The relationship between posttraumatic stress reactions, cultural adaptation, and mental health symptoms is still poorly understood. This empirical study examined the relative contribution of both posttraumatic reactions and acculturation rates to subjective mental health in 2 groups of Bosnian refugees, a clinical group (N = 34) and a nonclinical community group (N = 44). As hypothesized, posttraumatic reactions were highly predictive of mental health state in both groups. In addition, two specific acculturation aspects, cultural affiliation and the obtaining of instrumental skills, were significantly related to mental health symptoms. The implications of these findings for mental health professionals working with refugees and other traumatized populations are considered. © 2005 Wiley Periodicals, Inc. J Clin Psychol 62: 339–353, 2006.