The Moderating Role of Distress Tolerance in the Relationship Between Posttraumatic Stress Disorder Symptom Clusters and Suicidal Behavior Among Trauma Exposed Substance Users in Residential Treatment

Abstract

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) is associated with greater risk for suicidal behavior than either disorder alone. Research highlights the relevance of PTSD symptoms in particular to suicide risk within this population. Research has also provided support for an association between distress tolerance (DT) and both PTSD symptoms and suicidal behavior. This study examined the role of DT in the relationship between PTSD symptom severity and suicidal behavior in a sample of 164 SUD inpatients with a history of Criterion A traumatic exposure. Results indicated that DT moderated the relationship between PTSD symptoms (overall, re-experiencing, and hyperarousal) and medically attended suicide attempts, with the magnitude of the relationship increasing at higher levels of DT.

Keywords:

• acquired capability
• distress tolerance
• substance use
• suicide

ACKNOWLEDGMENT

Support for this study was provided in part by R21 DA022383 from the National Institute on Drug Abuse of the National Institutes of Health, awarded to the second author. The authors would also like to thank Michael McDermott, Melissa Soenke, Rachel Brooks, Jessica Fulton, and Sarah Anne Moore for their assistance with data collection.

Notes

Note. ^a Percentages presented reflect the presence of the disorder or behavior.

Note. ^a Variable scored where 1 = male and 0 = female.

^b Variables scored where 1 = presence and 0 = absence.

^c Non-transformed means presented. DSH = deliberate self-harm; BPD = borderline personality disorder; PTSD Severity = overall severity of PTSD symptoms; Re-experiencing = severity of re-experiencing symptoms; Avoidance = severity of avoidance symptoms; Emotional Numbing = severity of emotional numbing symptoms; Hyperarousal = severity of hyperarousal symptoms; Total Suicide = lifetime number of suicide attempts overall; Medical Suicide = lifetime number of medically attended suicide attempts.

*p < .05. **p < .01.

Note. ^a Variable scored where 1 = male and 0 = female.

^b Variables scored where 1 = presence and 0 = absence.

^c Only variables unique to each step in the model are presented. BPD = borderline personality disorder; SE = standard error; DT = distress tolerance; DT X PTSD = distress tolerance by PTSD symptom severity interaction.

*p < .05. **p < .01.

Note. ^a Variable scored where 1 = male and 0 = female.

^b Variables scored where 1 = presence and 0 = absence.

^c Only variables unique to each step in the model are presented. BPD = borderline personality disorder; SE = standard error; DT = distress tolerance; DT X PTSD = distress tolerance by PTSD symptom severity interaction.

*p < .05. **p < .01.

¹When negative affect induced during the PASAT was added as a covariate, this particular finding was rendered non-significant; however, all other significant associations remained significant when controlling for task-induced distress.

²Because past research has often considered DSH continuously, we re-ran our analyses utilizing lifetime frequency of DSH as a covariate rather than dichotomous DSH status. The results remained essentially unchanged, with the significance and direction of effects identical to the original analyses.