The role of psychological resilience in the relationship between Complex Post-Traumatic Stress Disorder symptom severity and functioning impairment in mental health support-seeking Australian Defence Force veterans: A cross-sectional study

Wachira  Suriyawong; Thanos Karatzias; Hannah  Steele; Grace WK  Ho; Mitchell K.  Byrne; M Shevlin; Noppamas  Pipatpiboon; David A  Mitchell; Bróna Nic Giolla  Easpaig; Xianliang  Liu; Jianxia  Zhai; Janina  Murta; Daniel  Bressington

The role of psychological resilience in the relationship between Complex Post-Traumatic Stress Disorder symptom severity and functioning impairment in mental health support-seeking Australian Defence Force veterans: A cross-sectional study

Wachira Suriyawong
, Thanos Karatzias
, Hannah Steele
, Grace WK Ho
, Mitchell K. Byrne
, M Shevlin
, Noppamas Pipatpiboon
, David A Mitchell
, Bróna Nic Giolla Easpaig
, Xianliang Liu
, Jianxia Zhai
, Janina Murta
, Daniel Bressington

Research output: Contribution to journal › Article › peer-review

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Abstract

Objective: Military veterans have high rates of mental health conditions; Complex Post-Traumatic Stress Disorder (CPTSD) may be the most functionally impaired trauma diagnosis in this patient group. Psychological resilience acts as a protective factor for mental health. Still, it is unclear how this may
influence relationships between the two main symptom clusters of CPTSD and functioning impairment in veterans. Therefore, we investigated the relationships between psychological resilience, trauma symptom severity, trauma exposure and work/social functional impairment among Australian Defence Force (ADF)
veterans.

Methods: Cross-sectional survey including 148 mental health support-seeking former-serving ADF veterans in primary care. Relationships between variables were explored using correlations, mean difference tests and mediation analysis to examine the role of resilience in the relationship between CPTSD symptoms and functional impairment.

Results: Resilience showed significant negative correlations with functioning impairment. The number of traumas showed weak positive correlations with disturbances in self-organisation (DSO) symptoms, PTSD symptoms and functional impairment. The CPTSD group had significantly lower resilience and functioning than those with no diagnosis. After controlling for the number of trauma exposures, resilience partially mediated the association between PTSD symptoms and functioning (indirect effect = 0.141, p < .05), and partially mediated the association between DSO symptoms and functioning (indirect effect = 0.157, p < .05).

Conclusion: Psychological resilience was associated with better functioning in veterans regardless of trauma diagnosis. Resilience also partially mediates the relationship between DSO/PTSD symptoms and functioning in those with ICD-11 CPTSD, indicating it is an important intervention target in ADF veterans
with polytrauma.

Original language	English
Journal	Australian and New Zealand Journal of Psychiatry (ANZJP)
Publication status	Accepted - 11 Jun 2026

Data Availability Statement

The data that support the findings of this study are available upon reasonable request from the corresponding author. The data are not publicly available due to the sensitive nature of the survey and resulting privacy and ethical restrictions.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: The study was funded by a Rainmaker grant from Charles Darwin University led by the last author (D.B.). The study also received support from the Chiang Mai University International Visiting Professor Fellowship Program. The author(s) received no other financial support for the research, authorship or publication of this article.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Complex post-traumatic stress disorder
psychological resilence
military veterans
Functioning
Trauma
International Trauma Questionnaire

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Suriyawong, W., Karatzias, T., Steele, H., Ho, G. WK., Byrne, M. K., Shevlin, M., Pipatpiboon, N., Mitchell, D. A., Easpaig , B. N. G., Liu , X., Zhai , J., Murta , J., & Bressington , D. (Accepted/In press). The role of psychological resilience in the relationship between Complex Post-Traumatic Stress Disorder symptom severity and functioning impairment in mental health support-seeking Australian Defence Force veterans: A cross-sectional study. Australian and New Zealand Journal of Psychiatry (ANZJP).

