First Onset in Adulthood of Mental Disorders: Exposure to War vs. Non-war Childhood Adversities: A National Study.

Background: There is evidence that some childhood trauma increases the risk of the first onset of mental disorders and for the first time into adulthood. There are no studies that assessed whether exposure to war has this delayed long-term effect. Objectives: To fill this gap by investigating the comparative roles of war and non-war trauma on the first onset of adulthood mood and anxiety disorders. Methods: A nationally representative sample of 2,857 Lebanese was assessed using the World Health Organization Composite International Diagnostic Interview 3.0. with the onset of exposure to trauma and of first onset of mood and anxiety disorders. Results: Non-war childhood traumata especially those belonging to family malfunctioning continue to exert their effect for the first time well beyond their occurrence as they were the most universal predictors for adult onset of both mood and anxiety disorders. War trauma during childhood predicted mood anxiety and mood (anxiety only in males) only below age 18 y. war childhood trauma predicts the first onset of mood and anxiety disorders before age 18 y in females, but only anxiety in males. Conclusion: Childhood traumata are not equal in predicting the first onset of mood and anxiety disorders into adulthood. Family malfunctioning looks to carry the longest such risk and war more of shorter immediate effects. This might change though with re-exposure to war in adulthood which might unravel dormant vulnerability.

CHRONIC MEDICAL CONDITIONS IN CROATIAN WAR VETERANS COMPARED TO THE GENERAL POPULATION: 25 YEARS AFTER THE WAR.

Many published reports have documented an increased prevalence of chronic medical conditions among veterans, but there were only a few studies that compared these increases with the general population. The aim of this study was to determine differences in chronic medical conditions between Croatian war veterans and the general population. This study included two groups of subjects, i.e. 1453 participants who are Croatian war veterans and 1429 participants from the general population. Medical history, physical examination, laboratory tests and specific diagnostic procedures were taken during systematic physical examination in both groups. The prevalence of hypertension, diabetes, hyperlipidemia, hypothyroidism and hyperthyroidism, chronic obstructive pulmonary disease, coronary heart disease, malignancy, psychiatric diseases, cholelithiasis, nephrolithiasis, smoking and alcohol consumption was analyzed. Croatian war veterans were found to be more likely to develop hypertension than individuals in the general population (29.5% vs. 24.3%), as well as diabetes (7.3% vs. 3.8%), hyperlipidemia (56.4% vs. 27.3%), hyperthyroidism (3.1% vs. 0.8%), coronary heart disease (4.3% vs. 1%), malignancy (4.1% vs. 2.2%), psychiatric diseases (15.4% vs. 1.1%), and alcohol consumption (53% vs. 29%). Significant difference was found in favor of the general population for hypothyroidism (14.3% vs. 8%). There were no differences in the prevalence of chronic obstructive pulmonary disease, cholelithiasis, nephrolithiasis, and smoking. Our findings confirmed the hypothesis of a higher prevalence of cardiovascular diseases, malignancy and psychiatric diseases among Croatian war veterans and emphasized the need of better control of their medical conditions.

Cohort profile: biological pathways of risk and resilience in Syrian refugee children (BIOPATH).

The BIOPATH cohort was established to explore the interplay of psychosocial and biological factors in the development of resilience and mental health problems in Syrian refugee children. Based in Lebanon, a middle-income country significantly impacted by the refugee crisis, it is the first such cohort of refugees in the Middle East. Families were recruited from informal tented settlements in the Beqaa region using purposive cluster sampling. At baseline (October 2017-January 2018), N = 3188 individuals participated [n = 1594 child-caregiver dyads; child gender, 52.6% female; mean (SD) age = 11.44 (2.44) years, range = 6-19]. Re-participation rate at 1-year follow-up was 62.8%. Individual interviews were conducted with children and primary caregivers and biological samples collected from children. Measures include: (1) children's well-being and mental health problems (using tools validated against clinical interviews in a subsample of the cohort); (2) psychosocial risk and protective factors at the level of the individual (e.g. coping strategies), family (e.g. parent-child relationship), community (e.g. collective efficacy), and wider context (e.g. services); (3) saliva samples for genetic and epigenetic (methylation) analyses; (4) hair samples to measure cortisol, dehydroepiandrosterone (DHEA) and testosterone. This cohort profile provides details about sampling and recruitment, data collection and measures, demographic data, attrition and potential bias, key findings on resilience and mental health problems in children and strengths and limitations of the cohort. Researchers interested in accessing data should contact Professor Michael Pluess at Queen Mary University of London, UK (e-mail: m.pluess@qmul.ac.uk).

