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Published in: Journal of Immigrant and Minority Health 3/2017

01-06-2017 | Original Paper

Posttraumatic Stress Symptoms and their Relationship to Drug and Alcohol use in an International Sample of Latino Immigrants

Authors: Zorangelí Ramos, Lisa R. Fortuna, Michelle V. Porche, Ye Wang, Patrick E. Shrout, Stephen Loder, Samantha McPeck, Nestor Noyola, Manuela Toro, Rodrigo Carmona, Margarita Alegría

Published in: Journal of Immigrant and Minority Health | Issue 3/2017

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Abstract

We identify the prevalence and correlates of posttraumatic stress (PTSD) symptoms and their relationship to alcohol and substance use disorders (AUD/SUD) among Latino immigrants in two countries. A screening battery assessing PTSD symptoms (PCL-C), alcohol use (AUDIT), drug abuse (DAST), and psychological measures was administered to 562 Latino immigrants recruited in clinics. We used logistical regression analyses to evaluate the relationship between PTSD symptoms and AUD/SUD. Prevalence of elevated PTSD symptoms was high (53.7 % in Boston, 47.9 % in Madrid and, 43.8 % in Barcelona). Screening positive for psychological measures was significantly correlated to screening positive on the PCL-C (p < 0.001). Significant gender differences in risk of AUD/SUD were moderated by PTSD symptoms. Presence of any PTSD symptoms predicted problems with benzodiazepine misuse. Given the high rates of co-morbidity between PTSD symptoms and AUD/SUD, we recommend early interventions for dual pathology for Latino immigrants with trauma history.
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Metadata
Title
Posttraumatic Stress Symptoms and their Relationship to Drug and Alcohol use in an International Sample of Latino Immigrants
Authors
Zorangelí Ramos
Lisa R. Fortuna
Michelle V. Porche
Ye Wang
Patrick E. Shrout
Stephen Loder
Samantha McPeck
Nestor Noyola
Manuela Toro
Rodrigo Carmona
Margarita Alegría
Publication date
01-06-2017
Publisher
Springer US
Published in
Journal of Immigrant and Minority Health / Issue 3/2017
Print ISSN: 1557-1912
Electronic ISSN: 1557-1920
DOI
https://doi.org/10.1007/s10903-016-0426-y

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