Youth exposed to natural disasters are at risk of developing trauma-related symptoms as well as engaging in substance use. Although previous research has established associations between disaster-related stressors and substance use in youth, less has focused on how symptoms of posttraumatic stress disorder (PTSD) may underpin this association. The current study used network analysis to identify specific PTSD symptoms associated with substance use following a natural disaster. Participants were 91,732 youths (Grades 3–12) from across Puerto Rico who completed a needs assessment 5–9 months after Hurricane Maria made landfall in September 2017. We examined associations between PTSD symptoms and substance use, identified clusters of symptoms and bridges between them, and explored age- and binary gender–related differences in associations between specific PTSD symptoms and substance use. Analyses identified two symptom communities: (a) arousal and reactivity, negative alterations in cognition and mood, and substance use, and (b) avoidance and intrusion. Broader findings suggested that substance use was most strongly associated with PTSD-related irritability and angry outbursts among youths. Surrounding nodes explained only 4.1% of the variance in substance use, but this was higher among youths who reported not having a supportive adult, R² = 8.5; friend, R² = 7.9; or teacher/counselor, R² = 7.7, in their life. The bridge symptoms of sleep disruption and physiological reactivity were identified as potentially critical intervention targets for disrupting PTSD symptom networks after a natural disaster. Implications for triaged mental health care following natural disasters and directions for future research are discussed.

中文翻译：

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对波多黎各青年与飓风玛丽亚相关的创伤性应激和物质使用的网络分析

遭受自然灾害的青少年面临出现创伤相关症状以及吸毒的风险。尽管之前的研究已经确定了灾害相关压力源与青少年药物滥用之间的关联，但很少关注创伤后应激障碍 (PTSD) 症状如何支撑这种关联。当前的研究使用网络分析来识别与自然灾害后物质使用相关的特定 PTSD 症状。参与者是来自波多黎各各地的 91,732 名青少年（3-12 年级），他们在 2017 年 9 月玛丽亚飓风登陆 5-9 个月后完成了需求评估。我们研究了 PTSD 症状与药物使用之间的关联，确定了症状群以及它们之间的桥梁，并探讨了特定 PTSD 症状与物质使用之间的关联的年龄和二元性别差异。分析确定了两个症状群：（a）觉醒和反应性、认知和情绪的负面改变以及物质使用，以及（b）回避和侵入。更广泛的研究结果表明，物质使用与青少年创伤后应激障碍（PTSD）相关的烦躁和愤怒爆发密切相关。周围节点仅解释了物质使用差异的 4.1%，但在报告没有成人支持的青少年中这一比例更高，R ² = 8.5；朋友，R ² = 7.9；或老师/辅导员，R ² = 7.7，在他们的生活中。睡眠中断和生理反应的桥梁症状被确定为破坏自然灾害后 PTSD 症状网络的潜在关键干预目标。讨论了自然灾害后分类心理保健的影响以及未来研究的方向。