​Povezava med travmatskimi izkušnjami pred 18. letom in sodelovalnostjo pri bolnišničnem zdravljenju odvisnosti od prepovedanih psihoaktivnih snovi

Ristić-Ilić, Jelena (author), Kastelic, Andrej (mentor)

Uvod: Bolezni odvisnosti predstavljajo velik javnozdravstveni in socialni problem, ki se skozi čas povečuje. Podobno velja za psihične in zdravstvene posledice zgodnje travmatske izkušnje. Dosedanje raziskave so ugotavljale povezanost med travmatskimi izkušnjami v otroštvu in jemanjem prepovedanih psihoaktivnih snovi (PAS), vendar niso obsežno raziskale dejavnikov, ki vplivajo na izhod zdravljenja v smislu sodelovalnosti. Namen dela je bil ugotoviti povezanost med travmatskimi dogodki pred 18. letom, prisotnostjo pomembnega zaščitniškega odraslega v času travmatskega dogodka, anksioznostjo in depresivnostjo v času zdravljenja, tveganimi vedenji in vključenostjo pomembnih bližnjih oseb pri aktualnem bolnišničnem zdravljenju ter sodelovalnostjo pacientov pri zdravljenju. Metode: Uporabljena je bila kvantitativna presečna metoda raziskovanja. V obdobju od 13. 1. 2020 do 31. 5. 2021 so bili razdeljeni vprašalniki vsem bolnišnično sprejetim pacientom (N=218) Centra za zdravljenje odvisnih od prepovedanih drog Univerzitetne psihiatrične klinike Ljubljana. Sodelovanje je odklonil en pacient, raziskave se jih je udeležilo 217. Strukturirani vprašalnik so izpolnjevali prvi teden po sprejemu v bolnišnični program zdravljenja. Za oceno travmatskih izkušenj pred 18. letom je bila uporabljena krajša različica vprašalnika Early Trauma Inventory Self Report-Short Form (ETISR-SF). Intervjuje je opravil zdravnik. Tvegano pitje alkohola je bilo ocenjeno z vprašalnikom AUDIT, prisotnost depresivnih in anksioznih simptomov pa z Zungovimi samoocenjevalnimi lestvicami depresivnosti in anksioznosti, ki so jih pacienti izpolnjevali samostojno v prisotnosti zdravstvenega osebja. Podatki o vrstah PAS so pridobljeni z uporabo urinskih testov ob sprejemu, podatki o virusni hepatitis C okužbi iz mikrobioloških izvidov, o prejšnjih zdravljenjih in pridruženih duševnih motnjah pa iz medicinske dokumentacije in bolnišničnega informacijskega sistema. Sodelovalnost je bila opredeljena kot zaključek bolnišničnega zdravljenja v skladu s skupno dogovorjenim načrtom med pacientom in psihiatrom/terapevtom (da-ne). Za analizo podatkov je bila uporabljena opisna in bivariantna statistika ter regresija. Povezave s p < 0,05 so se obravnavale kot statistično značilne. Rezultati: V raziskavo se je vključilo 217 bolnišnično zdravljenih pacientov na CZOPD, od tega 51 (23,5 %) žensk in 166 (76,5 %) moških, starih 36±7 let. O pomembni travmatski izkušnji v otroštvu je poročalo 78,8 % udeleženih. Izkazalo se je, da je sodelovalnost pri zdravljenju statistično značilno povezana s čustveno travmatsko izkušnjo pred 18. letom [RO (95 % IZ) 0,52 (0,3; 0,9), p = 0,019], ne pa s preostalimi vrstami travmatskih izkušenj (splošna, fizična, spolna). Čustvena travmatska izkušnja je bila povezana z večino raziskovanih tveganih vedenj. Pri slabi tretjini udeležencev (30,4 %) je bil v času travmatske izkušnje prisoten zaščitniški odrasli, a se to ni izkazalo kot statistično značilno povezano s sodelovalnostjo pri bolnišničnem zdravljenju [RO (95 % IZ) 0,75 (0,42; 1,35), p = 0,339]. Število tveganih vedenj je bilo statistično značilno povezano s prisotnostjo travmatske izkušnje pred 18. letom [RO (95 % IZ) 1,35 (1,17; 1,57), p < 0,001], ne pa s sodelovalnostjo pri zdravljenju [RO (95 % IZ) 1,01 (0,91; 1,11), p = 0,897]. Prisotnost anksioznih in depresivnih simptomov v času zdravljenja se ni izkazala za statistično pomembno povezano s sodelovalnostjo pri zdravljenju: [RO (95 % IZ) 0,81 (0,47; 1,38), p = 0,434] in [RO (95 % IZ) 0,64 (0,34; 1,18), p = 0,151], prav tako ne s pomembno travmatsko izkušnjo: [RO (95 % IZ) 1,05 (0,99; 1,12), p = 0,091] in [RO (95 % IZ) 0,99 (0,95; 1,03), p = 0,551]. Razlike po spolu in starosti na vzorcu niso bile statistično značilne. Zaključek: Ugotovitve raziskave, da je več kot tri četrt pacientov poročalo o pomembni travmatični izkušnji, da je prisotnost travmatične izkušnje povezana s številom tveganih vedenj in da je čustvena travmatična izkušnja povezana z negativnim izhodom zdravljenja bolezni odvisnosti, nakazujejo potrebo po rutinskem ocenjevanju travmatskih izkušenj v otroštvu pri obravnavi pacientov, odvisnih od PAS. Rezultati lahko predstavljajo izhodišča za nadaljnje raziskovanje v smislu iskanja drugih dejavnikov, ki součinkujejo s sodelovalnostjo pri zdravljenju.

