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LeardMann CA, McMaster HS, Warner S, Esquivel AP, Porter B, Powell TM, Tu XM, Lee WW, Rull RP, Hoge CW. Comparison of Posttraumatic Stress Disorder Checklist Instruments From Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition vs Fifth Edition in a Large Cohort of US Military Service Members and Veterans. JAMA Netw Open 2021; 4:e218072. [PMID: 33904913 PMCID: PMC8080232 DOI: 10.1001/jamanetworkopen.2021.8072] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE The definition of posttraumatic stress disorder (PTSD) changed markedly between the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and DSM-5, creating challenges for studies and in medical settings spanning this transition. OBJECTIVE To evaluate the ability to compare and assess PTSD, based on DSM-IV and DSM-5 criteria, using PTSD Checklists (PCLs). DESIGN, SETTING, AND PARTICIPANTS This diagnostic study was conducted with survey data collected in October 2019, from the Millennium Cohort Study, a population-based US military cohort study. The population for the present study was restricted to a subset of initial web responders of the 2019 survey cycle, randomly assigned to 1 of 4 survey groups. EXPOSURES Each group received the DSM-IV and DSM-5 PCL (PCL-Civilian [PCL-C] version and PCL for DSM-5 [PCL-5]). PCL instruments were counterbalanced to control for order effects. MAIN OUTCOMES AND MEASURES Survey data were used to assess PTSD (using the PCL-C and PCL-5), major depressive disorder (using the Patient Health Questionnaire), generalized anxiety (using the Generalized Anxiety Disorder scale), and problem drinking (using the Patient Health Questionnaire). Demographic and military characteristics included age, sex, race/ethnicity, marital status, education, service branch, pay grade, enrollment panel, and military service status. RESULTS Among the 1921 participants (mean [SD] age, 50.1 [12.5] years), 1358 (70.7%) were men, 1638 (85.3%) were non-Hispanic White individuals, 1440 (75.0%) were married, and 1190 (61.9%) had at least a bachelor's degree; 295 (15.4%) had probable PTSD according to DSM-IV criteria with PCL-C compared with 286 (14.9%) using DSM-5 criteria with PCL-5 (κ = 0.77). There was substantial agreement between PCLs for probable PTSD based on DSM-IV criteria (295 [15.4%] with PCL-C; 316 [16.4%] with PCL-5; κ = 0.80) and DSM-5 criteria (286 [14.9%] with PCL-5; 258 [13.4%] with PCL-C; κ = 0.77). Estimated PTSD sum scores showed excellent agreement with observed scores. Using an established crosswalk, PCL-5 sum scores estimated with the PCL-C were similar to observed PCL-5 scores. Of the 17 corresponding items between the 2 instruments, 16 had substantial agreement. Appending 2 additional PCL-C items to the PCL-5 did not significantly alter estimates. The PCL-C and PCL-5 had nearly identical associations with comorbid conditions. CONCLUSIONS AND RELEVANCE The findings of this diagnostic study suggest that PTSD can be successfully assessed and compared over time with either PCL instrument in veteran and military populations.
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Affiliation(s)
- Cynthia A. LeardMann
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Hope Seib McMaster
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Steven Warner
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Alejandro P. Esquivel
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Ben Porter
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
- Social Science Research Center, Mississippi State University, Starkville
| | - Teresa M. Powell
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Xin M. Tu
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - William W. Lee
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Rudolph P. Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
| | - Charles W. Hoge
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Office of the Army Surgeon General, Falls Church, Virginia
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Walter KH, LeardMann CA, Carballo CE, McMaster HS, Donoho CJ, Stander VA. Posttraumatic Stress Disorder Symptom Clusters in Service Members Predict New-Onset Depression Among Military Spouses. J Trauma Stress 2021; 34:229-240. [PMID: 32885510 PMCID: PMC7984456 DOI: 10.1002/jts.22575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/08/2022]
Abstract
Military operations in Iraq and Afghanistan have brought increased attention to posttraumatic stress disorder (PTSD) among service members and, more recently, its impact on spouses. Existing research has demonstrated that PTSD among service members is associated with depression among military spouses. In the current study, we extended these findings by using data from service member-spouse dyads enrolled in the Millennium Cohort Family Study for which the service member had evidence of PTSD (n = 563). Prospective analyses identified the association between PTSD symptom clusters reported by the service member and new-onset depression among military spouses. Over the 3-year study period, 14.4% of these military spouses met the criteria for new-onset depression. In adjusted models, service member ratings of symptoms in the effortful avoidance cluster, odds ratio (OR) = 1.61, 95% CI [1.03, 2.50], predicted an increased risk of new-onset depression among military spouses, whereas reexperiencing symptoms, adjusted OR = 0.57; 95% CI [0.32, 1.01], were marginally protective. These findings suggest that PTSD symptom clusters in service members differentially predict new-onset depression in military spouses, which has implications for treatment provision.
