We examined transdiagnostic and posttraumatic stress disorder (PTSD)–specific associations with multiple forms of trauma exposure within a nationwide U.S. sample (N = 1,649, 50.0% female) of military veterans overselected for PTSD. A higher-order Distress factor was estimated using PTSD, major depressive disorder (MDD), and generalized anxiety disorder (GAD) symptoms as indicators. A structural equation model spanning three assessment points over an average of 3.85 years was constructed to examine the unique roles of higher-order Distress and PTSD-specific variance in accounting for the associations between trauma exposure, measured using the Life Events Checklist (LEC) and Deployment Risk and Resiliency Inventory Combat subscale (DRRI-C), and psychosocial impairment. The results suggest the association between trauma exposure and PTSD symptoms was primarily mediated by higher-order distress (70.7% of LEC effect, 63.2% of DRRI-C effect), but PTSD severity retained a significant association with trauma exposure independent of distress, LEC: β = .10, 95% CI [.06, .13]; DRRI-C: β = .11, 95% CI [.07, .14]. Both higher-order distress, β = .31, and PTSD-specific variance, β = .36, were necessary to account for the association between trauma exposure and future impairment. Findings suggest that trauma exposure may contribute to comorbidity across a range of internalizing symptoms as well as to PTSD-specific presentations.

中文翻译：

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创伤暴露和跨诊断困扰：检查共同的和创伤后应激障碍的特定关联

我们在美国全国范围内对因 PTSD 过度选择的退伍军人样本（ N = 1,649，50.0% 女性）中检查了跨诊断和创伤后应激障碍 (PTSD) 与多种形式的创伤暴露之间的特定关联。使用 PTSD、重度抑郁症 (MDD) 和广泛性焦虑症 (GAD) 症状作为指标来估计高阶痛苦因素。构建了一个跨越平均 3.85 年的三个评估点的结构方程模型，以检验高阶痛苦和 PTSD 特异性方差在解释创伤暴露之间的关联方面的独特作用，使用生活事件检查表（LEC）和部署风险和弹性库存战斗子量表（DRRI-C）和心理社会障碍。结果表明，创伤暴露与 PTSD 症状之间的关联主要由高阶痛苦（LEC 效应的 70.7%、DRRI-C 效应的 63.2%）介导，但 PTSD 严重程度与创伤暴露保持显着关联，与痛苦、LEC 无关。 ：β = .10，95% CI [.06，.13]；DRRI-C：β = .11，95% CI [.07，.14]。高阶痛苦 (β = 0.31) 和 PTSD 特异性方差 (β = 0.36) 对于解释创伤暴露与未来损伤之间的关联是必要的。研究结果表明，创伤暴露可能会导致一系列内化症状的合并症以及创伤后应激障碍 (PTSD) 特有的表现。