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Objective: The number of refugees worldwide is unprecedented in recent history. Little is known, however, about profiles of psychological symptoms following persecution and displacement. Methods: This study reports on a latent class analysis that identified profiles of posttraumatic stress disorder (PTSD), depression and anxiety symptoms in a nationally representative sample of 1625 refugees in Australia. The association between specific symptom profiles, exposure to potentially traumatic events and post-migration stressors, and overall health and help-seeking was examined. Results: Latent class analysis yielded an optimal five-class solution. These classes comprised the Pervasive Symptom class (19.2%), the High PTSD Symptom class (17.1%), the High Depression/Anxiety Symptom class (16.4%), the Moderate PTSD Symptom class (16.2%) and the Low Symptom class (31.1%). Participants in the symptomatic classes were more likely to be female, older and report greater post-migration stressors than those in the Low Symptom class. In addition, individuals in classes characterized by PTSD symptoms had been exposed to more types of potentially traumatic events. Membership in symptomatic classes was associated with poorer overall heath and greater help-seeking. Conclusion: Qualitatively distinct symptom profiles were observed in a nationally representative sample of refugees. In addition to a group of people who reported high symptoms across psychological disorders and may warrant clinical intervention, we identified two subclinical classes who may be missed by existing diagnostic classification systems. Post-migration stressors play an important role in influencing refugee symptom profiles over and above exposure to potentially traumatic events. Clinicians should consider specific symptom profiles and contextual factors when planning interventions with refugees.

Background: Many refugees experience bereavement, and as a result they suffer elevated rates of prolonged grief disorder. Evidence also indicates that elevated rates of psychological disturbance in refugee children can be associated with parental mental health. This study examined the extent to which prolonged grief disorder in refugees is associated with their parenting behaviour and in turn with their children’s mental health. Methods: This study recruited participants from the Building a New Life in Australia prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015–2016 and comprised 1799 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, harsh and warm parenting, probable prolonged grief disorder and posttraumatic stress disorder. Children were administered the Strengths and Difficulties Questionnaire. The current analyses on bereaved refugees comprise 110 caregivers and 178 children. Results: In this cohort, 37% of bereaved refugees reported probable prolonged grief disorder. Path analysis indicated that caregivers’ grief was directly associated with children’s emotional difficulties. Caregiver warmth was associated with reduced emotional problems in children of refugees with minimal grief but associated with more emotional problems in caregivers with more severe grief. More harsh parenting was associated with children’s conduct problems, and this was more evident in those with less severe grief. Conclusion: Severity of prolonged grief disorder is directly linked to refugee children’s mental health. The association between parenting style, grief severity and children’s mental health highlights that managing grief reactions in refugees can benefit both refugees and their children.

Recent research has found that exposure to traumatic events may occur in certain patterns, rather than randomly. Person-centered analyses, and specifically latent class analysis, is becoming increasingly popular in examining patterns, or 'classes' of trauma exposure. This review aimed to identify whether there are consistent homogeneous subgroups of trauma-exposed individuals, and the relationship between these trauma classes and psychiatric diagnosis. A systematic review of the literature was completed using the databases EMBASE, MEDLINE (PubMed) and PsycINFO. From an initial yield of 189, 17 studies met inclusion criteria. All studies identified a group of individuals who had a higher likelihood of exposure to a wide range of traumas types, and this group consistently exhibited worse psychiatric outcomes than other groups. Studies differed in the nature of the other groups identified although there was often a class with high levels of sexual interpersonal trauma exposure, and a class with high levels of non-sexual interpersonal trauma. There was some evidence that risk for psychiatric disorder differed across these classes. Person-centered approaches to understanding the relationship between trauma exposure and mental health may offer ways to improve our understanding of the role trauma exposure plays in increasing vulnerability to psychiatric disorder.

BackgroundProlonged separation from parental support is a risk factor for psychopathology. This study assessed the impact of brief separation from parents during childhood trauma on adult attachment tendencies and post-traumatic stress.MethodChildren (n = 806) exposed to a major Australian bushfire disaster in 1983 and matched controls (n = 725) were assessed in the aftermath of the fires (mean age 7–8 years) via parent reports of trauma exposure and separation from parents during the fires. Participants (n = 500) were subsequently assessed 28 years after initial assessment on the Experiences in Close Relationships scale to assess attachment security, and post-traumatic stress disorder (PTSD) was assessed using the PTSD checklist.ResultsBeing separated from parents was significantly related to having an avoidant attachment style as an adult (B = −3.69, s.e. = 1.48, β = −0.23, p = 0.013). Avoidant attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.31, p = 0.045), avoidance (B = 0.03, s.e. = 0.01, β = 0.30, p = 0.001) and numbing (B = 0.03, s.e. = 0.01, β = 0.30, p < 0.001) symptoms. Anxious attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.18, p = 0.001), numbing (B = 0.03, β = 0.30, s.e. = 0.01, p < 0.001) and arousal (B = 0.04, s.e. = 0.01, β = 0.43, p < 0.001) symptoms.ConclusionsThese findings demonstrate that brief separation from attachments during childhood trauma can have long-lasting effects on one's attachment security, and that this can be associated with adult post-traumatic psychopathology.

Aims Despite the frequency that refugees suffer bereavement, there is a dearth of research into the prevalence and predictors of problematic grief reactions in refugees. To address this gap, this study reports a nationally representative population-based study of refugees to determine the prevalence of probable prolonged grief disorder (PGD) and its associated problems. Methods This study recruited participants from the Building a New Life in Australia (BNLA) prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015–2016, and comprised 1767 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, probable PGD, post-traumatic stress disorder (PTSD) and mental illness. Children were administered the Strengths and Difficulties Questionnaire. Results In this cohort, 38.1% of refugees reported bereavement, of whom 15.8% reported probable PGD; this represents 6.0% of the entire cohort. Probable PGD was associated with a greater likelihood of mental illness, probable PTSD, severe mental illness, currently unemployed and reported disability. Children of refugees with probable PGD reported more psychological difficulties than those whose parents did not have probable PGD. Probable PGD was also associated with the history of imprisonment, torture and separation from family. Only 56.3% of refugees with probable PGD had received psychological assistance. Conclusions Bereavement and probable PGD appear highly prevalent in refugees, and PGD seems to be associated with disability in the refugees and psychological problems in their children. The low rate of access to mental health assistance for these refugees highlights that there is a need to address this issue in refugee populations.

Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health.

Adjustment disorder has been recategorized as a trauma- and stressor-related disorder in DSM-5. The aim of this study was to determine the prevalence of adjustment disorder in the first 12 months after severe injury; to determine whether adjustment disorder was a less severe disorder compared with other disorders in terms of disability and quality of life; to investigate the trajectory of adjustment disorder; and to examine whether the subtypes described in DSM-5 are distinguishable.In a multisite, cohort study, injury patients were assessed during hospitalization and at 3 and 12 months postinjury (N=826). Structured clinical interviews were used to assess affective, anxiety, and substance use disorders, and self-report measures of disability, anxiety, depression, and quality of life were administered.The prevalence of adjustment disorder was 19% at 3 months and 16% at 12 months. Participants with adjustment disorder reported worse outcomes relative to those with no psychiatric diagnosis but better outcomes compared with those diagnosed with other psychiatric disorders. Participants with adjustment disorder at 3 months postinjury were significantly more likely to meet criteria for a psychiatric disorder at 12 months (odds ratio=2.67, 95% CI=1.59-4.49). Latent-profile analysis identified a three-class model that was based on symptom severity, not the subtypes identified by DSM-5.Recategorization of adjustment disorder into the trauma- and stressor-related disorders is supported by this study. However, further description of the phenomenology of the disorder is required.

OBJECTIVE: Although traumatic injuries affect millions of patients each year and increase risk for psychiatric disorder, no evidence currently exists regarding associated suicidal risk. This study reports a longitudinal investigation of suicidal risk in the 2 years after traumatic injury. METHODS: A prospective design cohort study was conducted in 4 major trauma hospitals across Australia. A total of 1,129 traumatically injured patients were assessed during hospital admission between April 2004 and February 2006 and were followed up at 3 months (88%), 12 months (77%), and 24 months (72%). Lifetime psychiatric disorder was assessed in hospital using the Mini-International Neuropsychiatric Interview, version 5.5, which was also used to assess the prevalence of suicidality, psychiatric disorder, and exposure to adverse life events at 3, 12, and 24 months after traumatic injury. RESULTS: Approximately 6% of patients reported moderate/high suicidal risk at each assessment. At each assessment, half of suicidal patients reported no suicidal risk at the previous assessment. Suicidality at 24 months was predicted by current pain levels (odds ratio [OR] = 1.16; 95% CI, 1.09-1.23), recent life events (OR = 1.30; 95% CI,1.17-1.44), and current psychiatric disorder (OR = 17.07; 95% CI, 7.03-41.42), whereas only 36.6% of suicidal patients had consulted a mental health professional in the previous month, and 66.2% had consulted a primary care physician. CONCLUSIONS: Suicidal risk affects a significant proportion of patients who experience a traumatic injury, and the risk for suicide fluctuates markedly in the initial years following the injury. Primary care physicians need to be trained to assess for suicidal risk in the initial years after a traumatic injury.© Copyright 2016 Physicians Postgraduate Press, Inc. Language: en

Background: It is unclear which specific symptoms of post-traumatic stress disorder are related to poor perceived quality of life. Objective: To investigate the influence of post-traumatic stress disorder symptomatology on quality of life in traumatic injury survivors. Method: Traumatic injury survivors completed questionnaires on post-traumatic stress disorder symptomatology and quality of life at 3 months ( n = 987), 12 months ( n = 862), 24 months ( n = 830) and 6 years ( n = 613) post trauma. Results: Low quality of life was reported by 14.5% of injury survivors at 3 months and 8% at 6 years post event. The post-traumatic stress disorder symptom clusters that contributed most to poor perceived quality of life were numbing and arousal, the individual symptoms that contributed most were anger, hypervigilance and restricted affect. Conclusions: There was variability in the quality of life of traumatic injury survivors in the 6 years following trauma and a consistent proportion reported low quality of life. Early intervention to reduce anger, hypervigilance and restricted affect symptoms may provide a means to improving the quality of life of traumatic injury survivors.

Summary Background Children and adolescents, who account for most of the world's refugees, have an increased prevalence of psychological disorders. The mental health of refugee children is often associated with the severity of post-traumatic stress disorder (PTSD) in their caregivers. Despite the potential for refugee caregivers' PTSD to affect child mental health, little evidence exists concerning the underlying mechanisms of this association. This study tested the effect of refugee caregivers' previous trauma and levels of ongoing stressors on current PTSD, and in turn how this influences parenting behaviour and consequent child psychological health. Methods This cohort study recruited participants from the Building a New Life in Australia study, a population-based prospective cohort study of refugees admitted to 11 sites in Australia between October, 2013, and February, 2014. Eligible participants were aged 18 years or older and the principal or secondary applicant (ie, the refugee applicant within a migrating family unit) for a humanitarian visa awarded between May, 2013, and December, 2013. Primary caregiver PTSD and postmigration difficulties were assessed at Wave 1 (in 2013), and caregiver PTSD was reassessed at Wave 2 (in 2014). At Wave 3, between October, 2015, and February, 2016, primary caregivers repeated measures of trauma history, postmigration difficulties, probable PTSD, and harsh and warm parenting style, and completed the Strengths and Difficulties Questionnaire for their child. We used path analysis to investigate temporal patterns in PTSD, trauma history, postmigration stressors, parenting style, and children's psychological difficulties. Findings The current data comprised 411 primary caregivers who provided responses in relation to at least one child (660 children). 394 primary caregivers with 639 children had data on independent variables and were included in the final model. Path analyses revealed that caregivers' trauma history and postmigration difficulties were associated with greater subsequent PTSD, which in turn was associated with greater harsh parenting and in turn, higher levels of child conduct problems (β=0·049, p=0·0214), hyperactivity (β=0·044, p=0·0241), emotional symptoms (β=0·041, p=0·0218), and peer problems (β=0·007, p=0·047). There was also a direct path from primary caregiver PTSD to children's emotional problems (β=0·144, p=0·0001). Interpretation PTSD in refugees is associated with harsh parenting styles, leading to adverse effects on their children's mental health. Programmes to enhance refugee children's mental health should account for PTSD in parents and caregivers, and the parenting behaviours that these children are exposed to. Funding National Health and Medical Research Council.