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Affiliation(s)
- Kristen H. Walter
- Health and Behavioral Sciences DepartmentNaval Health Research CenterSan DiegoCA
| | - Cynthia A. LeardMann
- LeidosRestonVA,Deployment Health DepartmentNaval Health Research CenterSan DiegoCA
| | - Carlos E. Carballo
- LeidosRestonVA,Deployment Health DepartmentNaval Health Research CenterSan DiegoCA
| | - Hope Seib McMaster
- LeidosRestonVA,Deployment Health DepartmentNaval Health Research CenterSan DiegoCA
| | - Carrie J. Donoho
- Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMaryland
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McMaster HS, Stander VA, Williams CS, Woodall KA, O'Malley CA, Bauer LM, Davila EP. Engaging military couples in marital research: does requesting referrals from service members to recruit their spouses introduce sample bias? BMC Med Res Methodol 2018; 18:114. [PMID: 30355317 PMCID: PMC6201494 DOI: 10.1186/s12874-018-0575-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 10/15/2018] [Indexed: 11/30/2022] Open
Abstract
Background While enrolling dyads in research studies is not uncommon, there is limited literature on the utility of different recruitment strategies and the resulting selection biases. This paper examined two recruitment strategies used to enroll military couples in a longitudinal study, assessing the impact of both strategies on the representativeness of the final study sample. Method Descriptive and bivariate analyses were conducted to 1) identify characteristics associated with spouse referral, 2) compare response rates based on recruitment strategy and assess whether recruitment strategy modified correlates of response propensity among spouses, and 3) assess whether referred spouse characteristics differed from non-referred spouses in the final sample. The study sample consisted of married US service members with 2–5 years of military service as of October 2011 and their spouses. Results Service members who referred their spouses to participate in the Millennium Cohort Family Study were more likely to be male, have children, serve in the Army, and have combat deployment experience than those who did not refer their spouse. Nearly two-thirds (n = 5331, 64.9%) of referred spouses participated in the Family Study, compared with less than one-third (n = 3458, 29.5%) of directly contacted spouses. Spouse characteristics also differed significantly between recruitment groups. Conclusions Overall results suggest that minimal bias was introduced by using a referral recruitment methodology. Service members appeared to be more likely to refer their spouses if they perceived the research topic as relevant to their spouse, such that male service members with combat deployment experience were more likely to refer female spouses caring for multiple children. Referred spouses were significantly more likely to respond to the Millennium Cohort Family Study survey than those who were directly contacted; however, the overall success rate of using a referral strategy was less than recruiting spouses through direct contact. Differences between referred spouses and spouses contacted directly mirrored service member referring characteristics.
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Affiliation(s)
- Hope Seib McMaster
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD, 20817, USA.
| | - Valerie A Stander
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
| | - Christianna S Williams
- Abt Associates, Inc., Central Park West, Suite 210, 5001 South Miami Boulevard, Durham, NC, 27703, USA
| | - Kelly A Woodall
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD, 20817, USA
| | | | - Lauren M Bauer
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD, 20817, USA
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Steenkamp MM, Corry NH, Qian M, Li M, McMaster HS, Fairbank JA, Stander VA, Hollahan L, Marmar CR. Prevalence of psychiatric morbidity in United States military spouses: The Millennium Cohort Family Study. Depress Anxiety 2018; 35:815-829. [PMID: 29745445 DOI: 10.1002/da.22768] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/08/2018] [Accepted: 03/31/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Approximately half of US service members are married, equating to 1.1 million military spouses, yet the prevalence of psychiatric morbidity among military spouses remains understudied. We assessed the prevalence and correlates of eight mental health conditions in spouses of service members with 2-5 years of service. METHOD We employed baseline data from the Millennium Cohort Family Study, a 21-year longitudinal survey following 9,872 military-affiliated married couples representing all US service branches and active duty, Reserve, and National Guard components. Couples were surveyed between 2011 and 2013, a period of high military operational activity associated with Operation Iraqi Freedom and Operation Enduring Freedom. Primary outcomes included depression, anxiety, posttraumatic stress disorder (PTSD), panic, alcohol misuse, insomnia, somatization, and binge eating, all assessed with validated self-report questionnaires. RESULTS A total of 35.90% of military spouses met criteria for at least one psychiatric condition. The most commonly endorsed conditions were moderate-to-severe somatization symptoms (17.63%) and moderate-to-severe insomnia (15.65%). PTSD, anxiety, depression, panic, alcohol misuse, and binge eating were endorsed by 9.20%, 6.65%, 6.05%, 7.07%, 8.16%, and 5.23% of spouses, respectively. Having a partner who deployed with combat resulted in higher prevalence of anxiety, insomnia, and somatization. Spouses had lower prevalence of PTSD, alcohol misuse, and insomnia but higher rates of panic and binge eating than service members. Both members of a couple rarely endorsed having the same psychiatric problem. CONCLUSIONS One third of junior military spouses screened positive for one or more psychiatric conditions, underscoring the need for high-quality prevention and treatment services.
