Depressive symptoms were found to partially mediate the relationship between post-traumatic stress disorder (PTSD) and opioid misuse, according to an article published in Substance Abuse. Individuals with comorbid opioid-related disorders and PTSD and/or depression tend to have poor prognoses.

Valerie Hruschak, PhD, MSW, of the University of Pittsburgh, School of Social Work in Pennsylvania, and colleagues had adult patients aged ≥18 years complete a health survey while filling an opioid prescription in 1 of 4 community pharmacies in southwestern Pennsylvania between September 2014 and June 2015.

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Patients were also assessed for the presence of depressive symptoms with the Patient Health Questionnaire-2, general health, PTSD, opioid misuse, illicit drug use, hazardous alcohol use, and pain. Statistical analyses included Pearson correlations, independent samples t tests, and a mediation analysis with covariates.

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Overall, of 333 patients, 15.9% reported opioid misuse, 17.1% were positive for PTSD, and 52.6% were positive for depression. Of patients with PTSD or depression, 33.3% and 29.3%, respectively, engaged in opioid misuse.

A mediation analysis showed that PTSD significantly predicted depression (P <.001) and depression significantly predicted opioid misuse when controlling for PTSD (P =.002). There was a statistically significant indirect effect of PTSD on opioid misuse through a pathway mediated by depression and a direct effect of PTSD on opioid misuse, indicating partial mediation.

The investigators concluded, “These data suggest that patients with PTSD and depression are at a greater risk for opioid misuse and, thus, there is an increased need for screening, assessment, and intervention protocols for this patient population.”

They also noted some limitations, “However, the cross-sectional nature of this study limits our ability to draw definitive conclusions regarding directions of the relationships among PTSD, depression, and opioid misuse.”

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Hruschak V, Hildenbrand AK, Cochran G. Psychiatric comorbidity and co-occurring opioid misuse: Depression mediates the relationship between post-traumatic stress disorder and opioid misuse in community pharmacy settings [published online October 22, 2019]. Subst Abus. 10.1080/08897077.2019.1621238

This article originally appeared on Psychiatry Advisor