Parenting in times of refuge: A qualitative investigation.

This qualitative study sheds light on how the different phases of refuge and resettlement shape parents' perceptions of their parenting. We used in-depth interviews to examine parents' accounts of how war and refuge gave rise to different stressors, and how these in turn shaped parenting. We interviewed 27 Syrian refugee parents recently settled in the Netherlands (16 families) twice, using a grounded theory approach. We distinguished five phases of refuge, namely prewar, war, flight, displacement, and resettlement. During flight and displacement, stressors associated with financial and material losses appeared to induce parental empathy for children's suffering, which seemed to increase parental leniency. Stressors emerging from family separation during displacement, however, were reported to burden parents and to lead to uncertainty, which seemed to compromise parental warmth and sensitive discipline. While narratives suggest that families reacted in similar ways during the phases of war, flight, and displacement, differences seemed to emerge during the resettlement phase. Some parents stated that in resettlement, they experienced post-traumatic growth (e.g., increased compassion for their children) and were more autonomy supporting than before the war. Other parents seemed to struggle with accepting and supporting their children's emotions and appeared to resort more readily to parental control. Our findings suggest that emotional exhaustion plays a key role in how parents viewed their parenting changed during refuge, and that individual differences in parents' abilities to recover from emotional exhaustion played a key role in shaping parenting in resettlement.

Este estudio cualitativo aclara cómo las distintas fases del asilo y el reasentamiento determinan las percepciones de los padres con respecto a la crianza de sus hijos. Utilizamos entrevistas detalladas para analizar las explicaciones de los padres de cómo la guerra y el asilo provocaron diferentes factores desencadenantes de estrés, y de cómo estos a su vez moldearon la crianza. Entrevistamos a 27 padres refugiados sirios asentados recientemente en los Países Bajos (16 familias) dos veces utilizando un enfoque de teoría fundamentada. Distinguimos cinco fases del asilo, por ejemplo, la preguerra, la guerra, la huida, el desplazamiento y el reasentamiento. Durante la huida y el desplazamiento, los factores desencadenantes de estrés asociados con las pérdidas económicas y materiales aparentemente provocaron empatía en los padres por el sufrimiento de los niños, lo cual pareció aumentar la indulgencia de los padres. Sin embargo, se informó que los factores desencadenantes de estrés que surgieron por la separación de la familia durante el desplazamiento agobiaron a los padres y condujeron a la incertidumbre, lo cual aparentemente comprometió la amabilidad de los padres y la disciplina sensible. Si bien las historias sugieren que las familias reaccionaron de maneras similares durante las fases de la guerra, la huida y el desplazamiento, parecieron surgir diferencias durante la fase del reasentamiento. Algunos padres declararon que en el reasentamiento vivieron un crecimiento postraumático (p. ej.: una mayor compasión por sus hijos) y que fomentaron más la autonomía que antes de la guerra. A otros padres les costó aceptar y apoyar las emociones de sus hijos, y recurrieron más fácilmente al control parental. Nuestros resultados sugieren que el agotamiento emocional juega un papel fundamental en cómo los padres observaron un cambio en la crianza durante el asilo, y que las diferencias individuales en las habilidades de los padres para recuperarse del agotamiento emocional jugaron un papel clave a la hora de determinar la crianza en el reasentamiento.

Examining the Influence of Trauma Exposure on HIV Sexual Risk Between Men and Women in Post-Conflict Liberia.

The adverse impact of exposure to war-related traumatic events on mental health is well documented. Few studies, however, have focused on the impact of exposure to war-related traumatic events on HIV sexual risk behavior in post-conflict countries such as Liberia. We investigated whether exposure to war-related traumatic events was linked to HIV sexual risk behavior, and identified potential mediators of this relationship, including stressful life events, problematic alcohol use, and intimate partner violence (IPV) among women and men in Liberia. Data were collected from a sample of 395 participants in Monrovia, Liberia. Results from the serial multiple mediator model did not support direct or indirect effects between war-related traumatic events and HIV sexual risk behavior among women. For men, we found both direct and indirect effects between war-related traumatic events and HIV sexual risk behavior. Findings from this research highlight the need for trauma-informed HIV prevention strategies in Liberia.

