Mapping the Pathways Between Posttraumatic Stress Disorder, Depression, and Alcohol and Cannabis Use: A Network Analysis

Rachel E. Williamson, Kathryn S. Macia, Joshua Burton, Robert E. Wickham

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The present study examines the network structure and, using Bayesian network analysis, estimates the directional pathways among symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and levels of alcohol and cannabis use. Method: A sample of 1471 adults in the United States, who reported at least one potentially traumatic event, completed the PTSD Checklist (PCL-5), Patient Health Questionnaire (PHQ-9), and the Alcohol/Cannabis Use Disorders Identification Test (AUDIT/CUDIT). A regularized partial correlation network provided estimates of symptoms clusters and connections. Directional pathways within the network were then estimated using a directed acyclic graph (DAG). Results: Symptoms clustered in theoretically consistent ways. Risky behavior demonstrated the highest strength centrality and bridge strength. Neither alcohol nor cannabis use appeared central in the network, and DAG results suggested that MDD and PTSD symptoms are more likely to lead to substance use than the other way around. Conclusions: Results suggest that cannabis use is largely connected to alcohol use. Consistent with prior research, risky behavior appeared to be the primary bridge between substance use and PTSD. The direction of associations between substance use and psychological symptoms requires further attention.

Original languageEnglish
Pages (from-to)318-326
Number of pages9
JournalJournal of Dual Diagnosis
Volume20
Issue number4
DOIs
StatePublished - Mar 31 2024

Keywords

  • Alcohol use
  • cannabis use
  • depression
  • directed acyclic graph
  • network analysis
  • PTSD
  • Marijuana Abuse/epidemiology
  • Alcohol Drinking/epidemiology
  • Humans
  • Middle Aged
  • Stress Disorders, Post-Traumatic/epidemiology
  • Male
  • Young Adult
  • United States/epidemiology
  • Risk-Taking
  • Adolescent
  • Bayes Theorem
  • Depressive Disorder, Major/epidemiology
  • Adult
  • Female
  • Diagnosis, Dual (Psychiatry)

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