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A higher\u2010order 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\u2010order Distress and PTSD\u2010specific 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\u2010C), and psychosocial impairment. The results suggest the association between trauma exposure and PTSD symptoms was primarily mediated by higher\u2010order distress (70.7% of LEC effect, 63.2% of DRRI\u2010C effect), but PTSD severity retained a significant association with trauma exposure independent of distress, LEC: \u03b2 = .10, 95% CI [.06, .13]; DRRI\u2010C: \u03b2 = .11, 95% CI [.07, .14]. Both higher\u2010order distress, \u03b2 = .31, and PTSD\u2010specific variance, \u03b2 = .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\u2010specific presentations.<\/jats:p>","DOI":"10.1002\/jts.23009","type":"journal-article","created":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T05:53:15Z","timestamp":1705470795000},"page":"372-383","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Trauma exposure and transdiagnostic distress: Examining shared and posttraumatic stress disorder\u2013specific associations"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8834-067X","authenticated-orcid":false,"given":"Michael L.","family":"Crowe","sequence":"first","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Department of Psychiatry Boston University Chobanian &amp; Avedisian School of Medicine  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sage E.","family":"Hawn","sequence":"additional","affiliation":[{"name":"Department of Psychology Old Dominion University  Norfolk Virginia USA"},{"name":"National Center for PTSD  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika J.","family":"Wolf","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Department of Psychiatry Boston University Chobanian &amp; Avedisian School of Medicine  Boston Massachusetts USA"},{"name":"National Center for PTSD  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terence M.","family":"Keane","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Department of Psychiatry Boston University Chobanian &amp; Avedisian School of Medicine  Boston Massachusetts USA"},{"name":"National Center for PTSD  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8988-1796","authenticated-orcid":false,"given":"Brian P.","family":"Marx","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Department of Psychiatry Boston University Chobanian &amp; Avedisian School of Medicine  Boston Massachusetts USA"},{"name":"National Center for PTSD  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,1,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2020.2148"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40479\u2010019\u20100099\u2010y"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1037\/ser0000220"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1037\/pas0000254"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jts.20443"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2017.01.014"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1745691618810696"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/21677026211017834"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0029598"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2011.02.011"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/2167702620954799"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0012591"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/1073191104269954"},{"key":"e_1_2_8_16_1","volume-title":"Treating trauma in dialectical behavior therapy: The DBT prolonged exposure protocol (DBT PE)","author":"Harned M. 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