Validation of the Extreme Experiences Scale (EX2) for Armed Conflict Contexts.

Psychological approaches to the study of armed conflict have focused on analyzing post-traumatic stress outcomes, and on evaluating the intensity of exposure to violent confrontation. Nevertheless, psychometrically valid tools required for measuring these traumatic experiences are scarce To validate the Extreme Experiences scale (EX2) for armed conflict contexts for its use in Colombia, and to provide a framework for validation in conflict contexts around the world This Cross-sectional aims to validate the scale with 187 participants, study of validate with 187 participants, comprising population with high exposure to conflict (former combatants and a set of armed conflict victims) and low conflict-exposed individuals (control group). Structures of two domains and 18 items were confirmed: Direct Extreme Experiences (dEX2) and Indirect Extreme Experiences (iEX2); these dimensions were also validated by expert judgment, producing 14-item version. Good levels of internal consistency were found, with a KR-20 of 0.80 for the 18-item version, and 0.77 for the 14-item. The scale differentiates between population with 'high exposure to conflict' from population with 'low exposure' (dnp > 0.5 and area under the ROC >0.90). The scale scores have significant correlation with some mental health constructs. The EX2 scale has good internal consistency, as well as structural validity with regard to exposed groups. This scale can be potentially validated for its use in countries with armed confrontation history. In future versions, the scale may include additional items in order to improve content validity.

Maternal immune and affiliative biomarkers and sensitive parenting mediate the effects of chronic early trauma on child anxiety.

BACKGROUND: Chronic early trauma alters children's stress reactivity and increases the prevalence of anxiety disorders; yet the neuroendocrine and immune mechanisms underpinning this effect are not fully clear. Animal studies indicate that the mother's physiology and behavior mediate offspring stress in a system-specific manner, but few studies tested this external-regulatory maternal role in human children exposed to chronic stress. METHODS: We followed a unique cohort of children exposed to continuous wartime trauma (N = 177; exposed; N = 101, controls; N = 76). At 10 years, maternal and child's salivary immunoglobulin A (s-IgA) and oxytocin (OT), biomarkers of the immune and affiliation systems, were assayed, maternal and child relational behaviors observed, mother and child underwent psychiatric diagnosis, and child anxiety symptoms assessed. RESULTS: War-exposed mothers had higher s-IgA, lower OT, more anxiety symptoms, and their parenting was characterized by reduced sensitivity. Exposed children showed higher s-IgA, more anxiety disorders and post traumatic stress disorder, and more anxiety symptoms. Path analysis model defined three pathways by which maternal physiology and behavior impacted child anxiety; (a) increasing maternal s-IgA, which led to increased child s-IgA, augmenting child anxiety; (b) reducing maternal OT, which linked with diminished child OT and social repertoire; and (c) increasing maternal anxiety, which directly impacted child anxiety. CONCLUSIONS: Our findings, the first to measure immune and affiliation biomarkers in mothers and children, detail their unique and joint effects on children's anxiety in response to stress; highlight the relations between chronic stress, immune activation, and anxiety in children; and describe how processes of biobehavioral synchrony shape children's long-term adaptation.

Longitudinal Associations among Posttraumatic Stress Disorder Symptoms, Traumatic Brain Injury, and Neurocognitive Functioning in Army Soldiers Deployed to the Iraq War.

OBJECTIVES: Military deployment is associated with increased risk of adverse emotional and cognitive outcomes. Longitudinal associations involving posttraumatic stress disorder (PTSD), relatively mild traumatic brain injury (TBI), and neurocognitive compromise are poorly understood, especially with regard to long-term outcomes, and rigorous research is necessary to better understand the corresponding relationships. The objective of this study was to examine short-term and long-term (>5 years) longitudinal associations among PTSD, neurocognitive performance, and TBI following military deployment. METHODS: In this prospective study, N=315 U.S. Army soldiers were assessed at military installations before (2003-2005) and after (2004-2006) an index deployment to the Iraq War, and again an average of 7.6 years later (2010-2014) as a nationally dispersed cohort of active duty soldiers, reservists, and veterans. Thus, the study design allowed for two measurement intervals over which to examine changes. All assessments included the PTSD Checklist, civilian version, and individually-administered performance-based neurocognitive tests. TBI history was derived from clinical interview. RESULTS: Autoregressive analyses indicated that visual reproduction scores were inversely related to subsequent PTSD symptom severity at subsequent assessments. Conversely, increases in PTSD symptom severity over each measurement interval were associated with poorer verbal and/or visual recall at the end of each interval, and less efficient reaction time at post-deployment. TBI, primarily mild in this sample, was associated with adverse PTSD symptom outcomes at both post-deployment and long-term follow-up. CONCLUSIONS: These results suggest longitudinal relationships among PTSD symptoms, TBI, and neurocognitive decrements may contribute to sustained emotional and neurocognitive symptoms over time. (JINS, 2018, 24, 311-323).

