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

Abstract

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.

Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial

“…We have previously reported that the two-stage questionnaire reduced resource burden without substantial loss of sensitivity for PTSD. 17 For the secondary outcomes we included a question from the short form-36 (SF-36) to assess functional impairment 18 and a modified version of the Brief Traumatic Brain Injury Screening schedule exploring possible symptoms associated with injury; these symptoms were losing consciousness, being dazed or confused, not remembering the injury and symptoms of concussion (e.g. headache and dizziness).…”

Longitudinal reciprocal associations between depression, anxiety, and substance use disorders over three decades of life

“…To increase the probability of the development of psychiatric syndromes, a sub-sample of 591 subjects was selected for interview, with two-thirds consisting of high scorers (defined by the 85 th percentile or higher of the global severity index [GSI] of the SCL-90) and a random sample of those with scores below the 85 th percentile. Such a two-phase procedure, consisting of initial screening and subsequent interview with a stratified high-risk sub-sample, is a recommended approach in epidemiologic research (Burdett et al, 2016;Dunn et al, 1999). Altogether, seven interview waves were conducted : in 1979 (m=292; f=299), 1981 (m=220; f=236), 1986 (m=225; f=232), 1988 (m=200; f=224), 1993 (m=192; f=215), 1999 (m=162; f=205), and 2008 (m=144; f=191).…”

Depression in internal medicine inpatients at the time of hospital discharge and referral to primary care

“…6 Therefore, more comprehensive valuation is recommended, including two-phase case-finding techniques. 7 The relevance of depression in medical patients is supported by outcome studies showing that it impairs healthrelated quality of life and is associated with increased costs, 8 decreased compliance with medical treatment, 3 and impairment of the outcome of medical conditions. 9 Particularly relevant is the fact that depression has been linked with higher mortality rates in different medical illnesses, and the increased mortality rate persists when controlling for different risk factors, which include both biological factors and unhealthy behaviours.…”