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BackgroundPost-traumatic stress disorder (PTSD) and substance use (tobacco, alcohol, and cannabis) are highly comorbid. Many factors affect this relationship, including sociodemographic and psychosocial characteristics, other prior traumas, and physical health. However, few prior studies have investigated this prospectively, examining new substance use and the extent to which a wide range of factors may modify the relationship to PTSD.MethodsThe Advancing Understanding of RecOvery afteR traumA (AURORA) study is a prospective cohort of adults presenting at emergency departments (N = 2,943). Participants self-reported PTSD symptoms and the frequency and quantity of tobacco, alcohol, and cannabis use at six total timepoints. We assessed the associations of PTSD and future substance use, lagged by one timepoint, using the Poisson generalized estimating equations. We also stratified by incident and prevalent substance use and generated causal forests to identify the most important effect modifiers of this relationship out of 128 potential variables.ResultsAt baseline, 37.3% (N = 1,099) of participants reported likely PTSD. PTSD was associated with tobacco frequency (incidence rate ratio (IRR): 1.003, 95% CI: 1.00, 1.01, p = 0.02) and quantity (IRR: 1.01, 95% CI: 1.001, 1.01, p = 0.01), and alcohol frequency (IRR: 1.002, 95% CI: 1.00, 1.004, p = 0.03) and quantity (IRR: 1.003, 95% CI: 1.001, 1.01, p = 0.001), but not with cannabis use. There were slight differences in incident compared to prevalent tobacco frequency and quantity of use; prevalent tobacco frequency and quantity were associated with PTSD symptoms, while incident tobacco frequency and quantity were not. Using causal forests, lifetime worst use of cigarettes, overall self-rated physical health, and prior childhood trauma were major moderators of the relationship between PTSD symptoms and the three substances investigated.ConclusionPTSD symptoms were highly associated with tobacco and alcohol use, while the association with prospective cannabis use is not clear. Findings suggest that understanding the different risk stratification that occurs can aid in tailoring interventions to populations at greatest risk to best mitigate the comorbidity between PTSD symptoms and future substance use outcomes. We demonstrate that this is particularly salient for tobacco use and, to some extent, alcohol use, while cannabis is less likely to be impacted by PTSD symptoms across the strata.

Background and ObjectiveSustained attention is a transdiagnostic phenotype linked with most forms of psychopathology. We sought to understand factors that influence the development of sustained attention, by looking at the relationship between childhood adversity and adult sustained attention.Participants, Setting, and MethodsParticipants were 5,973 TestMyBrain.org visitors from English-speaking countries who completed a continuous performance task (gradCPT) of sustained attention and a childhood adversity questionnaire. We analyzed gradCPT performance using a signal detection approach.ResultsDiscrimination ability (the main metric of performance on the gradCPT) was associated with total childhood adversity load, even when controlling for covariates related to age, gender, parental education, race, country of origin, and relative socioeconomic status (β = −0.079, b = −0.032).ConclusionOur results demonstrate that attention differences related to childhood adversity exposure can (1) be measured using brief, performance-based measures of sustained attention, (2) persist into adulthood, and (3) be detected at the population level. These results, paired with the well-documented associations between sustained attention and psychopathology, indicate that sustained attention may be an important mechanism for understanding early influences on mental health.