PTSD, optimism, and life satisfaction during early SUD treatment among native Hawaiian and Pacific islander patients

Mental health and resilience change rapidly early in substance use disorder (SUD) treatment. However, these processes have not been characterized among Native Hawaiian and Pacific Islander (NHPI) patients, despite disproportionate trauma exposure and treatment barriers. Examining how posttraumatic stress disorder (PTSD) symptoms, optimism, and quality of life satisfaction fluctuate during early treatment may help improve care. This study investigated within- and between-person associations among PTSD, optimism, and life satisfaction over the first month of treatment. From 2021 to 2024, N = 180 NHPI patients completed up to four weekly surveys assessing PTSD symptoms, optimism, and life satisfaction. Mixed-effects models with random intercepts separated predictors of PTSD symptoms into between- and within-person effects, controlling for treatment week. We estimated single-predictor models for life satisfaction and optimism, a combined model including both, and a covariate-adjusted combined model. Across models, less severe PTSD symptoms were associated with higher mean (between-person) and week-to-week (within-person) optimism and life satisfaction. In the covariate-adjusted combined model, lower PTSD severity remained associated with higher mean optimism (b = -0.12, SE = 0.02, p < .001), higher mean life satisfaction (b = -0.05, SE = 0.02, p < .001), and higher-than-usual week-to-week levels of optimism (b = -0.06, SE = 0.01, p < .001) and life satisfaction (b = -0.03, SE = 0.01, p = .007). During early treatment, higher between-person and week-to-week (within-person) optimism and life satisfaction were consistently associated with lower PTSD severity. Findings suggest that strengths-based factors are important considerations when delivering trauma-informed, culturally responsive care to NHPI patients in early recovery.