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Trauma Prevalence and Its Association With Health-related Quality of Life in Pregnant Persons With Opioid Use
T John Winhusen1, Frankie Kropp, Shelly F Greenfield
1From the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH (TJW, FK, DL); Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH (TJW, FK, DL); Depart of Psychiatry, Harvard Medical School, Boston, MA (SFG); McLean Hospital, Division of Women's Mental Health and Division of Alcohol, Drugs and Addiction, Belmont, MA (SFG); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA (EEK); Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA (EEK); Department of Psychiatry and Behavioral Sciences and Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN (PRM); Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AJG); Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT (AJG); Department of Family and Community Health, Marshall University Joan C. Edwards School of Medicine, Huntington, WV (THD); Department of Pediatrics, One Boston Medical Center Place, Boston Medical Center, Boston, MA (EMW); University of Pittsburgh School of Medicine, Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical, Pittsburgh, PA (AD, XX); Department of Family Medicine Oregon Health Sciences University Portland, OR (KP); Department of Population Health Sciences, Joan & Sanford I. Weill Medical College of Cornell University, New York, NY (AJ); and Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research University of Kentucky College of Medicine, Lexington, KY (MRL).
Objectives:
Trauma screening is recommended for pregnant persons with opioid use disorder (OUD), but there is limited literature on screening results from buprenorphine treatment. This study's objectives were to 1) describe the types, and severity, of traumatic events reported and 2) evaluate the associations between trauma and health-related quality of life (HRQoL).
Methods:
Baseline data from an ongoing trial were analyzed. Participants were 155 pregnant persons with OUD receiving, or enrolling in, buprenorphine treatment at one of 13 sites. The experience, and relative severity, of 14 high magnitude stressors were assessed with the trauma history screen. The Patient-Reported Outcomes Measurement Information System-29+2 was used to assess 8 HRQoL domains.
Results:
Traumatic stressors were reported by 91% of the sample (n = 155), with 54.8% reporting a lifetime persisting posttraumatic distress (PPD) event and 29.7% reporting a childhood PPD event. The most prevalent lifetime PPD event was sudden death of a close family/friend (25.8%); physical abuse was the most prevalent childhood PPD event (10.3%). Participants with lifetime PPD, relative to no PPD, reported significantly greater pain interference ( P = 0.02). Participants with childhood PPD, relative to no PPD, had significantly worse HRQoL overall ( P = 0.01), and worse pain intensity ( P = 0.002), anxiety ( P = 0.003), depression ( P = 0.007), fatigue ( P = 0.002), and pain interference ( P < 0.001).
Conclusions:
A majority of pregnant persons enrolled/enrolling in buprenorphine treatment reported persisting posttraumatic distress with sudden death of close family/friend being the most prevalent originating event; clinicians should consider the impact that the opioid-overdose epidemic may be having in increasing trauma exposure in patients with OUD.
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