Age of alcohol use initiation and psychiatric symptoms among young adult trauma survivors

Sex and context differences in the effects of trauma on comorbid alcohol use and post-traumatic stress phenotypes in actively drinking rats

Alcohol use disorder (AUD) and affective disorders are frequently comorbid and share underlying mechanisms that could be targets for comprehensive treatment. Post-traumatic stress disorder (PTSD) has high comorbidity with AUD, but comprehensive models of this overlap are nascent. We recently characterized a model of comorbid AUD and PTSD-like symptoms, wherein stressed rats receive an inhibitory avoidance (IA)-related footshock on two occasions followed by two-bottle choice (2BC) voluntary alcohol drinking. Stressed rats received the second footshock in a familiar (FAM, same IA box as the first footshock) or novel context (NOV, single-chambered apparatus); the FAM paradigm more effectively increased alcohol drinking in males and the NOV paradigm in females. During abstinence, stressed males displayed avoidance-like PTSD symptoms, and females showed hyperarousal-like PTSD symptoms. Rats in the model had altered spontaneous action potential-independent GABAergic transmission in the central amygdala (CeA), a brain region key in alcohol dependence and stress-related signaling. However, PTSD sufferers may have alcohol experience prior to their trauma. Here, we therefore modified our AUD/PTSD comorbidity model to provide 3 weeks of intermittent extended alcohol access before footshock and then studied the effects of NOV and FAM stress on drinking and PTSD phenotypes. NOV stress suppressed the escalation of alcohol intake and preference seen in male controls, but no stress effects were seen on drinking in females. Additionally, NOV males had decreased action potential-independent presynaptic GABA release and delayed postsynaptic GABAA receptor kinetics in the CeA compared to control and FAM males. Despite these changes to alcohol intake and CeA GABA signaling, stressed rats showed broadly similar anxiogenic-like behaviors to our previous comorbid model, suggesting decoupling of the PTSD symptoms from the AUD vulnerability for some of these animals. The collective results show the importance of alcohol history and trauma context in vulnerability to comorbid AUD/PTSD-like symptoms.

Increasing burden of major trauma in elderly adults during 2003-2015: Analysis of real-world data from Taiwan

BACKGROUND

Major trauma has been one of the leading causes of morbidity, mortality, and functional disability, resulting in substantial societal burden. The aim of this study was to estimate the trends in burden of adult major trauma in Taiwan during 2003-2015.

METHODS

Adult patients with initial encounter of major trauma (injury severity score ≥ 16) were abstracted from the claim data of National Health Insurance (NHI) in Taiwan from January 2003 to December 2015. We explored the trends of incidence and mortality rates over time stratified by age and sex, as well as life expectancy (LE), loss-of-LE, lifetime healthcare expenditure and total loss-of-LE compared with age, sex and calendar-year matched referents simulated from the vital statistics of Taiwan.

RESULTS

A total of 71,731 cases of adult major trauma, and an estimated loss of 979,676 life-years were found with an increasing trend in cumulative incidence rate (CIR_18-84) during 2003-2015. The incidence rates were significantly higher in men than women. For both sexes, the incidence rates for those aged 65 and above were about 2-3 times higher than those of all other age groups. The one-year case fatality rates among the elderly were about 31-61%, higher than all other ages. The lifetime healthcare expenditures per person were 47,616 USD in men and 43,416 USD in women.

CONCLUSION

There is a consistently increasing trend in incidence and mortality of major trauma in Taiwan, especially among elderly people. For Taiwan, an aged society beginning since 2018, the challenge should be tackled more effectively in the coming decades.

The role of alcohol-induced blackouts in symptoms of depression among young adults

OBJECTIVE

Blackouts are associated with other alcohol-related consequences and depression among young adults, but the mechanisms underlying these associations are unclear. Using two separate samples, we tested the hypothesis that blackouts would be linked to symptoms of depression due in part to their association with other alcohol-related consequences.

METHOD

Young adults who use alcohol completed assessments at baseline in Sample 1 (N₁ = 381, 58% female) and baseline, 3 months, and 6 months in Sample 2 (N₂ = 603, 53 % female). Bootstrapped confidence intervals were used to examine the direct and indirect effects of blackouts on depressive symptoms, using cross-sectional mediation analysis in Sample 1 and a counterfactual approach with longitudinal data in Sample 2.

RESULTS

In both samples, alcohol-induced blackouts were associated with alcohol-related consequences, which in turn were associated with symptoms of depression. In Sample 1, blackouts had both direct and indirect (mediated) effects on depressive symptoms. In Sample 2, blackouts measured at baseline only had an indirect effect on depressive symptoms six months later through other alcohol-related consequences at three months.

CONCLUSIONS

Among heavy-drinking college students, the majority of whom reported minimal symptoms of depression, blackouts were associated with increases in other alcohol-related consequences, which in turn were associated with increases in symptoms of depression. These findings suggest that prevention and intervention efforts targeting blackouts may help reduce other alcohol-related consequences among young adults.