Tobacco use trajectories among a large cohort of treated smokers with posttraumatic stress disorder

• Published in: Addictive behaviors 2015-02, Vol.41, p.238-246
• Main Authors: Malte, Carol A, Dennis, Paul A, Saxon, Andrew J, McFall, Miles, Carmody, Timothy P, Unger, William, Beckham, Jean C
• Format: Article
• Language: English
• Subjects: Clinical trials; Cluster Analysis; Cohort Studies; Comorbidity; Female; Follow-Up Studies; Humans; Major depressive disorder; Male; Mental Disorders - epidemiology; Mental health; Middle Aged; Post traumatic stress disorder; Posttraumatic stress disorder; Psychiatry; Recurrence; Relapse; Severity of Illness Index; Smoking; Smoking cessation; Smoking Cessation - statistics & numerical data; Stress Disorders, Post-Traumatic - epidemiology; Tobacco; Tobacco Use - epidemiology; Tobacco Use Disorder - epidemiology; Tobacco Use Disorder - therapy; Treatment Outcome; United States - epidemiology; Veterans; Veterans - statistics & numerical data
• ISSN: 0306-4603; 1873-6327
• DOI: 10.1016/j.addbeh.2014.10.034

Abstract Introduction This study identified distinct tobacco use trajectories across 18 months in 943 veteran smokers with posttraumatic stress disorder (PTSD) in order to describe quit and relapse patterns, examine associations between trajectory groups on baseline characteristics and cessation service utilization, and explore group differences in mental health outcomes. Methods Veterans who participated in a multisite, randomized trial of integrated smoking cessation care were grouped using k-means clustering based on reported daily tobacco use between baseline and 18 months. Four trajectory clusters were identified: no reduction (62%), temporary reduction (11%), late sustained reduction (9%) and early sustained reduction (18%). Results Median quit times in the early, late, temporary, and no reduction groups were 451, 141.5, 97, and 2 days, respectively. Compared to the early reduction group, the temporary reduction group exhibited higher baseline depression (p < 0.01) and anxiety (p < 0.01), but did not differ in treatment received, with both groups attending significantly more cessation visits (p < 0.001) and more likely to receive recommended pharmacotherapy (p < 0.001) than the no reduction group between baseline and 6 months. The early reduction group exhibited lower depression relative to the no reduction (p < 0.01) and temporary reduction (p < 0.01) groups across all assessments between baseline and 18 months. Differences were not observed between groups in depressive or PTSD symptom change over time between baseline and 18 months. Conclusions Tobacco use trajectories among treated smokers with PTSD vary distinctly. Characteristics of identified subgroups may lead to targeted interventions among smokers with PTSD and potentially other psychiatric disorders.