Premium
An Examination of the Diagnostic Efficiency of Post‐Deployment Mental Health Screens
Author(s) -
Skopp Nancy A.,
Swanson Robert,
Luxton David D.,
Reger Mark A.,
Trofimovich Lily,
First Michael,
Maxwell James,
Gahm Gregory A.
Publication year - 2012
Publication title -
journal of clinical psychology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.124
H-Index - 119
eISSN - 1097-4679
pISSN - 0021-9762
DOI - 10.1002/jclp.21887
Subject(s) - major depressive disorder , alcohol abuse , population , psychiatry , mental health , psychology , clinical psychology , alcohol use disorder , protocol (science) , medicine , alcohol , biochemistry , chemistry , cognition , environmental health , alternative medicine , pathology
Objective To conduct a blinded study to examine the diagnostic efficiency of the Department of Defense (DoD) Post‐Deployment Health Reassessment (PDHRA) screens for major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and alcohol abuse. Method Participants were 148 post‐deployed soldiers who were completing the PDHRA protocol. Soldiers’ mean age was 27.7 (standard deviation = 6.6) years, and 89.0% were male. Mental health professionals blinded to the PDHRA screening results administered the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition directly after the PDHRA assessment protocol. Results All screens exhibited excellent negative predictive power. Sensitivity metrics were lower, consistent with the relatively low base rates observed for MDD (10.1%), PTSD (8.8%), and alcohol abuse (5.4%). Metrics obtained for the PTSD screen were consistent with previous research with a similar base rate. A two‐item screen containing PTSD reexperiencing and hyperarousal symptom items revealed excellent psychometric properties (sensitivity = .92; specificity = .79). The alcohol abuse screen yielded high sensitivity (.86), but very poor precision; these metrics were somewhat improved when the screen was reduced to a single item. Conclusions The PDHRA MDD, PTSD, and alcohol abuse screens appear to be functioning well in accurately ruling out these diagnoses, consistent with a population‐level screening program. Cross validation of the current results is indicated. Additional refinement may yield more sensitive screening measures within constraints imposed by the low base rates in a typically healthy population.