Posttraumatic Cognitions as a Potential Mechanism of the Association of Posttraumatic Stress Disorder Symptom Severity and Alcohol Use Among Survivors of Military Sexual Assault

Posttraumatic stress disorder (PTSD) symptom severity and alcohol use are disproportionately high and often related to military sexual assault (MSA) survivors. Theories of trauma and alcohol use implicate the role of negative cognitive processes following traumatic events, suggesting that a potential mechanism of this association may be posttraumatic cognitions (PTCs). PTCs include negative beliefs about the self and the world following trauma exposure. Further, as sex differences are shown in PTSD, PTCs, and alcohol use, these relationships may vary by biological sex. This secondary data analysis of MSA survivors (<i>n</i> = 400; 50% male) examined PTCs as a mediator of the association of PTSD symptom severity and alcohol use, and whether these effects differed by sex. An indirect effect of PTCs was specified with sex entered as a moderator of the "a" and "b" paths. An indirect effect of PTCs on the association of PTSD severity and alcohol use among males was detected (<i>b</i> = 0.06, 95% CI [0.01, 0.11]), but this was not significant among females (<i>b</i> = 0.03 [-0.01, 0.07]). Sex (coefficient = 0.38 [0.01, 0.75]) moderated the association of PTSD and PTCs such that the association was stronger among males (coefficient = 1.23 [0.99, 1.48]). There was no moderated effect of sex on the association of PTCs and alcohol use. Efforts to reduce alcohol use among males may benefit from targeting PTSD severity by lowering PTCs, while that among females-and other dimensions such as race and sexual orientation-requires additional investigation.