Journal of Traumatic Stress Disorders & TreatmentISSN: 2324-8947

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Psychological Trauma, Substance Use and Mood Disorders and Level of Distress among Impaired Professionals: A Mediating Model of Comorbidity

The prevalence of co-occurring psychiatric and substance use disorders is well established, yet, inadequately understood. Individuals with co-occurring psychiatric and substance use disorders display complex clinical presentations have poor prognosis, and institutional barriers hinder them from receiving treatment. To clarify our understanding of this common, yet complex, clinical presentation, we test the hypothesis that substance use disorder symptoms, mood disorders, and psychological trauma symptoms directly contribute to patient distress.

Material and methods

Between January 2006 and June 2010, participants were evaluated and treated in an outpatient setting on a health sciences center campus in Oklahoma City by the Department of Psychiatry and Behavioral Sciences. All participants were impaired professionals. Two groups of professionals participated: 1) health care providers (N=96) and 2) non-healthcare providers (N=44). We applied Structural Equation Modeling (SEM) techniques to the analysis.


Mood disorder, substance use disorder, and trauma symptoms were all positively related to the level of distress. Symptoms of mood disorders had a total direct effect of 0.51 (p<0.0001) on level of distress. Trauma symptoms had a total effect of 0.46 (p<0.0001) on level of distress. This total effect includes 0.18 (p=0.05) direct effect on level of distress and 0.28 (p<0.0001) indirect effect through mood disorder symptoms leading to level of distress. Thus, mood disorder symptoms mediated the relationship between trauma symptoms and level of distress symptoms. The strongest positive direct paths were from symptoms of trauma to mood disorders, with a coefficient of 0.55, and from symptoms of mood disorders to level of distress, with a coefficient of 0.51.


This approach challenges the existing treatment models, which targets diagnostic categories with prescribed treatment programsand regimens that may require abstinence before addressing trauma and mood symptoms. The effect of comorbid symptoms on patients’ levels of distress is more complicated than existing models of co-occurring typologies or treatment approaches would indicate. The results have clinical implications and contribute to advancing the fields’ current understanding of the relationship between co-occurring substance use disorders, mood disorders, posttraumatic stress disorder, and patients’ levels of distress, thereby improving treatment outcomes.


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