• Language: Slovenian
• Keywords: travmatska izkušnja pred 18. letom, odvisnost, prepovedane psihoaktivne snovi, sodelovalnost pri bolnišničnem zdravljenju.
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2023
• PID: 20.500.12556/RUL-151746
• Publication date in RUL: 19.10.2023

Secondary language

• Language: English
• Title: The connection between traumatic experiences before the age of 18 and adherence in hospital treatment of ilegal psychoactive substance use disorders

Abstract

Introduction: Addiction disorders represent a major public health and social problem that is increasing over time. The same applies to the psychological and medical consequences of an early traumatic experience. Previous research has identified a link between traumatic childhood experiences and the use of illegal psychoactive substances, but has not extensively explored factors that influence treatment outcomes in terms of adherence. The purpose of the work was to determine the connection between traumatic events before the age of 18, the presence of an important protective adult at the time of the traumatic event, anxiety and depression during treatment, risk behaviors and the involvement of important close people in current hospital treatment, and patient adherence in treatment. Methods: A quantitative cross-sectional research method was used. In the period from January 13, 2020 to May 31, 2021, questionnaires were distributed to all inpatients (N=218) of the Center for the Treatment of Drug Addiction, University Psychiatric Clinic Ljubljana. One patient refused to participate, 217 participated in the research. The structured questionnaire was completed during the first week after admission to the hospital treatment program. A shorter version of the Early Trauma Inventory Self Report-Short Form (ETISR-SF) was used to assess traumatic experiences before the age of 18. The interviews were conducted by a doctor. Risky drinking of alcohol was assessed with the AUDIT questionnaire, and the presence of depressive and anxiety symptoms with the Zung self-rating depression and anxiety scales, which the patients completed independently in the presence of medical staff. Data on: types of illegal psychoactive substances are obtained using urine tests on admission; hepatitis C viral infection from serological blood testing; and previous treatments and associated mental disorders from medical records and the hospital information system. Adherence was defined as completion of inpatient treatment according to a mutually agreed upon plan between the patient and the psychiatrist/therapist (yes-no). Descriptive and bivariate statistics and regression were used for data analysis. Associations with p < 0.05 were considered statistically significant. Results: The study included 217 inpatients, of which 51 (23.5%) were women and 166 (76.5%) were men, aged 36±7 years. A significant traumatic experience in childhood was reported by 78.8% of the participants. Treatment adherence was found to be statistically significantly associated with emotional traumatic experience before age 18 [OR (95% CI) 0.52 (0.3, 0.9), p = 0.019], but not with the remaining types traumatic experiences (general, physical, sexual). An emotional traumatic experience was associated with most of the risk behaviors investigated. Just under a third of participants (30.4%) had a protective adult present at the time of the traumatic experience, but this was not statistically significantly associated with adherence in hospital treatment [OR (95% CI) 0.75 (0.42; 1 .35), p = 0.339]. The number of risk behaviors was statistically significantly associated with the presence of a traumatic experience before the age of 18 [OR (95% CI) 1.35 (1.17, 1.57), p < 0.001], but not with treatment adherence [OR ( 95% CI) 1.01 (0.91, 1.11), p = 0.897]. The presence of anxiety and depressive symptoms during treatment did not appear to be statistically significantly associated with treatment adherence: [OR (95% CI) 0.81 (0.47, 1.38), p = 0.434] and [OR (95% CI) 0.81 (0.47, 1.38), p = 0.434 CI) 0.64 (0.34, 1.18), p = 0.151], also not with significant traumatic experience: [OR (95% CI) 1.05 (0.99, 1.12), p = 0.091] and [OR (95% CI) 0.99 (0.95, 1.03), p = 0.551]. Differences by gender and age in the sample were not statistically significant. Conclusion: The research findings that more than three-quarters of inpatients reported a significant traumatic experience, that the presence of a traumatic experience is related to the number of risk behaviors, and that an emotionally traumatic experience is related to a negative outcome of addiction treatment, suggest the need for routine assessment of childhood traumatic experiences in treatment of patients dependent on psychoactive substances. The results can represent starting points for further research in terms of finding other factors that interact with adherence in treatment.

• Keywords: traumatic experiences before the age of 18, addiction, illegal psychoactive substances, adherence in hospital treatment.