The Posttraumatic Stress Disorder Checklist (PCL-5; Weathers et al., 2013) was recently revised to reflect the changed diagnostic criteria for posttraumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). We investigated the psychometric properties of PCL-5 scores in a large cohort (N = 912) of military service members seeking PTSD treatment while stationed in garrison. We examined the internal consistency, convergent and discriminant validity, and DSM-5 factor structure of PCL-5 scores, their sensitivity to clinical change relative to PTSD Symptom Scale-Interview (PSS-I; Foa, Riggs, Dancu, & Rothbaum, 1993) scores, and their diagnostic utility for predicting a PTSD diagnosis based on various measures and scoring rules. PCL-5 scores exhibited high internal consistency. There was strong agreement between the order of hypothesized and observed correlations among PCL-5 and criterion measure scores. The best-fitting structural model was a 7-factor hybrid model (Armour et al., 2015), which demonstrated closer fit than all other models evaluated, including the DSM-5 model. The PCL-5's sensitivity to clinical change, pre- to posttreatment, was comparable with that of the PSS-I. Optimally efficient cut scores for predicting PTSD diagnosis were consistent with prior research with service members (Hoge, Riviere, Wilk, Herrell, & Weathers, 2014). The results indicate that the PCL-5 is a psychometrically sound measure of DSM-5 PTSD symptoms that is useful for identifying provisional PTSD diagnostic status, quantifying PTSD symptom severity, and detecting clinical change over time in PTSD symptoms among service members seeking treatment. (PsycINFO Database Record

Surprisingly little research has examined the widely held assumption that religion and spirituality are generally helpful in adjusting to bereavement. A systematic literature search located 73 empirical articles that examined religion/spirituality in the context of bereavement. The authors describe the multidimensional nature of religion/spirituality and use this framework to organize and integrate the findings of these empirical articles. Overall, results suggest that relations between religion and adjustment to bereavement are generally positive but inconsistent and vary depending in part on how religion/spirituality is measured. The authors conclude with a critique of the current research and directions for future research.

Because exposure to potentially traumatic events is common (Kessler, Sonnega, Bromet, & Hughes, 1995), the mechanisms through which post-traumatic stress disorder (PTSD) symptoms develop is a critical area of investigation (Ozer, Best, Lipsey, & Weiss, 2003). Among the mechanisms that may predict PTSD symptoms is spiritual struggle, a set of negative religious cognitions related to understanding or responding to stressful events. Although prominent theories emphasize cognitive factors in the development and maintenance of PTSD symptoms, they have not explicitly addressed spiritual struggle. The present prospective study tested the role of spiritual struggle in the development and maintenance of PTSD symptoms following trauma. We assessed exposure to trauma and non-trauma events during the first year of college, spiritual struggle due to the most stressful event, and PTSD symptoms resulting from the index event. Spiritual struggle partially mediated the relationship between trauma and PTSD symptoms. Interestingly, some individual subscales of spiritual struggle (specifically, Punishing God Reappraisal, Reappraisal of God's Powers, and Spiritual Discontent) partially mediated the relationship between trauma and Correspondence concerning this article should be addressed to Jennifer H. Wortmann, Department of Psychology, University of Connecticut, 406 Babbidge Road Unit 1020, Storrs, CT 06269. jennifer.wortmann@uconn.edu . 1 It is important to note that some negative cognitions may reflect objective appraisals of a negative situation, such as likelihood of recurrent exposure. 2 Three participants did not report the number of months since the most stressful or distressing event occurred. Although participants were invited to complete Time 2 in April, they were permitted to return responses in May; therefore, an option to indicate that the stressful event occurred nine months prior was available, and twenty students indicated that nine months had passed since their most stressful or distressing event. 3 Other possible contributors to PTSD symptoms at Time 2 include female gender (Brewin, Andrews, & Valentine, 2000), prior trauma (Ozer, Best, Lipsey, & Weiss, 2003), and time since event. Bivariate correlations between gender and PTSD symptoms at Times 1 and 2 were non-significant (r = .10, n.s. and r = .07, n.s., respectively). Bivariate correlations indicated that total number of traumas prior to Time 1 correlated positively with PTSD symptoms at Time 1 (r = .40, p < .001) but not at Time 2 (r = .09, n.s.). Although trauma prior to Time 1 correlated positively with reporting trauma between Times 1 and 2 (r = .24, p = .001), PTSD symptoms at Time 1 also correlated positively with reporting trauma between Times 1 and 2 (r = .18, p = .006), and analyses controlled for PTSD symptoms at Time 1. Bootstrapping analyses were re-run controlling for total number of prior traumas; however, adding this additional control did not add to the total variance accounted for by the model (adjusted R 2 = .10). Similarly, months s...

Warzone experiences that violate deeply held moral beliefs and expectations may lead to moral injury and associated spiritual distress (Litz et al., 2009). Helping morally injured war veterans who are grappling with spiritual or religious issues is part of multicultural competence (Vieten et al., 2013) and falls within the scope of practice of mental health clinicians. Moreover, practicing clinicians report that they lack adequate knowledge of the diverse spiritual and religious backgrounds of their clients and when to seek consultation from and collaborate with spiritual/religious teachers (Vieten et al., 2016). We argue that optimal assessment and treatment of psychically traumatized military personnel and veterans requires an understanding of the idioms and perspectives of various spiritual (religious and philosophical) traditions on transgression and their recommendations for forgiveness and healing. To this end, we (a) provide an overview of the source of moral codes associated with various traditions, (b) discuss aspects of warzone events that may violate those moral codes and spiritual reactions to those violations, (c) describe spiritual traditions' approaches to making amends for transgressions, and (d) provide brief case scenarios that illustrate spiritual features of moral injury and point to circumstances in which collaboration with chaplains or clergy may be helpful for addressing aspects of moral injury.

Patients with congestive heart failure (CHF) often report high levels of religiousness, which may mitigate the stressfulness of their condition. However, religious struggle, reflecting negative attitudes toward God and a strained meaning system, may be detrimental to well-being. Little is known about religious struggle in those with CHF, particularly in relation to physical health and well-being over time. We examined associations of religious struggle and subsequent mental and physical well-being in 101 endstage CHF patients who completed questionnaires twice over 3 months. Religious struggle predicted higher number of nights subsequently hospitalized, higher depression, and marginally lower life satisfaction. When controlling for baseline levels of well-being, effectively assessing change in those outcomes, religious struggle remained a significant predictor of hospitalization and also emerged as a marginally significant predictor of lower physical functioning. Struggle was unrelated to health-related quality of life. Post-hoc analyses suggest that these effects were particularly strong for those endorsing greater religious identification. Religious struggle appears to have a potentially negative impact on well-being in advanced CHF; therefore, helping patients to address issues of struggle may meaningfully lessen the personal and societal costs of CHF.