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Affiliation(s)
- Maria M Steenkamp
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | | | - Meng Qian
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | - Meng Li
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | - Hope Seib McMaster
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - John A Fairbank
- Mid-Atlantic (VISN 6) Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, and UCLA-Duke University National Center for Child Traumatic Stress (NCCTS), Duke University School of Medicine, Durham, NC, USA
| | | | - Laura Hollahan
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | - Charles R Marmar
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
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McMaster HS, LeardMann CA, Speigle S, Dillman DA. An experimental comparison of web-push vs. paper-only survey procedures for conducting an in-depth health survey of military spouses. BMC Med Res Methodol 2017; 17:73. [PMID: 28441932 PMCID: PMC5405460 DOI: 10.1186/s12874-017-0337-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 04/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Previous research has found that a “web-push” approach to data collection, which involves contacting people by mail to request an Internet survey response while withholding a paper response option until later in the contact process, consistently achieves lower response rates than a “paper-only” approach, whereby all respondents are contacted and requested to respond by mail. Method An experiment was designed, as part of the Millennium Cohort Family Study, to compare response rates, sample representativeness, and cost between a web-push and a paper-only approach; each approach comprised 3 stages of mail contacts. The invited sample (n = 4,935) consisted of spouses married to U.S. Service members, who had been serving in the military between 2 and 5 years as of October, 2011. Results The web-push methodology produced a significantly higher response rate, 32.8% compared to 27.8%. Each of the 3 stages of postal contact significantly contributed to response for both treatments with 87.1% of the web-push responses received over the Internet. The per-respondent cost of the paper-only treatment was almost 40% higher than the web-push treatment group. Analyses revealed no meaningfully significant differences between treatment groups in representation. Conclusion These results provide evidence that a web-push methodology is more effective and less expensive than a paper-only approach among young military spouses, perhaps due to their heavy reliance on the internet, and we suggest that this approach may be more effective with the general population as they become more uniformly internet savvy.
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Affiliation(s)
- Hope Seib McMaster
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA.
| | - Cynthia A LeardMann
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Steven Speigle
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Don A Dillman
- Department of Sociology and the Social and Economic Sciences Research Center, Washington State University, Pullman, WA, 99164, USA
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Corry NH, Williams CS, Battaglia M, McMaster HS, Stander VA. Assessing and adjusting for non-response in the Millennium Cohort Family Study. BMC Med Res Methodol 2017; 17:16. [PMID: 28129735 PMCID: PMC5273843 DOI: 10.1186/s12874-017-0294-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/16/2017] [Indexed: 11/22/2022] Open
Abstract
Background In conducting population-based surveys, it is important to thoroughly examine and adjust for potential non-response bias to improve the representativeness of the sample prior to conducting analyses of the data and reporting findings. This paper examines factors contributing to second stage survey non-response during the baseline data collection for the Millennium Cohort Family Study, a large longitudinal study of US service members and their spouses from all branches of the military. Methods Multivariate logistic regression analysis was used to develop a comprehensive response propensity model. Results Results showed the majority of service member sociodemographic, military, and administrative variables were significantly associated with non-response, along with various health behaviours, mental health indices, and financial and social issues. However, effects were quite small for many factors, with a few demographic and survey administrative variables accounting for the most substantial variance. Conclusions The Millennium Cohort Family Study was impacted by a number of non-response factors that commonly affect survey research. In particular, recruitment of young, male, and minority populations, as well as junior ranking personnel, was challenging. Despite this, our results suggest the success of representative population sampling can be effectively augmented through targeted oversampling and recruitment, as well as a comprehensive survey weighting strategy.
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Affiliation(s)
- Nida H Corry
- Abt Associates Inc., Central Park West, Suite 210, 5001 South Miami Boulevard, 27703, Durham, NC, USA.
| | - Christianna S Williams
- Abt Associates Inc., Central Park West, Suite 210, 5001 South Miami Boulevard, 27703, Durham, NC, USA
| | - Mike Battaglia
- Abt Associates Inc., Central Park West, Suite 210, 5001 South Miami Boulevard, 27703, Durham, NC, USA
| | - Hope Seib McMaster
- Military Population Health Directorate at the Naval Health Research Center, 140 Sylvester Road, 92106, San Diego, CA, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 100, 20817, Bethesda, MD, USA
| | - Valerie A Stander
- Military Population Health Directorate at the Naval Health Research Center, 140 Sylvester Road, 92106, San Diego, CA, USA
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