Suriyawong, Wachira ; Karatzias, Thanos ; Steele, Hannah et al. / The role of psychological resilience in the relationship between Complex Post-Traumatic Stress Disorder symptom severity and functioning impairment in mental health support-seeking Australian Defence Force veterans: A cross-sectional study. In: Australian and New Zealand Journal of Psychiatry (ANZJP). 2026.

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abstract = "Objective: Military veterans have high rates of mental health conditions; Complex Post-Traumatic Stress Disorder (CPTSD) may be the most functionally impaired trauma diagnosis in this patient group. Psychological resilience acts as a protective factor for mental health. Still, it is unclear how this may influence relationships between the two main symptom clusters of CPTSD and functioning impairment in veterans. Therefore, we investigated the relationships between psychological resilience, trauma symptom severity, trauma exposure and work/social functional impairment among Australian Defence Force (ADF) veterans. Methods: Cross-sectional survey including 148 mental health support-seeking former-serving ADF veterans in primary care. Relationships between variables were explored using correlations, mean difference tests and mediation analysis to examine the role of resilience in the relationship between CPTSD symptoms and functional impairment. Results: Resilience showed significant negative correlations with functioning impairment. The number of traumas showed weak positive correlations with disturbances in self-organisation (DSO) symptoms, PTSD symptoms and functional impairment. The CPTSD group had significantly lower resilience and functioning than those with no diagnosis. After controlling for the number of trauma exposures, resilience partially mediated the association between PTSD symptoms and functioning (indirect effect = 0.141, p < .05), and partially mediated the association between DSO symptoms and functioning (indirect effect = 0.157, p < .05). Conclusion: Psychological resilience was associated with better functioning in veterans regardless of trauma diagnosis. Resilience also partially mediates the relationship between DSO/PTSD symptoms and functioning in those with ICD-11 CPTSD, indicating it is an important intervention target in ADF veterans with polytrauma. ",

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author = "Wachira Suriyawong and Thanos Karatzias and Hannah Steele and Ho, \{Grace WK\} and Byrne, \{Mitchell K.\} and M Shevlin and Noppamas Pipatpiboon and Mitchell, \{David A\} and Easpaig, \{Br{\'o}na Nic Giolla\} and Xianliang Liu and Jianxia Zhai and Janina Murta and Daniel Bressington",

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Suriyawong, W, Karatzias, T, Steele, H, Ho, GWK, Byrne, MK, Shevlin, M, Pipatpiboon, N, Mitchell, DA, Easpaig , BNG, Liu , X, Zhai , J, Murta , J & Bressington , D 2026, 'The role of psychological resilience in the relationship between Complex Post-Traumatic Stress Disorder symptom severity and functioning impairment in mental health support-seeking Australian Defence Force veterans: A cross-sectional study', Australian and New Zealand Journal of Psychiatry (ANZJP).

The role of psychological resilience in the relationship between Complex Post-Traumatic Stress Disorder symptom severity and functioning impairment in mental health support-seeking Australian Defence Force veterans: A cross-sectional study. / Suriyawong, Wachira ; Karatzias, Thanos; Steele, Hannah et al.
In: Australian and New Zealand Journal of Psychiatry (ANZJP), 11.06.2026.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The role of psychological resilience in the relationship between Complex Post-Traumatic Stress Disorder symptom severity and functioning impairment in mental health support-seeking Australian Defence Force veterans: A cross-sectional study

AU - Suriyawong, Wachira

AU - Karatzias, Thanos

AU - Steele, Hannah

AU - Ho, Grace WK

AU - Byrne, Mitchell K.