War-Related Life Course Stress and Late-Life Subjective Age in Northern Vietnam.

Background and Objectives: The role of early life stressors in subjective aging is weakly understood, especially in low- to middle-income countries. This paper investigated how early life stressors encountered in armed conflict influence subjective age among Vietnamese older adults who experienced war over decades of their early life. Research Design and Methods: We analyzed survey data from the 2018 Vietnam Health and Aging Study involving 2,447 Vietnamese older adults who encountered diverse war-related stressors in early adulthood. The analytical sample (N = 2,341) included 50.9% women and 49.1% men, with an average age of 69.8. 41.1% are military veterans. We conducted survey-adjusted multinomial logistic regression analyses with mediation to predict the probability of feeling younger or older than one's chronological age. We examined how childhood adversity (i.e., childhood hunger and low parental SES) and wartime stressors (i.e., war-related violence, malevolent environment, and military service) influenced late-life subjective age, both directly and as mediated by late-life mental, functional, and physical health. Results: We found significant associations between early adulthood war-related stressors and subjective age. Formal military service significantly lessened the relative risk of feeling subjectively old, and more plentiful wartime violence exposures significantly increased the risk of feeling younger than one's chronological age. Violence exposure's effects were both direct and indirect through functional and mental health. Conversely, greater exposure to wartime malevolent conditions (e.g., shortages of clean water and evacuations) and multiple episodes of severe hunger in childhood increased the risk of feeling older, effects both direct and mediated by late-life functional and mental health. Discussion and Implications: Results suggest wartime stressors, especially war's malevolent environments and severe childhood hunger, experienced in many conflict-affected populations globally, have the potential to subjectively "age" survivors. Yet, not all war exposures are equal, and some may yield psychological and socioeconomic resources that support healthy aging.

Explaining post-traumatic stress symptoms and sleep disturbance in Ukrainian civilians: perceived threat versus objective war exposure.

Objective: This study investigated the impact of war exposure on post-traumatic stress symptoms (PTSS) and sleep disturbance across Ukraine. Subjective and objective indicators of war exposure were modelled as predictors of these symptoms.Methods: We created two predictors: first, we used governmental and crowd-sourced data to create an objective war exposure index for each of the 21 non-occupied regions of Ukraine, based on the number of air raid alarms, explosions, and proximity to frontline; and second, we obtained self-report cross-sectional data, using convenience sampling, from a nation-wide survey (N = 991) on subjective experience of threat triggered by the war. The survey also measured the outcome variables of PTSS and sleep disturbance. Hierarchical multilevel regressions modelled the relationship of this objective war exposure index with the two outcome variables, after accounting for demographics. A final regression step modelled subjective threat as predictor of these symptoms.Results: We observed strongly elevated levels of PTSS and sleep disturbance and strong regional differences in objective and subjective war indicators. Objective war exposure predicted PTSS but not sleep disturbance, whereas subjective threat predicted both symptom domains.Conclusion: The study demonstrates the utility of objective war exposure data for predicting the prevalence of PTSS in the different regions. The results further underscore the prominent role of subjective appraisal processes in the symptomatology of PTSS and sleep disturbance, thus informing theories on trauma-related disorders. Our results can guide the allocation of mental health services by identifying highly affected regions.

Objective data on air raid alarms and explosions have been prospectively collected in Ukraine.We related those objective data to symptom reports of 991 responders in most Ukraine regions.Objective data explained symptoms of post-traumatic stress but not sleep disturbance.

Social Determinants of Health: Considerations for Care of Older Veterans.

Social determinants of health (SDOH), the environments and circumstances in which people are born, grow, live, work and age, are potent drivers of health, health disparities, and health outcomes over the lifespan. Military service affords unique experiences, exposures, and social and health vulnerabilities which impact the life course and may alter health equity and health outcomes for older veterans. Identifying and addressing SDOH, inclusive of the military experience, allows person-centered, more equitable care to this vulnerable population. Nurses and other health professionals should be familiar with how to identify and address health-related social needs and implement interdiciplinary, team-based approaches to connect patients with resources and benefits specifically available to veterans.

