Publication year
2012
Citation Title
Use of the Air Force post-deployment health reassessment for the identification of depression and posttraumatic stress disorder: Public health implications for suicide prevention.
Journal Name
American Journal of Public Health: Research and Practice
Journal Volume
102
Issue Number
S1
Page Numbers
S60-S65
DOI
10.2105/ajph.2011.300580
Summary
A sample of Active, Reserve, and National Guard Airmen (N = 58,242) was used to evaluate the effectiveness of the Post-Deployment Health Reassessment (PDHRA) survey, designed to identify military members at risk for depression and posttraumatic stress disorder (PTSD). The survey was administered 90 to 180 days post deployment. Results indicate that the Post-Deployment Health Reassessment survey might be used to identify sub-acute behavioral health concerns that might not have been otherwise diagnosed, potentially reducing barriers to care among Airmen following deployment and thereby may account for lower suicide rates in this population.
Key Findings
This survey was moderately effective in identifying Airmen with depression and PTSD.
Although 17% of the sample noted one or more traumatic combat experiences, participants had a very low prevalence of diagnosed PTSD (0.3%; n = 160) or depression (0.6%; n = 338).
Support network conflict had the largest positive association with depression and trauma. Although the effects were small, traumatic brain injury (TBI) symptoms were also predictive of both trauma and depression. In contrast, number of deployments was not significantly associated with depression or trauma.
Being female was associated with marginally higher levels of trauma and depression.
Implications for Program Leaders
Enhance education, activities, and curriculum related to coping behaviors and dealing with anxiety symptoms
Develop gender-specific support groups and classes to better serve female Service members
Offer workshops that educate military families on the relationships between trauma, depression, and anxiety symptoms
Implications for Policy Makers
Encourage the development and continuation of programs that can promote resilience in Service members, their partners, and children
Continue to support the use of evidence and research based screening tools to assess these mental health issues, as well as examine other health issues (e.g., alcohol consumption) and relationship and family difficulties
Recommend training for community providers to educate them about unique factors that contribute to mental health difficulties among Service members
Methods
Researchers used a comprehensive population sampling strategy: All Active, Reserve, and National Guard Airmen who completed the Post-Deployment Health Reassessment survey between January 1, 2008, and December 31, 2008, were included in this study.
Statistical analyses were used to assess associations between answers on the survey and the later development of a diagnosis of depression or PTSD.
This study focused on military Service members in the Air Force (83% enlisted and 17% officers).
Participants
The study sample consisted of 58,242 members of the Air Force aged 17 years or older. Most of the sample consisted of enlisted airmen (n= 48,290) with the largest group representing staff sergeants (n= 15,139).
The sample was 85% male, and the race/ethnic composition was not specified.
The average number of deployments was 1.98 (SD = 1.76) and many respondents has not deployed to a combat zone.
Limitations
The Post-Deployment Health Reassessment survey is based on one-time retrospective, self-reports, which limits reliability of the data.
Without longitudinal data, no clear evidence exists that deployment caused trauma-related or depressive symptoms.
Results may not generalize to men or women serving in other branches of the military.
Avenues for Future Research
Replicate this study with Service members from other branches of the military
Use longitudinal designs to examine if deployment causes trauma-related or depressive symptoms
Explore the personality and individual factors that may contribute to these outcomes
Focus
Air Force
Target Population
Population Focus
Military Branch
Military Component
Abstract
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.
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