This study investigated whether impairment persists after posttraumatic stress disorder (PTSD) has resolved. Traumatically injured patients ( N = 1,035) were assessed during hospital admission and at 3 (85%) and 12 months (73%). Quality of life prior to traumatic injury was measured with the World Health Organization Quality of Life–BREF during hospitalization and at each subsequent assessment. PTSD was assessed using the Clinician-Administered PTSD Scale at 3 and 12 months. After controlling for preinjury functioning, current pain, and comorbid depression, patients whose PTSD symptoms had resolved by 12 months were more likely to have poorer quality of life in psychological (OR = 3.51), physical (OR = 10.17), social (OR = 4.54), and environmental (OR = 8.83) domains than those who never developed PTSD. These data provide initial evidence that PTSD can result in lingering effects on functional capacity even after remission of symptoms.

BackgroundTraumatic injuries affect millions of patients each year, and resulting post-traumatic stress disorder (PTSD) significantly contributes to subsequent impairment.AimsTo map the distinctive long-term trajectories of PTSD responses over 6 years by using latent growth mixture modelling.MethodRandomly selected injury patients (n = 1084) admitted to four hospitals around Australia were assessed in hospital, and at 3, 12, 24 and 72 months. Lifetime psychiatric history and current PTSD severity and functioning were assessed.ResultsFive trajectories of PTSD response were noted across the 6 years: (a) chronic (4%), (b) recovery (6%), (c) worsening/recovery (8%), (d) worsening (10%) and (e) resilient (73%). A poorer trajectory was predicted by female gender, recent life stressors, presence of mild traumatic brain injury and admission to intensive care unit.ConclusionsThese findings demonstrate the long-term PTSD effects that can occur following traumatic injury. The different trajectories highlight that monitoring a subset of patients over time is probably a more accurate means of identifying PTSD rather than relying on factors that can be assessed during hospital admission.

Objective Little research to date has explored the typologies of psychopathology following trauma, beyond development of particular diagnoses such as posttraumatic stress disorder (PTSD). The objective of this study was to determine the longitudinal patterns of these typologies, especially the movement of persons across clusters of psychopathology. Method In this 6-year longitudinal study, 1,167 hospitalized severe injury patients who were recruited between April 2004-February 2006 were analyzed, with repeated measures at baseline, 3 months, 12 months, and 72 months after injury. All patients met the DSM-IV criterion A1 for PTSD. Structured clinical interviews were used to assess psychiatric disorders at each follow-up point. Latent class analysis and latent transition analysis were applied to assess clusters of individuals determined by psychopathology. The Mini International Neuropsychiatric Interview (MINI) and Clinician-Administered PTSD Scale (CAPS) were employed to complete diagnoses. Results Four latent classes were identified at each time point: (1) Alcohol/Depression class (3 months, 2.1%; 12 months, 1.3%; and 72 months, 1.1%), (2) Alcohol class (3 months, 3.3%; 12 months, 3.7%; and 72 months, 5.4%), (3) PTSD/Depression class (3 months, 10.3%; 12 months, 11.5%; and 72 months, 6.4%), and (4) No Disorder class (3 months, 84.2%; 12 months, 83.5%; and 72 months, 87.1%). Latent transition analyses conducted across the 2 transition points (12 months and 72 months) found consistently high levels of stability in the No Disorder class (90.9%, 93.0%, respectively) but lower and reducing levels of consistency in the PTSD/Depression class (81.3%, 46.6%), the Alcohol/Depression class (59.7%, 21.5%), and the Alcohol class (61.0%, 36.5%), demonstrating high levels of between-class migration. Conclusions Despite the array of psychiatric disorders that may develop following severe injury, a 4-class model best described the data with excellent classification certainty. The high levels of migration across classes indicate a complex pattern of psychopathology expression over time. The findings have considerable implications for tailoring multifocused interventions to class type, as well as flexible stepped care models, and for the potential development and delivery of transdiagnostic interventions targeting underlying mechanisms.

BackgroundThe latent structure of the proposed ICD-11 post-traumatic stress disorder (PTSD) symptoms has not been explored.AimsTo investigate the latent structure of the proposed ICD-11 PTSD symptoms.MethodConfirmatory factor analyses using data from structured clinical interviews administered to injury patients (n = 613) 6 years post-trauma. Measures of disability and psychological quality of life (QoL) were also administered.ResultsAlthough the three-factor model implied by the ICD-11 diagnostic criteria fit the data well, a two-factor model provided equivalent, if not superior, fit. Whereas diagnostic criteria based on this two-factor model resulted in an increase in PTSD point prevalence (5.1% v. 3.4%; z = 2.32, PP = 0.933) and QoL (P = 0.591) to those identified by the ICD-11 criteria.ConclusionsConsistent with theorised reciprocal relationships between re-experiencing and avoidance in PTSD, these findings support an alternative diagnostic algorithm requiring at least two of any of the four re-experiencing/avoidance symptoms and at least one of the two hyperarousal symptoms.

Although recent veterans have been found to be at increased risk of psychiatric disorders, limited research has focused on alcohol or substance use disorders. This systematic review and meta-analysis examined whether alcohol or substance use disorders were more common in Gulf War, Afghanistan, and Iraq War veterans compared with military comparison groups nondeployed to the corresponding conflict, including never deployed personnel. Literature was searched (1990-2014) in multiple electronic databases. Studies were assessed for eligibility and quality, including risk of bias. Eighteen studies (1997-2014) met inclusion criteria. Pooled analysis based on a random-effects model yielded a summary odds ratio of 1.33 (95% confidence interval (CI): 1.22, 1.46) for alcohol (7 studies) and 2.13 (95% CI: 0.96, 4.72) for substance use (3 studies) disorders among Gulf War veterans, as well as 1.36 (95% CI: 1.11, 1.66) for alcohol (7 studies) and 1.14 (95% CI: 1.04, 1.25) for substance use (4 studies) disorders among Iraq/Afghanistan veterans; meta-regressions found no statistically significant association between theater of war and alcohol use or substance use disorders. Our findings indicate that Gulf and Iraq/Afghanistan war veterans are at higher alcohol use disorder risk than nondeployed veterans, but further studies with increased power are needed to assess substance use disorder risk in Gulf War veteran populations.

