Depression May Partially Mediate the Relationship Between PTSD and Opioid Misuse

Depression may partially mediate the association between post-traumatic stress disorder and opioid misuse.

The following article is part of conference coverage from the IASP 2018 conference in Boston, Massachusetts. Clinical Pain Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in pain medicine. Check back for the latest news from IASP 2018.

Depression may partially mediate the association between post-traumatic stress disorder (PTSD) and opioid misuse, according to a study to be presented at the World Congress on Pain 2018, held September 12-16, in Boston, Massachusetts.

“Individuals who misuse opioids frequently have comorbid psychiatric issues, including post-traumatic stress disorder (PTSD) and depression, which can have significant implications on pain care,” study lead author, Valerie Hruschak, MS, PhD candidate at the University of Pittsburgh in Pennsylvania, told Clinical Pain Advisor. “These findings directly impact clinical care and emphasize the importance of access to integrated pain management that is patient-centered and involves coordination of medical, psychological, and social aspects of healthcare.”

A health survey was administered to patients filling opioid prescriptions at 4 community pharmacies (n=333). The Patient Health Questionnaire-2 (PHQ-2), the Primary Care-Post Traumatic Stress Disorder assessment (PC-PTSD), and the Prescription Opioid Misuse Index (POMI) were used to assess depressive symptoms, PTSD, and opioid misuse, respectively. In addition to investigating the associations between patient characteristics (demographic and clinical) and PTSD, depression, and opioid misuse, the researchers evaluated the potential of depression to mediate the association between PTSD and opioid misuse.

Of the survey respondents, 16% reported misusing opioid medications, of whom 33% and 29% were diagnosed with PTSD and depression, respectively. PTSD was found to be a significant predictor of depression (a=0.43; 95% CI, 0.31-0.54; P <.001), and depression was found to be predictive of opioid misuse when controlling for PTSD (b=0.13; 95% CI, 0.05-0.22; P =.002). An indirect effect of PTSD on opioid misuse — mediated by depression — as well as a direct effect of PTSD on opioid misuse was established (indirect effect: ab=0.06; 95% CI, 0.02-0.10; direct effect: c=0.012; 95% CI, 0.03 -0.22; P =.01).

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“[Study results suggest…] the pressing need for screening, assessment, and intervention protocols for individuals with psychiatric comorbidities who are being prescribed opioids for pain management,” noted the study authors. “In building on this foundation, the next steps for future research should employ longitudinal designs and examine these relationships in national samples,” added Ms Hruschak.


Hruschak V, Hildenbrand A, Cochran G. Opioid misuse and psychiatric comorbidities: Implications for pain care. Presented at the World Congress on Pain 2018; September 12-16, 2018; Boston, MA. Poster 64383.

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This article originally appeared on Clinical Pain Advisor