标题：Use of the Air Force Post-Deployment Health Reassessment for the Identification of Depression and Posttraumatic Stress Disorder: Public Health Implications for Suicide Prevention
摘要：Objectives. Military members are required to complete the Post-Deployment Health Assessment on return from deployment and the Post-Deployment Health Reassessment (PHDRA) 90 to 180 days later, and we assessed the PDHRA’s sensitivity and specificity in identifying posttraumatic stress disorder (PTSD) and depression after a military deployment among US Air Force personnel. Methods. We computed the PDHRA’s sensitivity and specificity for depression and PTSD and developed a structural model to suggest possible improvements to it. Results. For depression, sensitivity and specificity were 0.704 and 0.651, respectively; for PTSD, they were 0.774 and 0.650, respectively. Several variables produced significant direct effects on depression and trauma, suggesting that modifications could increase its sensitivity and specificity. Conclusions. The PDHRA was moderately effective in identifying airmen with depression and PTSD. It identified behavioral health concerns in many airmen who did not develop a diagnostic mental health condition. Its low level of specificity may result in reduced barriers to care and increased support services, key components of a public health approach to suicide prevention, for airmen experiencing subacute levels of distress after deployment, which may, in part, account for lower suicide rates among airmen after deployment. The conflicts in Iraq and Afghanistan represent the longest wartime engagement in US military history. 1 Their impact on military members is only beginning to be understood, and the effects are likely to reverberate for decades. Because of the protracted nature of these conflicts, military members and veterans may have increased mental health needs. 2 As of 2009, 1.6 million US military members had deployed in support of Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom. Of these, an estimated 300 000 have returned with a mental health condition, such as depression or posttraumatic stress disorder (PTSD). 3 Exposure to violent combat is often a precursor to emotional dysfunction, most notably an increased risk of PTSD and depression, 4–6 that may lead to suicidal behavior, including suicide attempts and ideation. The relatively high rates of depression and PTSD and the marked increase in military suicide rates from 2005 to 2009 have made mental health issues the source of significant concern for the military. 6–8 In response to the physical and emotional hazards of deployment and the increasing frequency of suicides among military members that some believe are a consequence of prolonged and repeated deployments, 6,7,9,10 the US Department of Defense established a robust program to screen and track deployment-related physical and psychiatric illnesses. 11,12 Thus, all military members are currently required to complete the Post-Deployment Health Assessment, which is part of a broader military health monitoring system, immediately on their return from deployment. A nearly identical screening tool, the Post-Deployment Health Reassessment (PDHRA), is administered 90 to 180 days later. 13 Additional screening may occur at the discretion of medical providers or military members’ commanders. 14 The PDHRA has been used since 2005 to assess the health of military members in the months after a deployment. 14 It was augmented in 2008 by broadening questions about traumatic brain injury (TBI) and alcohol misuse. 15 Although significant resources have been dedicated to identifying postdeployment health and mental health issues, the efficacy of the screening and assessment instruments has not been established. 16,17 Postdeployment assessments were developed by consensus in professional working groups and rapidly deployed in response to a congressional mandate. 16 No scaling or testing of the assessments was or has been conducted before or since implementation; 16 therefore, their reliability and validity have not been established. Specifically, whether the PDHRA is an effective tool for identifying military members at risk for developing mental health concerns after a deployment is not known. To address this gap, we evaluated the PDHRA’s effectiveness in identifying military members at risk for depression and PTSD and identified ways to improve its sensitivity and specificity. In addition, we assessed the relationship between deployment and other factors associated with depression and PTSD to further understand factors that might increase the risk of negative outcomes, including suicide, after a deployment.
