Adverse pregnancy outcomes and current health status in women with PTSD and SUD

1. Adverse pregnancy outcomes and current health status in women with PTSD and SUD KORTE JE1, KILLEEN T1, CAMPBELL A2, HIEN D3and BRADY KT1,4 1. Medical University of South Carolina, Charleston SC, USA 2. Columbia University, New York NY, USA 3. City College of New York, New York NY, USA 4. Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA RESULTS METHODS BACKGROUND AND OBJECTIVE • Definition of current health status • In ASI-Lite: Participants were asked “How many days have you experienced medical problems in the past 30 days?”, and “How troubled or bothered have you been by these medical problems in the past 30 days?” • In ASI-Lite addendum: Participants were asked about overall health status (excellent to very poor) • Participants were asked a series of questions about current health status (strongly agree to strongly disagree): • “I am somewhat ill” • “I am as healthy as anyone I know” • My health is excellent” • “I have been feeling bad lately” • Statistical analysis • Preliminary analyses: chi square and t-test for bivariate associations • Generalized estimating equations (GEE) to fit longitudinal models examining health and health perceptions over time • Main predictor of interest: adverse reproductive history • Other covariates: age, ethnicity, marital status, baseline value of self reported health status • Health problems over time • During study follow-up, women with adverse reproductive histories: • Were significantly more likely to be troubled by medical problems (p=0.003) • More likely to report that they had been feeling bad lately (p=0.02) • Rated current health status more poorly (p=0.03) • Reported 3.1 more average days of medical problems in the previous month (p=0.002). • In longitudinal GEE models across study follow-up timepoints: • Women with adverse reproductive history rated their overall health slightly worse (0.17 points on a 5-point scale, p=0.051). • Other self-reported measures of current health were consistent with this finding, although most were not significant with p-values of 0.071 (“My health is excellent”), 0.095 (“I am somewhat ill”) to 0.28 (“I am as healthy as anybody I know”). • A statistically significant effect of adverse reproductive history, and a significant time effect, were seen for endorsement of the statement “I have been feeling bad lately” (Figure 1). • Reproductive history effect: Women with adverse reproductive history were significantly more likely to agree that they had been feeling bad lately (0.35 points on a 5-point scale, p=0.014) (Figure 1) • Time effect: women became less likely to agree with this statement as the study follow-up progressed (p=0.032). (Figure 1) Women with comorbid diagnoses of post-traumatic stress disorder and substance use disorder are at increased risk of chronic health problems in comparison to the general population. In addition, while some types of substance use are known to increase the risk of adverse pregnancy outcomes, such outcomes may in turn constitute stressful or traumatic life events, increasing the risk of psychological disorders including initiation or continuation of illicit substance use. For women with substance use disorders, adverse reproductive events may be related both to their substance use and to their perceived health and functional status. Adverse reproductive events may be particularly salient for women with both substance use disorder and post-traumatic stress disorder, in the context of the abuse or other trauma contributing to their PTSD. In this study our objective was to evaluate the prevalence of adverse reproductive history in women with PTSD and SUD, and characterize their assessment of their own health status. In addition, we sought to evaluate the relationship between a history of adverse reproductive events and self report of health status over time in these women. METHODS • Design • Secondary data analysis of NIDA CTN 0015 • Randomized controlled trial for treatment of women with comorbid substance use disorder (SUD) and post-traumatic stress disorder (PTSD). • Between 2004-2006, 353 women were randomized to two study arms: • Seeking Safety (twelve bi-weekly group sessions), an integrated manualized intervention using cognitive behavioral strategies to address both trauma and substance use disorders. • Women’s Health Education (twelve bi-weekly group sessions), a non-specific short term manualized treatment focusing on women’s health (including anatomy/physiology, pregnancy, childbirth, sexually transmitted diseases, HIV, and AIDS). • Follow-up visits were scheduled at 1 week, 3 months, 6 months, and 12 months post treatment. • Study Population • Female outpatients presenting for treatment at seven community treatment centers in the United States • Definition of adverse pregnancy outcomes • Basic details of reproductive history collected in an addendum to ASI-Lite: Age at menarche, pregnancy history, number of babies born who later died, number of abortions, number of miscarriages, number of stillbirths, number of premature births, and drug use during pregnancy. • We defined a history of adverse pregnancy outcomes in two ways. • Reporting at least one of the adverse outcomes, or • Reporting any adverse outcome other than miscarriage RESULTS Figure 1. Agreement over time with “I have been feeling bad lately”. 1=strongly agree; 5=strongly disagree • Baseline characteristics • Most women (328/353) had been pregnant. Most of these women reported at least one adverse reproductive outcome (Table 1) • Treatment-seeking women with PTSD and SUD experienced medical problems on an average of 10.1 days out of the previous 30 days (10.5 vs. 9.6 days, p=0.44, in women with and without adverse reproductive history, respectively) • Most women rated their overall health as fair to good. However, most women agreed that they were “somewhat ill”, and that they had been “feeling bad lately” (Table 2). No significant differences were observed at baseline between women with and without adverse reproductive history. SUMMARY AND CONCLUSIONS • In this study, we found that women with a history of adverse reproductive events were at increased risk for poor perceived health status across time, but not at baseline, in comparison to women without adverse reproductive history. • A history of adverse reproductive events may be related to worse health status and health status perceptions through a variety of mechanisms including physical/medical effects, psychological effects, and non-causal correlation or reverse causality. • Many women with comorbid PTSD and SUD suffer from poor health status and health perceptions. These women may benefit from screening and referral to treatment for medical problems. ACKNOWLEDGEMENTS • NIDA Clinical Trials Network. U10 DA13727 (Brady PI); U10 DA13035 (Nunes PI) CPDD Conference, Palm Springs CA • June 9-14 2012