AU - Shevlin, M

AU - Pipatpiboon, Noppamas

AU - Mitchell, David A

AU - Easpaig , Bróna Nic Giolla

AU - Liu , Xianliang

AU - Zhai , Jianxia

AU - Murta , Janina

AU - Bressington , Daniel

PY - 2026/6/11

Y1 - 2026/6/11

N2 - Objective: Military veterans have high rates of mental health conditions; Complex Post-Traumatic Stress Disorder (CPTSD) may be the most functionally impaired trauma diagnosis in this patient group. Psychological resilience acts as a protective factor for mental health. Still, it is unclear how this may influence relationships between the two main symptom clusters of CPTSD and functioning impairment in veterans. Therefore, we investigated the relationships between psychological resilience, trauma symptom severity, trauma exposure and work/social functional impairment among Australian Defence Force (ADF) veterans. Methods: Cross-sectional survey including 148 mental health support-seeking former-serving ADF veterans in primary care. Relationships between variables were explored using correlations, mean difference tests and mediation analysis to examine the role of resilience in the relationship between CPTSD symptoms and functional impairment. Results: Resilience showed significant negative correlations with functioning impairment. The number of traumas showed weak positive correlations with disturbances in self-organisation (DSO) symptoms, PTSD symptoms and functional impairment. The CPTSD group had significantly lower resilience and functioning than those with no diagnosis. After controlling for the number of trauma exposures, resilience partially mediated the association between PTSD symptoms and functioning (indirect effect = 0.141, p < .05), and partially mediated the association between DSO symptoms and functioning (indirect effect = 0.157, p < .05). Conclusion: Psychological resilience was associated with better functioning in veterans regardless of trauma diagnosis. Resilience also partially mediates the relationship between DSO/PTSD symptoms and functioning in those with ICD-11 CPTSD, indicating it is an important intervention target in ADF veterans with polytrauma.

AB - Objective: Military veterans have high rates of mental health conditions; Complex Post-Traumatic Stress Disorder (CPTSD) may be the most functionally impaired trauma diagnosis in this patient group. Psychological resilience acts as a protective factor for mental health. Still, it is unclear how this may influence relationships between the two main symptom clusters of CPTSD and functioning impairment in veterans. Therefore, we investigated the relationships between psychological resilience, trauma symptom severity, trauma exposure and work/social functional impairment among Australian Defence Force (ADF) veterans. Methods: Cross-sectional survey including 148 mental health support-seeking former-serving ADF veterans in primary care. Relationships between variables were explored using correlations, mean difference tests and mediation analysis to examine the role of resilience in the relationship between CPTSD symptoms and functional impairment. Results: Resilience showed significant negative correlations with functioning impairment. The number of traumas showed weak positive correlations with disturbances in self-organisation (DSO) symptoms, PTSD symptoms and functional impairment. The CPTSD group had significantly lower resilience and functioning than those with no diagnosis. After controlling for the number of trauma exposures, resilience partially mediated the association between PTSD symptoms and functioning (indirect effect = 0.141, p < .05), and partially mediated the association between DSO symptoms and functioning (indirect effect = 0.157, p < .05). Conclusion: Psychological resilience was associated with better functioning in veterans regardless of trauma diagnosis. Resilience also partially mediates the relationship between DSO/PTSD symptoms and functioning in those with ICD-11 CPTSD, indicating it is an important intervention target in ADF veterans with polytrauma.

KW - Complex post-traumatic stress disorder

KW - psychological resilence

KW - military veterans

KW - Functioning

KW - Trauma

KW - International Trauma Questionnaire

M3 - Article

SN - 1440-1614

JO - Australian and New Zealand Journal of Psychiatry (ANZJP)

JF - Australian and New Zealand Journal of Psychiatry (ANZJP)

ER -

Suriyawong W, Karatzias T, Steele H, Ho GWK, Byrne MK, Shevlin M et al. The role of psychological resilience in the relationship between Complex Post-Traumatic Stress Disorder symptom severity and functioning impairment in mental health support-seeking Australian Defence Force veterans: A cross-sectional study. Australian and New Zealand Journal of Psychiatry (ANZJP). 2026 Jun 11.