The validity of military screening for mental health problems: diagnostic accuracy of the PCL, K10 and AUDIT scales in an entire military population

Background Unintended pregnancy is prevalent among women living with HIV, and is associated with poor health outcomes for women and babies. Reproductive coercion may be one unexplored mechanism for this elevated risk. Methods Past year reproductive coercion data were obtained via self-reported survey from a sample of women receiving HIV specialty care in Baltimore, MD. Results Eleven of the 67 women (16.4%) included in the sample reported past year reproductive coercion. Almost two thirds (64%) of women reporting reproductive coercion were also positive for recent PTSD symptoms compared to 27% of women who did not report reproductive coercion (Fisher’s Exact p=0.033). Discussion The prevalence of reproductive coercion among our sample of in care women living with HIV suggests that attention should be paid to the impact of partner influence and coercive behaviors regarding pregnancy intentions. Because of the many potential negative consequences of unintended pregnancy for women living with HIV, it is important that providers be aware of such abuse and steps that can be taken to identify and support patients who are experiencing reproductive coercion.

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“…29,30 The PTSD Checklist Civilian Version (PCL-C) was used to assess for past month PTSD symptoms. 31,32 …”

Section: Methodsmentioning

confidence: 99%

Reproductive coercion among women living with HIV

Anderson

Grace

Miller

2017

Aids

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“…Similarly, a study in the Australian military (validating against a structured diagnostic interview detecting 30‐day disorder) found sensitivity and specificity of 0.30 and 0.97, respectively, at PCL‐C cutoff 50, with an optimal screening cutoff (i.e. one which maximized the total of sensitivity and specificity) of 29, for which sensitivity and specificity were 0.79 and 0.78, respectively (Searle et al, ). Functional impairment has been demonstrated at levels below the cutoff of 50 (Rona et al, ).…”

Section: Methodsmentioning

confidence: 99%

“…A score of eight is the usual cutoff, and has been validated against a number of diagnostic measures, but shows highly variable sensitivity and specificity dependent on the nature of and prevalence in the underlying sample (Reinert and Allen, , ); this value is too common to be of value among the UK Armed Forces, which show a high prevalence of alcohol misuse (Fear et al, ). Given the difference in alcohol usage and drinking cultures of different forces, international comparisons with other screening programmes with respect to AUDIT are problematic; for reference, however, among the Australian Defence Force the optimal epidemiological cutoff was 20, while the optimal screening cutoff was eight (Searle et al, ).…”

Section: Methodsmentioning

confidence: 99%

“…of 0.30 and 0.97, respectively, at PCL-C cutoff 50, with an optimal screening cutoff (i.e. one which maximized the total of sensitivity and specificity) of 29, for which sensitivity and specificity were 0.79 and 0.78, respectively (Searle et al, 2015). Functional impairment has been demonstrated at levels below the cutoff of 50 (Rona et al, 2009).…”

Section: Two-phase Identification Of Mental Ill Healthmentioning

confidence: 98%

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Use of a two‐phase process to identify possible cases of mental ill health in the UK military

Burdett

Fear

Jones

et al. 2016

Int J Methods Psych Res

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Two-phase mental health screening methods, in which an abridged mental health measure is used to establish who should receive a more comprehensive assessment, may be more efficient and acceptable to respondents than a stand-alone complete questionnaire. Such two-phase methods are in use in US armed forces post-deployment mental health screening. This study assesses the sensitivity and specificity of abridged instruments (used in the first phase) compared to the full instruments (the second phase), and whether false negative cases resulting from the use of abridged tests were detected by another test, among a UK military screening sample. Data from a group of UK Armed Forces personnel (n = 1464) who had completed full questionnaires assessing symptoms of post-traumatic stress disorder (PTSD) (PTSD Checklist - Civilian Version, PCL-C) and alcohol misuse (Alcohol Use Disorder Identification Test, AUDIT) were used. An abridged version of the PCL-C performed well in discriminating potential PTSD cases (as measured by the full instrument); AUDIT showed less discriminatory power, particularly due to poor specificity. Many cases missed by one abridged test would have been detected by an alternative test. Thus two-phase screening designs reduce the resource burden of a project without substantial loss of sensitivity for PTSD, but are less effective in discriminating potential cases of alcohol misuse. Copyright © 2016 John Wiley & Sons, Ltd.

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“…This 17‐item PTSD screening instrument (Weathers et al, ) asks respondents to rate the extent to which they have been bothered by PTSD symptoms during the previous 30 days using a 5‐point scale (1 = not at all , 5 = extremely ). Items include problems and complaints that people sometimes have in response to stressful experiences, such as “repeated, disturbing memories, thought, or images of a stressful experience” and “feeling distant or cut off from other people.” The PCL is one of the most frequently used screening instruments for PTSD in military populations—it has demonstrated good reliability (Blanchard, Jones‐Alexander, Buckley, & Formeris, ) and is well validated in military populations (Searle et al, ; Wilkins, Lang, & Norman, ). Unlike the military version of the PCL, the civilian version measures prior military service PTSD symptomatology.…”

Section: Methodsmentioning

confidence: 99%

Relaxation training assisted by heart rate variability biofeedback: Implication for a military predeployment stress inoculation protocol

et al. 2015

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Decreased heart rate variability (HRV) is associated with posttraumatic stress disorder (PTSD) and depression symptoms, but PTSD's effects on the autonomic stress response and the potential influence of HRV biofeedback in stress relaxation training on improving PTSD symptoms are not well understood. The objective of this study was to examine the impact of a predeployment stress inoculation training (PRESTINT) protocol on physiologic measures of HRV in a large sample of the military population randomly assigned to experimental HRV biofeedback-assisted relaxation training versus a control condition. PRESTINT altered the parasympathetic regulation of cardiac activity, with experimental subjects exhibiting greater HRV, that is, less arousal, during a posttraining combat simulation designed to heighten arousal. Autonomic reactivity was also found to be related to PTSD and self-reported use of mental health services. Future PRESTINT training could be appropriate for efficiently teaching self-help skills to reduce the psychological harm following trauma exposure by increasing the capacity for parasympathetically modulated reactions to stress and providing a coping tool (i.e., relaxation method) for use following a stressful situation.

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The validity of military screening for mental health problems: diagnostic accuracy of the PCL, K10 and AUDIT scales in an entire military population

Cited by 59 publications

References 43 publications

Reproductive coercion among women living with HIV

Reproductive coercion among women living with HIV

Use of a two‐phase process to identify possible cases of mental ill health in the UK military

Relaxation training assisted by heart rate variability biofeedback: Implication for a military predeployment stress inoculation protocol

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