Parenting in Times of War: A Meta-Analysis and Qualitative Synthesis of War Exposure, Parenting, and Child Adjustment.

This mixed methods systematic review and meta-analysis sheds more light on the role parenting practices play in children's adjustment after war exposure. Specifically, we quantitatively examined whether parenting behavior explained some of the well-known associations between war exposure and children's adjustment. In addition, we meta-synthesized qualitative evidence answering when and why parenting practices might change for war-affected families. We searched nine electronic databases and contacted experts in the field for relevant studies published until March 2018, identifying 4,147 unique publications that were further screened by title and abstract, resulting in 158 publications being fully screened. By running a meta-analytic structural equation model with 38 quantitative studies (N = 54,372, Mage = 12.00, SDage = 3.54), we found that more war-exposed parents showed less warmth and more harshness toward their children, which partly mediated the association between war exposure and child adjustment, that is, post-traumatic stress symptoms, depression and anxiety, social problems, externalizing behavior, and lower positive outcomes (e.g., quality of life). War exposure was not associated with parents' exercise of behavioral control. By meta-synthesizing 10 qualitative studies (N = 1,042; age range = 0-18), we found that the nature of war-related trauma affected parenting differently. That is, parents showed harshness, hostility, inconsistency, and less warmth in highly dangerous settings and more warmth and overprotection when only living under threat. We conclude that it is both how much and what families have seen that shapes parenting in times of war.

Under-Age Children Returning From Jihadist Group Operation Areas: How Can We Make a Diagnosis and Construct a Narrative With a Fragmentary Anamnesis?

INTRODUCTION: Since 2011, the French government estimates that about 500 French children have been born in or taken by their parents to areas where terrorist operations prevail. Since May 2017, 75 children who returned to France have benefited from a dedicated health care system. METHOD: This article is the result of clinical interviews conducted with 53 patients evaluated and taken care of at Avicenne Hospital in Bobigny. To our knowledge, no studies have been published on this subject. RESULTS: A total of 32 evaluations have been completed, all of which indicated the need for care for these children. Of these children, 64% are under 5 years old, and 59% were born in France. Their clinical profiles are heterogeneous and fluctuate with time. DISCUSSION: The multiple adverse events experienced by these children and the uniqueness of children born to families suspected by authorities of having participated in activities related to terrorism make this situation unprecedented. How can we make a diagnosis of PTSD without the help of a precise anamnesis? How can we help these children form a structuring narrative that avoids the pitfalls inherent to generalized fascination?

Burnout Syndrome Among Hospital Healthcare Workers During the COVID-19 Pandemic and Civil War: A Cross-Sectional Study.

Objective: We aimed to determine the prevalence of burnout among hospital healthcare workers in Libya during the coronavirus disease (COVID-19) pandemic and civil war. Methods: A cross-sectional study was conducted from April 18 to May 2, 2020 among Libyan healthcare workers. Data on participant characteristics were collected with a specifically designed questionnaire. Burnout was assessed with the abbreviated Maslach Burnout Inventory (aMBI) comprising three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), with each sub-scale score range from 0 to 18. For EE and DP, scores of 10 to 18 were regarded as "moderate to severe burnout." PA was scored inversely, where a score ≤ 10 indicated severe burnout. Results: The study yielded a sample size of 532 participants. Of these, 357 (67.1%) reported emotional exhaustion (EE Score ≥ 10), 252 (47.4%) reported depersonalization (DP score ≥ 10), and 121 (22.7%) reported a lower sense of personal accomplishment (PA score ≤ 10). Verbal abuse was experienced by 304 participants (57.1%) and physical abuse in 93 (17.5). Gender was associated with high emotional exhaustion and high depersonalization. Being 35 years or older was associated with high depersonalization. Professional specialty was significantly associated with high emotional exhaustion and depersonalization. Fear of COVID-19 infection was associated with high emotional exhaustion and high depersonalization. Conclusion: The rising prevalence of mental disorders and inadequate availability of health services facilities during the COVID-19 pandemic and civil war demonstrated the need for healthcare policies to address the well-being of healthcare workers to decrease the risk of loss, suicide, and medical negligence.

