The structure of posttraumatic psychopathology in veterans attending primary care

doi:10.1016/j.janxdis.2011.09.004

Journal of Anxiety Disorders

Volume 26, Issue 1, January 2012, Pages 95-101

https://doi.org/10.1016/j.janxdis.2011.09.004 Get rights and content

Abstract

This study attempted to extend research indicating that posttraumatic stress disorder (PTSD) factors of Re-experiencing, Avoidance and Hyperarousal are more related to Fear/phobic disorders, while PTSD Dysphoria is more related to Anxious-Misery disorders. Trauma exposure, PTSD and comorbidity data for 668 veteran patients were analysed using confirmatory factor analyses and relative strengths of the relationships between PTSD factors and the Fear and Anxious-Misery factors were assessed. Combining Simms, Watson, and Doebbeling's (2002) model of PTSD symptoms and Krueger's (1999) Fear/Anxious Misery model of mood and anxiety disorders fit the data well. Contrary to previous research, PTSD Re-experiencing, Avoidance and Hyperarousal did not correlate more with the Fear factor; nor did PTSD Dysphoria correlate more with Anxious-Misery. Hyperarousal was more closely related to Fear than was Re-experiencing; however, Avoidance was not. Dysphoria was more closely related to the Anxious-Misery factor than all other PTSD factors.

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.

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^☆: 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.

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The structure of posttraumatic psychopathology in veterans attending primary care☆

Abstract

Highlights

Section snippets

Procedures

Results

Discussion

Conflict of interest

Acknowledgements

Journal of Public Economics

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Anxiety Disorders

Behavior Therapy

Journal of Affective Disorders

General Hospital Psychiatry

Clinical Psychology Review

Clinical Psychology Review

European Psychiatry

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