From Childhood to Adulthood: the Co-occurrence of Trauma, Substance Use, and Additional Stressors - Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur. Existing research mainly focuses on symptoms among adults and lacks consideration of situational stress factors (SSFs), limiting its generalizability to other developmental periods (e.g., adolescence) for many Americans. PTSD and SUD depend on specific events—trauma exposure and substance use—often occurring during childhood/adolescence. Therefore, it is imperative to adopt a developmental psychopathological perspective to investigate the causes of this comorbidity, from events to symptoms, and include all Americans experiencing SSFs to generalize findings to all communities. Such an approach will yield a comprehensive understanding of comorbid PTSD + SUD, helping us determine the need for tailoring etiologic hypotheses to adolescents and efficiently allocate resources for early intervention and prevention for all Americans. We will use two largescale,longitudinal, multi-domain datasets: the Adolescent Brain Cognitive Development (ABCD) Study and the National Longitudinal Study of Adolescent to Adult Health (Add Health), to comprehensively evaluate the relationship between trauma exposure and substance use, incorporating SSFs, among the full population of Americans from childhood through adulthood. The study aims to test whether SSFs moderate adolescent trauma and substance use co-occurrence (AIM 1; K99 phase; ABCD), examine etiological trajectories of cooccurring trauma and substance use from event occurrence to symptom onset (AIM 2; K99 phase; Add Health), and test whether SSFs moderate the trajectory from event-level co-occurrence to PTSD+SUD symptom onset from childhood through adulthood (AIM 3; R00 phase; ABCD and Add Health). The strategic use of large, nationwide datasets—ABCD and Add Health—holds an unparalleled opportunity to comprehensively understand the developmental etiology of comorbid PTSD+SUD, generalizable to all Americans, from childhood through adulthood (ABCD: ages 9 – 18; Add Health: ages 12 – 42); a research endeavor that is extremely difficult and costly to initiate from scratch. Dr. Patel’s proposed training plan will enhance his existing skill set in comorbid PTSD+SUD. The mentorship team will provide necessary expertise and support to facilitate Dr. Patel’s transition to independence by acquiring training in developing stressfocused research questions and data analyses with a focus on co-occurring factors (training goal 1; advisors Dr. Gonzalez & Dr. Potter), developmental psychopathology of adolescent trauma exposure and substance use (training goal 2; co-mentor Dr. Brown), advanced within-youth statistical techniques (training goal 3; commentor Dr. Pelham), gaining clinical experience with co-occurring adolescent trauma and substance use (training goal 4; advisors Dr. Norman & Dr. Hanson), and engaging in professional development training and mentorship (5; all mentors and advisors). The proposed award will position Dr. Patel as one of the very few experts on the developmental psychopathological etiology of comorbid PTSD + SUD, integrating SSFs to generalize the etiology across the full population.
