, the immune system, and health and illness. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress: Theoretical and clinical aspects (pp. 127–141). New York, NY: The Free Press.

    Google Scholar 

  • Tate, J. C., & Schmitz, J. M. (1993). A proposed revision of the Fagerstrom tolerance questionnaire. Addictive Behaviors, 18, 135–143.

    Article  PubMed  Google Scholar 

  • Uba, L., & Chung, R. C. (1991). The relationship between trauma and financial and physical well-being among Cambodians in the United States. Journal of General Psychology, 118, 215–226.

    PubMed  Google Scholar 

  • Ullman, S. E., & Siegel, J. M. (1996). Traumatic events and physical health in a community sample. Journal of Traumatic Stress, 9, 703–719.

    Article  PubMed  Google Scholar 

  • Wagner, A. W., Wolfe, J., Rotnitsky, A., Proctor, S. P., & Erickson, D. J. (2000). An investigation of the impact of posttraumatic stress disorder on physical health. Journal of Traumatic Stress, 13, 41–55.

    Article  PubMed  Google Scholar 

  • Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item Short-Form health survey (SF-36): Conceptual framework and item selection. Medical Care, 30, 473–483.

    Article  PubMed  Google Scholar 

  • Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD checklist: Reliability, validity, and diagnostic utility. Paper presented at the annual meeting of the international society for traumatic stress studies, San Antonio, CA.

  • White, H. R., & Labouvie, E. W. (1989). Towards the assessment of adolescent problem drinking. Journal of Studies on Alcohol, 50, 30–37.

    PubMed  Google Scholar 

  • Yehuda, R., Boisoneau, D., Lowy, M. T., & Giller, E. L. (1995). Dose-response changes in plasma cortisol and lymphocyte glucocorticoid receptors following dexamethasone administration in combat veterans with and without posttraumatic stress disorder. Archives of General Psychiatry, 52, 583–593.

    PubMed  Google Scholar 

  • Zatzick, D. F., Marmar, C. R., Weiss, D. S., & Browner, W. S. (1997). Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. The American Journal of Psychiatry, 154, 1690–1695.

    PubMed  Google Scholar 

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Author information

Author notes

  1. Amanda M. Flood & Meghan E. McDevitt-Murphy

    Present address: Deployment Health Center, 162 First St., Bldg. 1402, Port Hueneme, CA, 93043, USA

Authors and Affiliations

  1. Department of Psychology, Auburn University, Auburn, AL, USA

    Amanda M. Flood, Meghan E. McDevitt-Murphy, Frank W. Weathers, David E. Eakin & Trisha A. Benson

  2. Department of Psychology, University of Memphis, Memphis, TN, USA

    Meghan E. McDevitt-Murphy

Authors
  1. Amanda M. Flood
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  2. Meghan E. McDevitt-Murphy
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  3. Frank W. Weathers
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  4. David E. Eakin
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  5. Trisha A. Benson
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Corresponding author

Correspondence to Amanda M. Flood.

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Flood, A.M., McDevitt-Murphy, M.E., Weathers, F.W. et al. Substance use behaviors as a mediator between posttraumatic stress disorder and physical health in trauma-exposed college students. J Behav Med 32, 234–243 (2009). https://doi.org/10.1007/s10865-008-9195-y

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  • DOI: https://doi.org/10.1007/s10865-008-9195-y

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