Objective This study addresses the extent to which DSM-IV and DSM-5 definitions of acute stress disorder (ASD) predict subsequent posttraumatic stress disorder (PTSD) and related psychiatric disorders following trauma. Method Patients with randomized admissions to 5 hospitals across Australia (N = 596) were assessed in hospital and reassessed for PTSD at 3 (n = 508), 12 (n = 426), 24 (n = 439), and 72 (n = 314) months using the Clinician-Administered PTSD Scale; DSM-IV definition of PTSD was used at each assessment, and DSM-5 definition was used at 72 months. The Mini-International Neuropsychiatric Interview (MINI) was used at each assessment to assess anxiety, mood, and substance use disorders. Results Forty-five patients (8%) met DSM-IV criteria, and 80 patients (14%) met DSM-5 criteria for ASD. PTSD was diagnosed in 93 patients (9%) at 3, 82 patients (10%) at 12, 100 patients (12%) at 24, and 26 patients (8%) at 72 months; 19 patients (6%) met DSM-5 criteria for PTSD at 72 months. Comparable proportions of those diagnosed with ASD developed PTSD using DSM-IV (3 months = 46%, 12 months = 39%, 24 months = 32%, and 72 months = 25%) and DSM-5 (43%, 42%, 33%, and 24%) ASD definitions. Sensitivity was improved for DSM-5 relative to DSM-IV for depression (0.18 vs 0.30), panic disorder (0.19 vs 0.41), agoraphobia (0.14 vs 0.40), social phobia (0.12 vs 0.44), specific phobia (0.24 vs 0.58), obsessive-compulsive disorder (0.17 vs 0.47), and generalized anxiety disorder (0.20 vs 0.47). More than half of participants with DSM-5-defined ASD had a subsequent disorder. Conclusions The DSM-5 criteria for ASD results in better identification of people who will subsequently develop PTSD or another psychiatric disorder relative to the DSM-IV criteria. Although prediction is modest, it suggests that the new ASD diagnosis can serve a useful function in acute trauma settings for triaging those who can benefit from either early intervention or subsequent monitoring.

Objective: This longitudinal study investigated the temporal relationship patterns between disability and mental health after injury, with a focus on posttraumatic stress disorder (PTSD), depression, and anxiety. Method: We conducted a multi-sited longitudinal cohort study with a large sample of hospital patients admitted after injury (N = 1,149, mean age = 37.9, 73.6% male). Data were collected prior to discharge from hospital, and follow-up assessments took place 3 and 12 months postinjury. A cross-lagged structural equation model (SEM) was used to assess the prospective relationship between posttraumatic stress, anxiety, and depression symptoms and disability while controlling for demographic characteristics and objective measures of injury severity. Results: Acute depression significantly predicted 3-month disability, and 3-month PTSD severity significantly predicted 12-month disability. Premorbid disability had a significant effect on acute anxiety, depression, and posttraumatic stress symptoms, and 3-month depression but disability after the injury did not predict 12-month psychopathology. Conclusions: We did not find a reciprocal relationship between disability and psychopathology. Rather we found that depression played a role in early disability while PTSD played a role in contributing to long-term delays in the recovery process. The results of this study highlight the need for mental health screening for symptoms of PTSD and depression in the acute aftermath of trauma, combined with early intervention programs in injury populations. Depression and Anxiety 00:1–8, 2014. C � 2014 Wiley Periodicals, Inc.

This study tested the theory that rapid breathing at the time of a traumatic event leads to development of panic disorder (PD). Traumatically injured patients (n = 1,061) from 4 major trauma hospitals had their respiratory rates (RR) assessed at the scene of traumatic injury, subsequently assessed for lifetime PD, and reassessed 3 months later for PD (n = 843). At follow-up, 59 (7%) patients met criteria for new-onset PD. Patients with elevated RR (>21 breaths per minute) were more likely to meet criteria for PD than those without elevated RR (34% vs. 19%). PD diagnosis at 3 months was significantly predicted by elevated RR after controlling for gender, age, trauma type, injury severity, and fear at the time of the event (p = .03). Participants with elevated RR were 1.79 times more likely to develop PD than those with lower RR. These data suggest that rapid breathing at the time of a traumatic event may be associated with subsequent PD development. (PsycINFO Database Record © 2014 APA, all rights reserved).

OBJECTIVE: Interpersonal trauma and violence is currently considered a global public health emergency. However, studies have not differentiated between intimate interpersonal trauma and nonintimate interpersonal trauma in their impact on posttraumatic stress disorder (PTSD) symptomatology. This cross-sectional study based on epidemiologic data examined the differential likelihoods of endorsing PTSD symptoms following 3 categories of trauma: noninterpersonal (eg, accidents, natural disasters), nonintimate interpersonal (physical assaults perpetrated by nonintimates), and intimate interpersonal (physical assaults perpetrated by intimates or caregivers and sexual assaults). METHOD: DSM-IV PTSD symptom data drawn from a weighted subsample (N = 1,012) of people reporting "most severe" reactions following one of the above types of trauma in the 2007 Australian National Survey of Mental Health and Well-Being (NSMHWB) were analyzed using binary logistic regression. RESULTS: Participants reporting intimate interpersonal compared with noninterpersonal trauma were significantly (P < .001) more likely to endorse core symptoms (intrusive reexperiencing, avoidance of reminders, hypervigilance, and startle response) of PTSD. The intimate interpersonal trauma group members were significantly more likely than the nonintimate interpersonal trauma group members to endorse distress at reminders (odds ratio [OR] = 3.2; P < .001; 99.7% CI, 1.3-7.9), avoiding thinking about the event (OR = 3.2; P < .001; 99.7% CI, 1.3-7.7), detachment from others (OR = 3.2; P < .001; 99.7% CI, 1.2-8.9), and restricted affect (OR = 4.1; P < .001; 99.7% CI, 1.5-11.3). Participants reporting nonintimate interpersonal and noninterpersonal traumas did not significantly differ except in endorsement of behavioral avoidance (OR = 2.8; P < .001; 99.7% CI, 1.2-6.6), hypervigilance (OR = 2.5; P = .002; 99.7% CI, 1.0-6.3), and exaggerated startle response (OR = 3.5; P < .001; 99.7% CI, 1.7-7.4). CONCLUSIONS: Survivors of intimate trauma appear to experience particularly severe intrusive memories and reminders of past trauma and suppression of emotional responsivity. The unique impact of interpersonal trauma, however, intimate or otherwise, compared with noninterpersonal trauma, is the experience of an environment as unsafe and unpredictable, due to the potential of human threat. Such findings have significant implications for the assessment of and interventions for survivors of interpersonal violence.

