Depressive symptoms were found to partially mediate the relationship between post-traumatic stress disorder (PTSD) and opioid misuse, according to an article published in Substance Abuse. Individuals with comorbid opioid-related disorders and PTSD and/or depression tend to have poor prognoses.

Valerie Hruschak, PhD, MSW, of the University of Pittsburgh, School of Social Work in Pennsylvania, and colleagues had adult patients aged ≥18 years complete a health survey while filling an opioid prescription in 1 of 4 community pharmacies in southwestern Pennsylvania between September 2014 and June 2015.

Patients were also assessed for the presence of depressive symptoms with the Patient Health Questionnaire-2, general health, PTSD, opioid misuse, illicit drug use, hazardous alcohol use, and pain. Statistical analyses included Pearson correlations, independent samples t tests, and a mediation analysis with covariates.

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Overall, of 333 patients, 15.9% reported opioid misuse, 17.1% were positive for PTSD, and 52.6% were positive for depression. Of patients with PTSD or depression, 33.3% and 29.3%, respectively, engaged in opioid misuse.

A mediation analysis showed that PTSD significantly predicted depression (P <.001) and depression significantly predicted opioid misuse when controlling for PTSD (P =.002). There was a statistically significant indirect effect of PTSD on opioid misuse through a pathway mediated by depression and a direct effect of PTSD on opioid misuse, indicating partial mediation.

The investigators concluded, “These data suggest that patients with PTSD and depression are at a greater risk for opioid misuse and, thus, there is an increased need for screening, assessment, and intervention protocols for this patient population.”

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They also noted some limitations, “However, the cross-sectional nature of this study limits our ability to draw definitive conclusions regarding directions of the relationships among PTSD, depression, and opioid misuse.”


Hruschak V, Hildenbrand AK, Cochran G. Psychiatric comorbidity and co-occurring opioid misuse: Depression mediates the relationship between post-traumatic stress disorder and opioid misuse in community pharmacy settings [published online October 22, 2019]. Subst Abus. 10.1080/08897077.2019.1621238

This article originally appeared on Psychiatry Advisor