Robert H Pietrzak1, Robert A Rosenheck2, Joyce A Cramer3, Jennifer C Vessichio3, Jack Tsai2, Steven M Southwick4, John H Krystal5. 1. United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States. Electronic address: robert.pietrzak@yale.edu. 2. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; United States Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, United States. 3. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, United States. 4. United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States. 5. United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; United States Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, United States; Psychiatry Services, Yale-New Haven Hospital, New Haven, CT, United States.
Abstract
BACKGROUND: Three of the most common trauma-related mental disorders-posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD)-are highly comorbid and share common transdiagnostic symptom dimensions of threat (i.e., fear) and loss (i.e., dysphoria) symptomatology. However, empirical evaluation of the dimensional structure of component aspects of these disorders is lacking. METHODS: Using structured clinical interview data from U.S. military veterans with chronic military-related PTSD, we evaluated the transdiagnostic dimensional structure of PTSD, MDD, and GAD symptoms. We then examined the relationship between the best-fitting transdiagnostic model of these symptoms, and measures of physical and mental functioning, and life satisfaction and well-being. RESULTS: Exploratory factor analysis revealed that a 3-factor transdiagnostic model comprised of loss (i.e., dysphoria), threat (i.e., anxious arousal, re-experiencing, and avoidance symptoms), and somatic anxiety (i.e., physiological manifestations of anxiety) symptoms provided the best representation of trauma-related PTSD, MDD, and GAD symptoms. Somatic anxiety symptoms were independently associated with physical functioning, while loss symptoms were independently associated with mental functioning and life satisfaction and well-being. LIMITATIONS: Evaluation of study aims in a relatively homogeneous sample of veterans with chronic, military-related PTSD. CONCLUSIONS: Results of this study suggest that a 3-factor transdiagnostic model best characterizes the dimensional structure of PTSD, MDD, and GAD symptoms in military veterans with chronic military-related PTSD. This model evidenced external validity in demonstrating differential associations with measures of physical and mental functioning, and life satisfaction and well-being. Results provide support for emerging contemporary models of psychopathology, which emphasize transdiagnostic and dimensional conceptualizations of mental disorders. Such models may have utility in understanding the functional status of trauma survivors. Published by Elsevier B.V.
BACKGROUND: Three of the most common trauma-related mental disorders-posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD)-are highly comorbid and share common transdiagnostic symptom dimensions of threat (i.e., fear) and loss (i.e., dysphoria) symptomatology. However, empirical evaluation of the dimensional structure of component aspects of these disorders is lacking. METHODS: Using structured clinical interview data from U.S. military veterans with chronic military-related PTSD, we evaluated the transdiagnostic dimensional structure of PTSD, MDD, and GAD symptoms. We then examined the relationship between the best-fitting transdiagnostic model of these symptoms, and measures of physical and mental functioning, and life satisfaction and well-being. RESULTS: Exploratory factor analysis revealed that a 3-factor transdiagnostic model comprised of loss (i.e., dysphoria), threat (i.e., anxious arousal, re-experiencing, and avoidance symptoms), and somatic anxiety (i.e., physiological manifestations of anxiety) symptoms provided the best representation of trauma-related PTSD, MDD, and GAD symptoms. Somatic anxiety symptoms were independently associated with physical functioning, while loss symptoms were independently associated with mental functioning and life satisfaction and well-being. LIMITATIONS: Evaluation of study aims in a relatively homogeneous sample of veterans with chronic, military-related PTSD. CONCLUSIONS: Results of this study suggest that a 3-factor transdiagnostic model best characterizes the dimensional structure of PTSD, MDD, and GAD symptoms in military veterans with chronic military-related PTSD. This model evidenced external validity in demonstrating differential associations with measures of physical and mental functioning, and life satisfaction and well-being. Results provide support for emerging contemporary models of psychopathology, which emphasize transdiagnostic and dimensional conceptualizations of mental disorders. Such models may have utility in understanding the functional status of trauma survivors. Published by Elsevier B.V.
Authors: Natalie Mota; Jennifer A Sumner; Sarah R Lowe; Alexander Neumeister; Monica Uddin; Allison E Aiello; Derek E Wildman; Sandro Galea; Karestan C Koenen; Robert H Pietrzak Journal: J Clin Psychiatry Date: 2015-12 Impact factor: 4.384
Authors: Paolo Fusar-Poli; Marco Solmi; Natascia Brondino; Cathy Davies; Chungil Chae; Pierluigi Politi; Stefan Borgwardt; Stephen M Lawrie; Josef Parnas; Philip McGuire Journal: World Psychiatry Date: 2019-06 Impact factor: 49.548