This paper presents the results of a summative evaluation of the training component of the Australian Government Mental Health Response to the 2009 bushfires in Victoria, Australia. With very little evidence available to date on comprehensive attempts at implementing multilevel training frameworks in the wake of natural disasters, the evaluation provides valuable insights into an effort that sought to build the capacity of practitioners to respond to the psychosocial and mental health consequences of a significant bushfire disaster at various levels of the response system. Key findings of the evaluation are discussed with regards to their relevance for the training of mental health practitioners in a broader range of disaster circumstances.

Pretrauma factors of psychiatric history and neuroticism have been important in highlighting vulnerability to posttraumatic stress disorder (PTSD), whereas posttrauma support mechanisms have been associated with positive health and well-being outcomes, particularly in veterans. The relationship between these factors and PTSD has not been the subject of a systematic review in veterans. An online search was conducted, supplemented by reference list and author searches. Two investigators systematically and independently examined eligible studies. From an initial search result of 2,864, 17 met inclusion criteria. A meta-analysis of unit cohesion involving 6 studies found that low unit cohesion was associated with PTSD, standardised mean difference of -1.62, 95% confidence interval (CI) [-2.80, -0.45]. A meta-analysis of social support involving 7 studies found that low social support was associated with PTSD, standardised mean difference of - 12.40, 95% CI [-3.42, -1.38]. Three of 5 studies found a significant relationship between low-family support and PTSD; insufficient data precluded a meta-analysis. Regarding pretrauma vulnerability, 2 studies on psychiatric history and 1 on neuroticism found positive relationships with PTSD. Posttrauma factors of low support were associated with higher reporting of PTSD. Cross-sectional methodology may be inadequate to capture complex relationships between support and PTSD; more longitudinal research is required.

Aims This study aimed to test the efficacy of integrated cognitive behaviour therapy (CBT) for coexisting post traumatic stress disorder (PTSD) and alcohol use disorders (AUD). Setting Clinics across Sydney, Australia.Design Randomized controlled trial of 12 once-weekly individual sessions of either integrated CBT for PTSD and AUD(integrated therapy, IT; n = 33) or CBT for AUD plus supportive counselling (alcohol-support, AS; n = 29). Blind assessments were conducted at baseline and post-treatment and at 5 [standard deviation (SD) = 2.25] and 9.16(SD = 3.45) months post-treatment. Participants Sixty-two adults with concurrent PTSD and AUD. Measurements Outcomes included changes in alcohol consumption (time-line follow-back), PTSD severity [clinician-administered PTSD scale (CAPS)], alcohol dependence and problems, and depression and anxiety. Findings Reductions in PTSD severity were evident in both groups. IT participants who had received one or more sessions of exposure therapy exhibited a twofold greater rate of clinically significant change in CAPS severity at follow-up than AS participants [IT60%, AS 39%, odds ratio (OR): 2.31, 95% confidence interval (CI): 1.06, 5.01]. AS participants exhibited larger reductions than IT participants in alcohol consumption, dependence and problems within the context of greater treatment from other services during follow-up. Results lend support to a mutually maintaining effect between AUD and PTSD. Conclusions Individuals with severe and complex presentations of coexisting post-traumatic stress disorder(PTSD) and alcohol use disorders (AUD) can derive substantial benefit from cognitive behaviour therapy targeting AUD, with greater benefits associated with exposure for PTSD. Among individuals with dual disorders, these therapies can generate significant, well-maintained treatment effects on PTSD, AUD and psychopathology.

Military veterans with posttraumatic stress disorder (PTSD) frequently report exposure to multiple other traumas in addition to their military experiences. This study aimed to examine the impact of exposure-related factors for military veterans with PTSD on recovery after participation in a group-based treatment program. Subjects included 1548 military veterans with PTSD participating in specialist veterans' PTSD programs across Australia. The study included measures of PTSD, depression, anxiety and alcohol use. Analyses of variance found higher combat exposure was associated with more severe PTSD at intake. No differences in PTSD intake severity were evident in those with additional non-military trauma. Severity of combat exposure did not affect treatment outcomes, although those with low combat exposure and additional non-military trauma (which included high rates of molestation) did report reduced symptom improvement. These findings have implications for considerations of optimal interventions for those with lower levels of combat exposure and additional non-military trauma.

Background Posttraumatic stress disorder (PTSD) occurs twice as commonly amongst women as men. Two common domains of trauma, network trauma and gender based violence (GBV), may contribute to this gender difference in PTSD rates. We examined data from a nationally representative sample of the Australian population to clarify the characteristics of these two trauma domains in their contributions to PTSD rates in men and women. Methods We drew on data from the 2007 Australian National Survey of Mental Health and Well-being to assess gender differences across a comprehensive range of trauma domains, including (1) prevalence of lifetime exposure; (2) identification of an index trauma or DSM-IV Criterion A event; and (3) the likelihood of developing full DSM-IV PTSD symptoms once an index trauma was identified. Results Men reported more traumatic events (TEs) overall but women reported twice the prevalence of lifetime PTSD (women, 13.4%; men, 6.3%). Women reported a threefold higher level of exposure to GBV and were seven times more likely to nominate GBV as the index trauma as compared to men. Women were twice more likely than men to identify a network trauma as the index trauma and more likely to meet full PTSD symptoms in relation to that event (women, 20.6%; men, 14.6%). Conclusion Women are more likely to identify GBV and network trauma as an index trauma. Women's far greater exposure to GBV contributes to their higher prevalence of PTSD. Women are markedly more likely to develop PTSD when network trauma is identified as the index trauma. Preventing exposure to GBV and providing timely interventions for acute psychological reactions following network trauma may assist in reducing PTSD rates amongst women.

