title: Functional significance of a novel 7-factor model of DSM-5 PTSD symptoms: results from the National Health and Resilience in Veterans study.
abstract: BACKGROUND
  While posttraumatic stress disorder (PTSD) symptoms in the recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are clustered into four factors, emerging confirmatory factor analytic studies suggest that this disorder is best characterized by seven symptom clusters, including re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptoms. To date, however, data are lacking regarding the relation between this novel model of DSM-5 PTSD symptoms and measures of clinical significance in this population (e.g., functioning).
  
  
  METHODS
  Using data from the National Health and Resilience in Veterans Study (NHRVS), a contemporary, nationally representative sample of 1484 U.S. veterans, we evaluated clinical and functional correlates of a novel 7-factor model of DSM-5 PTSD symptoms.
  
  
  RESULTS
  Differential patterns of associations were observed between DSM-5 PTSD symptom clusters, and psychiatric comorbidities, suicidal ideation, hostility, and functioning and quality of life. Anhedonia symptoms, in particular, were strongly related to current depression, as well as reduced mental functioning and quality of life. Externalizing behaviors were most strongly related to hostility, supporting the convergent validity of this construct.
  
  
  CONCLUSIONS
  Cross-sectional design and employment of self-report measures.
  
  
  CONCLUSIONS
  These results suggest that a more refined 7-factor model of DSM-5 PTSD symptoms may provide greater specificity in understanding associations with comorbid psychopathology, suicidal ideation, and functioning and quality of life in U.S. veterans. They further suggest that prevention and treatment efforts that target distinct aspects of the PTSD phenotype may be more effective in mitigating key clinical and functional outcomes in this population.
authors.affiliation: 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.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pietrzak
authors.affiliation: 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.
authors.forename: Jack
authors.initials: J
authors.lastname: Tsai
authors.affiliation: Psychology Research Institute, University of Ulster, Coleraine, Northern Ireland, United Kingdom.
authors.forename: Cherie
authors.initials: C
authors.lastname: Armour
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
authors.forename: Natalie
authors.initials: N
authors.lastname: Mota
authors.affiliation: 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.
authors.forename: Ilan
authors.initials: I
authors.lastname: Harpaz-Rotem
authors.affiliation: 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.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Southwick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology*; D063189:Symptom Assessment / Q000523:psychology*; D014481:United States; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Functioning; Posttraumatic stress disorder; Symptomatology; Trauma; Veterans