Among traumatized Cambodian refugees, this article investigates worry (e.g., the types of current life concerns) and how worry worsens posttraumatic stress disorder (PTSD). To explore how worry worsens PTSD, we examine a path model of worry to see whether certain key variables (e.g., worry-induced somatic arousal and worry-induced trauma recall) mediate the relationship between worry and PTSD. Survey data were collected from March 2010 until May 2010 in a convenience sample of 201 adult Cambodian refugees attending a psychiatric clinic in Massachusetts, USA. We found that worry was common in this group (65%), that worry was often about current life concerns (e.g., lacking financial resources, children not attending school, health concerns, concerns about relatives in Cambodia), and that worry often induced panic attacks: in the entire sample, 41% (83/201) of the patients had " worry attacks" (i.e., worry episodes that resulted in a panic episode) in the last month. " Worry attacks" were highly associated with PTSD presence. In the entire sample, generalized anxiety disorder was also very prevalent, and was also highly associated with PTSD. Path analysis revealed that the effect of worry on PTSD severity was mediated by worry-induced somatic arousal, worry-induced catastrophic cognitions, worry-induced trauma recall, inability to stop worry, and irritability. The final model accounted for 75% of the variance in PTSD severity among patients with worry. The public health and treatment implications of the study's findings that worry may have a potent impact on PTSD severity in severely traumatized populations are discussed: worry and daily concerns are key areas of intervention for these worry-hypersensitive (and hence daily-stressor-hypersensitive) populations. © 2011 Elsevier Ltd.

Trauma recall Generalized anxiety order Catastrophic cognitions Refugees Panic attacks PTSD Worry USA Cambodian refugees

anxiety Models, Psychological Asian Panic Disorder refugee psychological aspect Cambodia Massachusetts health risk mental health human path analysis Refugees Life Change Events Stress, Psychological health status panic dizziness United States Humans family psychology Severity of Illness Index male female cognition health geography prevalence Article major clinical study adult posttraumatic stress disorder irritability generalized anxiety disorder Stress Disorders, Post-Traumatic spatial cognition catastrophic cognition worry induced panic attack somatic arousal disease severity heart palpitation psychosomatic disorder psychotrauma Mental Recall worry relative recall public health finance