BackgroundAlthough perceived social support is thought to be a strong predictor of psychological outcomes following trauma exposure, the temporal relationship between perceived positive and negative social support and post-traumatic stress disorder (PTSD) symptoms has not been empirically established. This study investigated the temporal sequencing of perceived positive social support, perceived negative social support, and PTSD symptoms in the 6 years following trauma exposure among survivors of traumatic injury.MethodParticipants were 1132 trauma survivors initially assessed upon admission to one of four Level 1 trauma hospitals in Australia after experiencing a traumatic injury. Participants were followed up at 3 months, 12 months, 24 months, and 6 years after the traumatic event.ResultsLatent difference score analyses revealed that greater severity of PTSD symptoms predicted subsequent increases in perceived negative social support at each time-point. Greater severity of PTSD symptoms predicted subsequent decreases in perceived positive social support between 3 and 12 months. High levels of perceived positive or negative social support did not predict subsequent changes in PTSD symptoms at any time-point.ConclusionsResults highlight the impact of PTSD symptoms on subsequent perceived social support, regardless of the type of support provided. The finding that perceived social support does not influence subsequent PTSD symptoms is novel, and indicates that the relationship between PTSD and perceived social support may be unidirectional.

A recent meta-analysis by Benish, Imel, and Wampold (2008, Clinical Psychology Review, 28, 746–758) concluded that all bona fide treatments are equally effective in posttraumatic stress disorder (PTSD). In contrast, seven other meta-analyses or systematic reviews concluded that there is good evidence that trauma-focused psychological treatments (trauma-focused cognitive behavior therapy and eye movement desensitization and reprocessing) are effective in PTSD; but that treatments that do not focus on the patients' trauma memories or their meanings are either less effective or not yet sufficiently studied. International treatment guidelines therefore recommend trauma-focused psychological treatments as first-line treatments for PTSD. We examine possible reasons for the discrepant conclusions and argue that (1) the selection procedure of the available evidence used in Benish et al.'s (2008)meta-analysis introduces bias, and (2) the analysis and conclusions fail to take into account the need to demonstrate that treatments for PTSD are more effective than natural recovery. Furthermore, significant increases in effect sizes of trauma-focused cognitive behavior therapies over the past two decades contradict the conclusion that content of treatment does not matter. To advance understanding of the optimal treatment for PTSD, we recommend further research into the active mechanisms of therapeutic change, including treatment elements commonly considered to be non-specific. We also recommend transparency in reporting exclusions in meta-analyses and suggest that bona fide treatments should be defined on empirical and theoretical grounds rather than by judgments of the investigators' intent.

Despite extensive research on posttraumatic stress disorder (PTSD), anger in PTSD has received little attention. This is surprising, given anger is a key predictor of treatment outcome in PTSD. This paper seeks to build an argument for investigating anger in PTSD as a discrete entity. A key argument is that the capacity to image visual mental phenomena is crucial to the aetiology and maintenance of anger in PTSD. Evidence is reviewed for the influence of visual imagery in anger in PTSD from the perspectives of neuropsychology, psychopathology, anger and PTSD. An argument is advanced for including visual imagery in an integrated (visual-linguistic) cognitive model of anger in PTSD. Directions for research on visual imagery in anger in PTSD and its treatment implications are discussed.

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.

Objective: Consensus on the parameters of trauma-related dreams required to meet criteria for post-traumatic stress disorder (PTSD) is critical when: (i) the diagnosis requires a single re-experiencing symptom; and (ii) trauma dreams are prevalent in survivors without PTSD. Method: This study investigated the phenomenology of PTSD dreams in 40 veterans, using structured interview and self-report measures. Results: Dream content varied between replay, non-replay, and mixed, but affect was largely the same as that experienced at the time of trauma across all dream types. ANOVA indicated no difference between dream types on PTSD severity or nightmare distress. Conclusions: The findings provide preliminary support for non-replay dreams to satisfy the DSM B2 diagnostic criterion when the affect associated with those dreams is the same as that experienced at the time of the traumatic event.

Objective The proposed DSM-V criteria for posttraumatic stress disorder (PTSD) specifically require both active avoidance and emotional numbing symptoms for a diagnosis. In DSM-IV, since both are included in the same cluster, active avoidance is not essential. Numbing symptoms overlap with depression, which may result in spurious comorbidity or overdiagnosis of PTSD. This paper investigated the impact of requiring both active avoidance and emotional numbing on the rates of PTSD diagnosis and comorbidity with depression. Method We investigated PTSD and depression in 835 traumatic injury survivors at 3 and 12 months post-injury. We used the DSM-IV criteria but explored the potential impact of DSM-IV and DSM-V approaches to avoidance and numbing using comparison of proportion analyses. Results The DSM-V requirement of both active avoidance and emotional numbing resulted in significant reductions in PTSD caseness compared with DSM-IV of 22% and 26% respectively at 3 and 12 months posttrauma. By 12 months, the rates of comorbid PTSD in those with depression were significantly lower (44% vs. 34%) using the new criteria, primarily due to the lack of avoidance symptoms. Conclusion These preliminary data suggest that requiring both active avoidance and numbing as separate clusters offers a useful refinement of the PTSD diagnosis. Requiring active avoidance may help to define the unique aspects of PTSD and reduce spurious diagnoses of PTSD in those with depression.