Intimate partner violence in pregnancy: a cross-sectional study from post-conflict northern Uganda.

OBJECTIVES: To determine the prevalence of intimate partner violence (IPV) in pregnancy and to understand associations and determinants. DESIGN: Cross-sectional survey. SETTING: Two rural health clinics in post-conflict northern Uganda. PARTICIPANTS: Women attending two rural health clinics for a new service providing cervical cancer screening, who had experienced pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: Data were collected by a questionnaire using validated questions from the demographic health survey women's questionnaire and the domestic violence module. Data were entered into tablets using Questionnaire Development System software. Bivariate and multivariate logistic regression was performed, using experience of IPV in pregnancy as the dependent variable. SPSS V.25 was used for all analysis. RESULTS: Of 409 participant women, 26.7% (95% CI 18.6% to 35.9%) reported having been slapped, hit or beaten by a partner while pregnant. For 32.3% (95% CI 20.2% to 37.9%) of the women the violence became worse during pregnancy. Women who had ever experienced IPV in pregnancy were more likely to have experienced violence in the previous 12 months (OR 4.45, 95% CI 2.80 to 7.09). In multivariate logistic regression, the strongest independent associations with IPV in pregnancy were partner's daily drinking of alcohol (OR 2.02, 95% CI 1.19 to 3.43) and controlling behaviours (OR 1.17, 95% CI 1.03 to 1.33). CONCLUSIONS: The women in this study had more exposure to IPV in pregnancy than previously reported for this region. Women's previous experience of intimate partner violence, partner's daily use of alcohol and his controlling behaviours were strong associations with IPV in pregnancy. This study highlights the uneven distribution of risk and the importance of research among the most vulnerable population in rural and disadvantaged settings. More research is needed in local rural and urban settings to illuminate this result and inform intervention and policy.

Stress and immune biomarkers interact with parenting behavior to shape anxiety symptoms in trauma-exposed youth.

The relations between stress, HPA-axis, and the immune system have been extensively studied; however, no study to date addressed the joint contribution of immune and HPA biomarkers to the development of anxiety in youth exposed to chronic trauma as mediated by mother-child interaction patterns. A unique cohort of war-exposed children and their mothers, compared to matched controls, were followed from infancy and the current study reports findings from early adolescence (mean age = 11.66, SD = 1.23; N = 111; exposed = 58 control = 53). Youth and mothers' salivary cortisol (CT) and secretory immunoglobulin (s-IgA) levels were measured three times during a 4-hour lab visit, mother-child interaction patterns were quantified from a joint task, and children's anxiety symptoms diagnosed. Trauma-exposed children had higher levels of CT and s-IgA, exhibited more anxiety symptoms, and showed lower social collaboration with mother during the joint task. Trauma-exposed mothers had higher CT and s-IgA levels and showed less supportive parenting during mother-child interaction. Structural equation modeling defined three bio-behavioral paths by which trauma increases anxiety in youth. While the first path charted a behavioral link from exposure to child anxiety via diminished maternal support, the other two paths described mediated biological paths, one through HPA-axis functioning, the other via the immune system. Paths via the child's HPA and immune system were mediated by the parallel maternal variable. Findings are the first to describe the complex bio-behavioral interplay of stress and immune biomarkers and parenting behavior in shaping to the development of risk and resilience trajectories in youth growing up amidst chronic trauma.

Portuguese version of the PTSD Checklist-Military Version (PCL-M)-I: Confirmatory Factor Analysis and reliability.

The PTSD Checklist-Military Version (PCL-M) is a brief self-report instrument widely used to assess Post-traumatic Stress Disorder (PTSD) symptomatology in war Veterans, according to DSM-IV. This study sought out to explore the factor structure and reliability of the Portuguese version of the PCL-M. A sample of 660 Portuguese Colonial War Veterans completed the PCL-M. Several Confirmatory Factor Analyses were conducted to test different structures for PCL-M PTSD symptoms. Although the respecified first-order four-factor model based on King et al.'s model showed the best fit to the data, the respecified first and second-order models based on the DSM-IV symptom clusters also presented an acceptable fit. In addition, the PCL-M showed adequate reliability. The Portuguese version of the PCL-M is thus a valid and reliable measure to assess the severity of PTSD symptoms as described in DSM-IV. Its use with Portuguese Colonial War Veterans may ease screening of possible PTSD cases, promote more suitable treatment planning, and enable monitoring of therapeutic outcomes.