The structure of posttraumatic psychopathology in veterans attending primary care☆
Highlights
► We modelled the relationship between PTSD factors and latent factors of Fear and Anxious-Misery. ► These relationships will have implications for PTSD structure in DSM-5. ► PTSD Re-experiencing, Avoidance and Hyperarousal did not correlate more with the Fear factor. ► Hyperarousal was more closely related to Fear than was Re-experiencing. ► Dysphoria was more closely related to the Anxious-Misery factor than all other PTSD factors.
Section snippets
Procedures
Data were derived from a cross-sectional survey conducted on a random sample of veterans at four VA Medical Centers’ primary care clinics in the Southeastern U.S. (Charleston and Columbia, SC; Tuscaloosa and Birmingham, AL). Participants were randomly selected from a master list of eligible patients (determined as discussed below). Participants who provided written informed consent (after being given a complete study description) were administered a semi-structured clinic assessment, and within
Results
The rates of exposure to the various events assessed on the TAA (Resnick et al., 1993) are presented in Table 1.
CAPS total scores ranged from 0 to 119 (M = 14.50, SD = 27.44). Prevalence of PTSD on the CAPS was 12%. Prevalence of MINI disorders included 17.8% (major depressive episode), 13.9% (dysthymia), 13.1% (generalized anxiety disorder), 8.0% (panic disorder), 3.9% (social phobia), 2.1% (obsessive compulsive disorder), and 1.2% (agoraphobia without panic).
A CFA for the four-factor PTSD model
Discussion
The results of this paper found that the Simms et al.’s (2002) four-factor model of PTSD and a model encompassing common anxiety and mood disorders within two factors of Fear and Anxious-Misery consistent with Krueger's (1999) model fit the data well. Fit statistics remained excellent when these two measurement models were combined together. These results replicate the findings of Forbes et al. (2010) in a general veterans’ medical sample. Contrary to those previous findings the three more
Conflict of interest
The Australian Centre for Posttraumatic Mental Health is partially funded by the Australian Government Department of Veterans’ Affairs.
Acknowledgements
This study was supported by grants VCR-99-010-2 from Veterans Affairs Health Services Research and Development (Veterans Affairs HSR&D) to K.M.M. and an Australian National Health and Medical Research Council Program Grant (300304). All views and opinions expressed herein are those of the authors and do not necessarily reflect those of our respective institutions or the Department of Veterans Affairs.
References (51)
- et al.
Did Vietnam veterans get sicker in the 1990? The complicated effects of military service on self-reported health
Journal of Public Economics
(2010) - et al.
Psychological morbidity associated with motor vehicle accidents
Behaviour Research and Therapy
(1994) - et al.
Specificity of autonomic arousal to DSM-IV panic disorder and posttraumatic stress disorder
Behaviour Research and Therapy
(2009) - et al.
Testing whether posttraumatic stress disorder and major depressive disorder are similar or unique constructs
Journal of Anxiety Disorders
(2011) - et al.
Behavioral/cognitive conceptualizations of post-traumatic stress disorder
Behavior Therapy
(1989) - et al.
A longitudinal analysis of posttraumatic stress disorder symptoms and their relationship with fear and anxious-misery disorders: implications for DSM-V
Journal of Affective Disorders
(2010) - et al.
Prevalence of posttraumatic stress disorder in Veterans Affairs primary care clinics
General Hospital Psychiatry
(2005) - et al.
Understanding posttraumatic nightmares: An empirical and conceptual review
Clinical Psychology Review
(2008) - et al.
Posttraumatic stress disorder: An empirical evaluation of core assumptions
Clinical Psychology Review
(2008) - et al.
The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability
European Psychiatry
(1997)
Saving PTSD from itself in DSM-V
Journal of Anxiety Disorders
Diagnostic and statistical manual of mental disorders
The development of a clinician-administered PTSD scale
Journal of Traumatic Stress
Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal
Journal of Abnormal Psychology
The latent structure of post-traumatic stress disorder: tests of invariance by gender and trauma type
Psychological Medicine
Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications
Journal of Abnormal Psychology
Posttraumatic stress disorder and the structure of common mental disorders
Depression and Anxiety
Post-traumatic stress disorder: Findings from the Australian National Survey of Mental Health and Well-being
Psychological Medicine
Reaction to trauma: A cognitive processing model
Journal of Abnormal Psychology
Which patients talk about stressful events and social problems to the general practitioner?
Psychological Medicine
Which instruments are most commonly used to assess traumatic event exposure and posttraumatic effects? A survey of traumatic stress professionals
Journal of Traumatic Stress
An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data
Psychological Methods
The future of posttraumatic stress disorder in the DSM
Psychological Injury and Law
Differentiation of depression and PTSD symptoms in combat veterans
Depression and Anxiety
Cited by (15)
Beyond Distress and Fear: Differential Psychopathology Correlates of PTSD Symptom Clusters
2021, Journal of Affective DisordersCitation Excerpt :Because individuals diagnosed with PTSD are particularly likely to meet criteria for disorders such as MDD, GAD and social phobia, metastructural models tend to characterize PTSD as reflecting primarily internalizing distress (e.g., Kotov et al., 2017; Watson, 2005) and possibly fear (D. Forbes et al., 2010, 2011, 2012; Lockwood & Forbes, 2014; Watson, 2005).
PTSD symptoms are differentially associated with general distress and physiological arousal: Implications for the conceptualization and measurement of PTSD
2019, Journal of Anxiety DisordersCitation Excerpt :At least two features of these factor- or scale-level studies might explain the discrepant findings. First, a number of these investigations employed either dichotomous indicators of the presence or absence of PTSD symptoms or dichotomous indicators of fear and general distress disorders (e.g., Forbes et al., 2010; Forbes et al., 2012; Grös et al., 2012). Dichotomous indicators are prone to error relative to continuous measures (MacCallum, Zhang, Preacher, & Rucker, 2002).
Posttraumatic stress disorder's dysphoria dimension and relations with generalized anxiety disorder symptoms
2015, Psychiatry ResearchCitation Excerpt :This theory has yielded somewhat mixed findings within the PTSD literature. Whereas some studies have demonstrated that PTSD׳s dysphoria items are more related to external measures of emotional distress (Biehn et al., 2013; Elhai et al., 2011b; Forbes et al., 2010; Gros et al., 2012), other studies have not yielded this finding (Forbes et al., 2012; Marshall et al., 2010; Miller et al., 2010). Despite the mixed findings, one study has specifically examined the relation between PTSD׳s dysphoria with GAD (Grant et al., 2008).
The role of frontal EEG asymmetry in post-traumatic stress disorder
2015, Biological Psychology
- ☆
All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.