Objective: Estimates of the prevalence of exposure to potentially traumatic events (PTEs) in population surveys have increased over time. There is limited empirical evidence on the impact of changes in measurement practices on these estimates. The present study examined the effect of increasing the number of events assessed on the prevalence of exposure longitudinally. Methods: Data were ultilized from the 1997 and 2007 Australian National Surveys of Mental Health and Wellbeing. The 1997 survey assessed exposure using 11 items from the Composite International Diagnostic Interview (CIDI), version 2.1. The 2007 survey utilized 29 items from the World Mental Health CIDI. Prevalence rates of exposure to matched events among age-matched samples from both surveys were compared to determine whether differences in the estimates obtained were due to respondents having been asked about an increased number of event types in the latter survey. Results: The effect of increasing the number of event types in the CIDI from 11 to 29 was to increase the overall population prevalence of exposure to PTEs by 18%. The difference between estimates was more pronounced in women than in men. The cross-cohort analyses revealed that these differences were not indicative of an increase in trauma exposure over time; but rather the endorsement of new events that were not listed in the earlier survey. Conclusions: The findings underscore the importance of using comprehensive assessments in the measurement of exposure to PTEs. Previous epidemiological surveys may have underestimated the prevalence of traumatic and other stressful life events, particularly among women.

Although symptoms characteristic of post-traumatic stress disorder (PTSD) have been noted in military personnel for many centuries, it was not until 1980 that the disorder was formally recognized and became the focus of legitimate study. This paper reviews our current state of knowledge regarding the prevalence and course of this complex condition in past and present members of the defence forces. Although rates vary across conflicts and countries, there is no doubt that PTSD affects substantial numbers of personnel and results in considerable impairment in functioning and quality of life. The paper goes on to discuss recent attempts to build resilience and to promote adjustment following deployment, noting that there is little evidence at this stage upon which to draw firm conclusions. Finally, effective treatment for PTSD is reviewed, with particular reference to the challenges posed by this population in a treatment setting.

In the field of traumatic stress, chemoprophylaxis is a term that is often used but rarely well understood. There has been no shortage of debate on the issue, but few rigorous studies to ground the discussion. The purpose of the current paper is to explore the issues surrounding this contentious area. Databases including PubMed, PsychArticles and Web of Knowledge were searched using the key words ‘chemo or pharmaco’, ‘prevention or prophylaxis’, and ‘PTSD or post-traumatic stress’. Relevant journals and reference lists of the papers obtained through this search were scanned for additional references. Studies that investigated the use of pharmacotherapy to prevent the onset of post-traumatic stress disorder were considered for this paper. Studies that examined the treatment of established PTSD were excluded. A total of 15 empirical studies were included in the review (including five randomized controlled trials), and twice as many non-data-driven papers. Evidence for the prophylactic use of alcohol, morphine, propranolol, and hydrocortisone is presented, followed by a discussion of the many challenges of using pharmacological interventions in this context. While attention to this issue has increased in recent times, the dearth of empirical data has done little to further the field. Larger studies are indicated following small trials with medications such as propranolol and hydrocortisone. There remain a number of ethical and practical questions to be answered before the widespread use of chemoprophylaxis can be recommended.

Objective: Following the February 2009 Victorian bushfires, Australia's worst natural disaster, the Australian Centre for Posttraumatic Mental Health, in collaboration with key trauma experts, developed a three-tiered approach to psychological recovery initiatives for survivors with training specifically designed for each level. The middle level intervention, designed for delivery by allied health and primary care practitioners for survivors with ongoing mild-moderate distress, involved a protocol still in draft form called Skills for Psychological Recovery (SPR). SPR was developed by the US National Center for PTSD and US National Child Traumatic Stress Network. This study examined health practitioner perceptions of the training in, and usefulness of, SPR. Methods: From a range of disciplines 342 health practitioners attended one of 25 one-day workshops on the delivery of SPR. Perceptions of evidence-based care and attitudes to manualized interventions were assessed at the commencement of the workshop. Following the workshop, participants’ perceptions of their confidence in applying, and perceived usefulness of, each module were assessed. A subset of 20 participants recorded their ongoing use of SPR recording 61 cases. Results: The vast majority of participants rated the SPR modules as useful for survivors of disasters and expressed confidence in implementing the intervention following the training. Participants’ pre-workshop attitudes towards evidence-based care and manualized interventions affected their perceptions of the usefulness of the protocol. The ‘Promoting positive activities’ and ‘Rebuilding healthy social connections’ modules were least influenced by variations in these perceptions. Conclusions: This study provides preliminary evidence that SPR is perceived by health providers from varying disciplines and paradigms as an acceptable and useful intervention for disaster survivors with moderate levels of mental health difficulties. Future SPR dissemination efforts may benefit from focusing on modules with the strongest evidence base and which are most amenable to practitioner acceptance and uptake.

Post-traumatic stress disorder (PTSD) can be difficult to treat, with gains often particularly modest in combat veterans. Although group-based treatments are commonly delivered for veterans, little is known about factors influencing their outcomes. Attachment style is known to be associated with psychopathology after trauma and is critical to group-based interventions, but has not yet been investigated in relation to treatment outcome. A better understanding of factors that influence outcome is critical in optimizing the effectiveness of such interventions. This study investigated attachment style as a predictor of outcome for 103 veterans attending group-based treatment for combat-related PTSD. Measures included the Clinician Administered PTSD Scale, PTSD Checklist, and Relationship Styles Questionnaire. Path analyses indicated preoccupied attachment style strongly negatively predicted outcome following treatment. The preoccupied attachment style impedes recovery in group-based treatment for veterans with PTSD. Potential mechanisms underlying this finding are discussed. The results suggest that greater attention should be paid at initial assessment to attachment style of veterans before entering PTSD treatment, particularly group-based interventions.

To conduct a descriptive study investigating the effect of access to motor vehicle accident (MVA) compensation on recovery outcomes at 24 months after injury.Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria, Australia. Participants were 391 randomly selected injury patients with moderate-to-severe injuries. Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes.Health outcomes at 24 months, including anxiety and depression severity, quality of life and disability.Medical records identified two groups of compensation patients: MVA-compensable and non-compensable patients. After controlling for baseline variables, the MVA-compensable patients, at 24 months, had higher levels of post-traumatic stress disorder, anxiety and depression, and were less likely to have returned to their pre-injury number of work hours. However, some patients in the non-compensable group had accessed other forms of compensation (eg, private health care or compensation for victims of crime). When these were removed from the non-compensable group, the differences between MVA-compensable and non-compensable groups all but disappeared.Our findings do not support previous research showing that access to compensation is associated with poor recovery outcomes. The relationship between access to compensation and health outcomes is complex, and more high-level research is required.

