Lifetime history of traumatic events in an American Indian community sample: Heritability and relation to substance dependence, affective disorder, conduct disorder and PTSD

Abstract

American Indians appear to experience a higher rate of traumatic events than what has been reported in general population surveys. American Indians also suffer higher alcohol related death rates than any other ethnic group in the U.S. population. Therefore efforts to delineate factors which may uniquely contribute to increased likelihood of trauma, post traumatic stress disorder (PTSD), and substance use disorders (SUD) over the lifetime in American Indians are important because of the high burden of morbidity and mortality that they pose to American Indian communities. Participants were American Indians recruited from reservations that were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), family history assessment and the stressful-life-events scale. Of the 309 participants, equivalent numbers of men and women (94%) reported experiencing traumas; however, a larger proportion of women received a PTSD diagnosis (38%) than men (29%). Having experienced multiple trauma and sexual abuse were most highly associated with PTSD. Having experienced assaultive trauma and having PTSD symptoms were both found to be moderately heritable (30–50%). Logistic regression revealed that having an anxiety and/or affective disorder and having a substance dependent diagnosis, but not having antisocial personality disorder/conduct disorder, were significantly correlated with having a diagnosis of PTSD. These studies suggest that trauma is highly prevalent in this American Indian community, it is heritable, is associated with PTSD, affective/ anxiety disorders and substance dependence. Additionally, trauma, PTSD and substance dependence appear to all co-emerge in early adulthood in this high- risk population.

Substance use and misuse in burn patients: Testing the classical hypotheses of the interaction between post-traumatic symptomatology and substance use

“…persons suffering from PTSD, no support for the high risk hypothesis, and they could not rule out the possibility of shared vulnerability to PTSD and drug use. However, it has been long advocated that substance misuse makes people more vulnerable to accidents such as burns 16,17 .…”

“…The high risk hypothesis receives evidence from epidemiological 16 and family genetic studies 17 , and the susceptibility hypothesis mainly from neurobiological and genetic studies 18,19 . The self-medication hypothesis has received support mainly from clinical 20 and epidemiological studies 21--23 .…”

Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes

“…AI groups in the US also experience higher rates of traumatic events than those in the general population (Manson et al, 2005; Evans-Campbell et al, 2006; Evans-Campbell, 2008; Robin et al, 1997; Ehlers et al, 2013a; Karmali et al, 2005; Sugarman & Grossman, 1996). Past estimates of depression among AI adults exceed those of the general population, and range from 20–30% (U.S.…”

Clinical characteristics of alcohol combined with other substance use disorders in an American Indian community sample

“…The lifetime prevalence of substance dependence in this Indian sample is high and genetic and environmental risk factors for substance dependence have been identified (Ehlers and Wilhelmsen, 2005, 2007; Ehlers et al, 2004b, 2006, 2007a, 2007b, 2007c, 2008a, 2008b, 2009, 2010a, 2010b, 2011, 2013; Gizer et al, 2011; Wall et al, 2003; Wilhelmsen and Ehlers, 2005). We have also demonstrated in this population that AUDs have an early age of onset, a rapid and severe clinical course, specific patterns of psychiatric comorbidity, and high rates of remission (Ehlers et al, 2008a; Gilder et al, 2004, 2006, 2008).…”