{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:01:41Z","timestamp":1792191701887,"version":"4.4.0"},"reference-count":60,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psychiatric Ment Health Nurs"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Trauma is a risk factor for mental health problems. Pathological dissociation is often theorized as a response to trauma, yet it remains a controversial topic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The present study is one of the very few to examine trauma and dissociation in a representative general population sample and is the first of its kind in the Chinese context. We examined the prevalence of pathological dissociation and its association with trauma, potential iatrogenic effects, and functional impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A random sample of community Hong Kong Chinese adults (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009945) completed validated measures of trauma exposure, dissociative symptoms, depressive symptoms, and functional impairment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In this sample, 33.3% endorsed at least one potentially traumatic event; 16.5% exhibited clinically significant pathological dissociation, of whom only 14.8% had ever sought professional mental health services. Childhood betrayal and non\u2010betrayal trauma and adulthood betrayal trauma were significantly associated with dissociative symptoms, while adulthood non\u2010betrayal trauma was not. Dissociative symptoms were the strongest predictor of functional impairment (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.443,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), even stronger than depressive symptoms (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.384,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study highlights the public health and clinical importance of recognizing dissociation, which is comparably prevalent to depression and even more strongly linked to functional impairment. Our results support the trauma model in general, but do not support the betrayal trauma theory or the iatrogenic model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>Dissociative symptoms are prevalent and clinically significant in the community. Nurses should be trained to identify and support people affected by\u00a0pathological dissociation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jpm.70194","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T07:18:22Z","timestamp":1787296702000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Population\u2010Based Cross\u2010Sectional Study of Trauma and Dissociation in the Community: Theoretical Re\u2010Examination and Implications for Mental Health Nursing"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4606-2173","authenticated-orcid":false,"given":"Hong Wang","family":"Fung","sequence":"first","affiliation":[{"name":"School of Nursing The Hong Kong Polytechnic University  Hung Hom Hong Kong"},{"name":"Mental Health Research Centre The Hong Kong Polytechnic University  Hung Hom Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4703-5430","authenticated-orcid":false,"given":"Grace Wing Ka","family":"Ho","sequence":"additional","affiliation":[{"name":"School of Nursing The Hong Kong Polytechnic University  Hung Hom Hong Kong"},{"name":"Mental Health Research Centre The Hong Kong Polytechnic University  Hung Hom Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6544-795X","authenticated-orcid":false,"given":"Stanley Kam Ki","family":"Lam","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Sciences Hong Kong Metropolitan University  Homantin Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6665-8425","authenticated-orcid":false,"given":"Anson Kai Chun","family":"Chau","sequence":"additional","affiliation":[{"name":"Department of Psychiatry The University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0590-7165","authenticated-orcid":false,"given":"Jacqueline","family":"Sin","sequence":"additional","affiliation":[{"name":"School of Nursing The Hong Kong Polytechnic University  Hung Hom Hong Kong"},{"name":"Mental Health Research Centre The Hong Kong Polytechnic University  Hung Hom Hong Kong"},{"name":"Department of Nursing and Midwifery, School of Health and Medical Sciences City St George's, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291715001981"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20841"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.32481\/djph.2022.05.010"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1037\/tra0001871"},{"issue":"10","key":"e_1_2_12_6_1","first-page":"62","article-title":"Dissociative Disorders: An Overview of Assessment, Phenomenology, and Treatment","volume":"27","author":"Brand B. 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