Traumatic injury affects millions of people each year. There is little understanding of the extent of psychiatric illness that develops after traumatic injury or of the impact of mild traumatic brain injury (TBI) on psychiatric illness. The authors sought to determine the range of new psychiatric disorders occurring after traumatic injury and the influence of mild TBI on psychiatric status.In this prospective cohort study, patients were drawn from recent admissions to four major trauma hospitals across Australia. A total of 1,084 traumatically injured patients were initially assessed during hospital admission and followed up 3 months (N=932, 86%) and 12 months (N=817, 75%) after injury. Lifetime psychiatric diagnoses were assessed in hospital. The prevalence of psychiatric disorders, levels of quality of life, and mental health service use were assessed at the follow-ups. The main outcome measures were 3- and 12-month prevalence of axis I psychiatric disorders, levels of quality of life, and mental health service use and lifetime axis I psychiatric disorders.Twelve months after injury, 31% of patients reported a psychiatric disorder, and 22% developed a psychiatric disorder that they had never experienced before. The most common new psychiatric disorders were depression (9%), generalized anxiety disorder (9%), posttraumatic stress disorder (6%), and agoraphobia (6%). Patients were more likely to develop posttraumatic stress disorder (odds ratio=1.92, 95% CI=1.08-3.40), panic disorder (odds ratio=2.01, 95% CI=1.03-4.14), social phobia (odds ratio=2.07, 95% CI=1.03-4.16), and agoraphobia (odds ratio=1.94, 95% CI=1.11-3.39) if they had sustained a mild TBI. Functional impairment, rather than mild TBI, was associated with psychiatric illness.A significant range of psychiatric disorders occur after traumatic injury. The identification and treatment of a range of psychiatric disorders are important for optimal adaptation after traumatic injury.

The prevalence and nature of post-traumatic stress disorder (PTSD) following mild traumatic brain injury (MTBI) is controversial because of the apparent paradox of suffering PTSD with impaired memory for the traumatic event. In this study, 1167 survivors of traumatic injury (MTBI: 459, No TBI: 708) were assessed for PTSD symptoms and post-traumatic amnesia during hospitalization, and were subsequently assessed for PTSD 3 months later (N = 920). At the follow-up assessment, 90 (9.4%) patients met criteria for PTSD (MTBI: 50, 11.8%; No-TBI: 40, 7.5%); MTBI patients were more likely to develop PTSD than no-TBI patients, after controlling for injury severity (adjusted odds ratio: 1.86; 95% confidence interval, 1.78–2.94). Longer post-traumatic amnesia was associated with less severe intrusive memories at the acute assessment. These findings indicate that PTSD may be more likely following MTBI, however, longer post-traumatic amnesia appears to be protective against selected re-experiencing symptoms. (JINS, 2009, 15, 862–867.)

Although much has been published on the effects of the 1990/1991 Gulf War on the psychological health of veterans, few studies have addressed the pattern and timing of post-war development of psychological disorders. Our study aims to identify the most common psychological disorders that first appeared post-Gulf War, the period of peak prevalence and the sequence of multiple psychological disorders. The temporal progression of psychological disorders in male Australian naval Gulf War veterans with no prior psychological disorders was calculated across each year of the post-Gulf War period. DSM-IV diagnoses were obtained using the Composite International Diagnostic Interview. Psychological disorder rates peaked in the first 2 years (1991–1992) following the Gulf War. Alcohol use disorders were the most likely to appear first. Classification and regression tree analysis found that risk of disorder was exacerbated if veterans had been exposed to a high number of potential psychological stressors during their military service. Lower military rank was associated with increased risk of alcohol disorders, particularly during the first 2 years post-Gulf War. In veterans with two or more disorders, anxiety disorders and alcohol disorders tended to appear before affective disorders. Our study found that psychological disorders occur in sequence following Gulf War deployment. Our findings may help clinicians to anticipate, and better manage, multiple symptomatology. The findings may also assist veteran and defence organisations in planning effective mental health screening, management and prevention policy.

Hope is a higher-order cognitive construct that encompasses the belief in one’s ability to accomplish personal goals. Hope has been conceptualised as consisting of two constructs – Pathways (the individual’s perceived means available to achieve goals) and Agency (belief in ones ability to succeed in using the identified Pathways). This study aimed to validate a measure of hope, the Dispositional Hope Scale (DHS: [Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigman, S. T., et al. (1991). The will and the ways: Development and validation of an individual differences measure of hope. Journal of Personality and Social Psychology, 60(4), 570–585]) in a large sample of traumatic injury survivors (N = 1025). The findings support the psychometric properties of the scale, as well as the two-factor structure of Agency and Pathways, in this population. This study provides support for the use of the DHS as a measure of hope in traumatised populations.

The potential impact on psychological well-being of working in the caring professions in the aftermath of trauma and disaster has been recognized for many years, with terms such as burnout, compassion fatigue, and vicarious traumatization coined to describe stress-related conditions. Although prevalent, these conditions do not affect all workers in the field. Various studies have investigated potential risk and protective factors. It is argued that the outcomes of this research should be used to guide practical interventions in the workplace designed to minimize stress-related problems. A framework that incorporates interventions at the primary, secondary, and tertiary prevention levels is outlined, and research investigating the efficacy of interventions at each of these levels is recommended.

This paper has been retracted due to a publisher's error: the order of the authors was incorrect. The Editor and Publisher of the Journal of Traumatic Stress apologize to the authors and our readership. The Peritraumatic Dissociative Experiences Questionnaire (PDEQ) is a widely used measure of peritraumatic dissociation, and is presumably a unidimensional construct. Two hundred forty-seven individuals admitted to five hospitals after traumatic injury were administered the Clinician Administered PTSD Scale, the Hospital Anxiety and Depression Scale, and the PDEQ. Factor analysis indicated that the PDEQ involved two factors containing four items each: one factor (altered awareness) indexes alterations in awareness and the other (derealization) reflects distortions in perceptions of the self and the world. Only the derealization factor was associated with acute stress, anxiety, and depression symptoms. Cross-validation with independent data provided only partial support for the 2-factor structure model. These data indicate that peritraumatic dissociation may involve two distinct constructs.