Perceived danger during deployment: a Rasch validation of an instrument assessing perceived combat exposure and the witnessing of combat consequences in a war zone

Karstoft, Karen‐Inge; Nielsen, Tine; Nielsen, Anni Brit Sternhagen

doi:10.1080/20008198.2018.1487224

Cited by 11 publications

(9 citation statements)

References 50 publications

(68 reference statements)

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“…Of particular interest are two subscales, the Exposure to Danger and Combat subscale (EDCS, focusing on combat exposure) and the Witnessing the Consequences of War subscale (WCWS, focusing on witnessing consequences of war), which have been shown to capture two distinct aspects of deployment. 14 Suicide attempt. The outcome of interest, SA, was identified from the National Patient Register 23 and the Psychiatric Central Research register.…”

Section: Methodsmentioning

confidence: 99%

“…It has previously been shown that (1) engaging in combat, ie, combat exposure, and (2) being witness to acts of war and being unable to prevent death and injury, ie, witnessing consequences of war, represent two distinctively different types of adversities for deployed personnel. 14 Still, there is little evidence on the association between the main measure of perceived danger, which combat exposure is counted to be, and suicidal behavior, measured as SA. 12,15 Yet, whether these two factors have different associations to SA remains to be examined.…”

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confidence: 99%

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Combat Exposure and Risk of Suicide Attempt Among Danish Army Military Personnel

Vedtofte¹,

Elrond²,

Erlangsen³

et al. 2021

J. Clin. Psychiatry

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Objective:The aim of this study was to estimate the association between self-reported perceived danger during deployment, measured as combat exposure or witnessing the consequences of war, and post-deployment suicide attempts among military personnel. Furthermore, the effect of post-deployment symptoms of posttraumatic stress disorder (PTSD) and/or depression on the risk of suicide attempts was also evaluated.Methods: This observational cohort study included Danish Army military personnel who returned from deployment in international missions from 1998 to 2016 and had completed a post-deployment questionnaire. Perceived exposure to danger was ascertained by self-report. Data on suicide attempt were retrieved from national registers. Adjusted Cox regression analyses were used to evaluate if military personnel indicating high level of combat exposure were more likely to have attempted suicides post-deployment than military personnel with lower levels of combat exposure.Results: Eighty-three suicide attempts were registered after homecoming among 12,218 military personnel. Perceived higher exposure to combat was associated with the risk of suicide attempt (hazard ratio = 1.08; 95% CI, 1.01-1.16). Furthermore, the association between combat exposure and suicide attempt was fully mediated by post-deployment symptoms of PTSD and/ or depression. No association was found between witnessing consequences of war and the risk of post-deployment suicide attempt.Conclusions: This nationwide study found that combat exposure was associated with an increased risk of suicide attempt among military personnel. This association was, however, fully mediated by mental disorders (PTSD and/or depression). These findings suggest that better psychological follow-up of military personnel identified as having PTSD and/or depression may be warranted.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Combat Exposure and Risk of Suicide Attempt Among Danish Army Military Personnel

Vedtofte¹,

Elrond²,

Erlangsen³

et al. 2021

J. Clin. Psychiatry

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“…Information on participants’ PCE was taken from the EDCS that is based on six items assessing exposure to combat and aggression. The EDCS has recently been validated using Rasch models (Karstoft, Nielsen, & Nielsen, 2018). The total EDCS score ranges from 6 to 24, with higher scores indicating more perceived exposure to danger and combat during deployment.…”

Section: Methodsmentioning

confidence: 99%

Effect of Predeployment Psychiatric Diagnoses on Postdeployment Long‐Term Sickness Absence and Mental Health Problems Among Danish Military Personnel

Stoltenberg

Nissen

Nielsen

et al. 2020

Journal of Traumatic Stress

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Military personnel may withhold information on mental health problems (MHPs) for fear of not being permitted to deploy. Past or current MHPs may, however, increase the risk of postdeployment MHPs. Using psychiatric diagnoses rather than self‐report assessments in predeployment screening may be a more effective screening strategy for determining deployment fitness. This retrospective follow‐up study investigated (a) the extent to which predeployment childhood and adult psychiatric diagnoses predicted postdeployment MHPs, measured as psychiatric diagnosis and the purchase of psychiatric drugs, and long‐term sickness absence among formerly deployed Danish military personnel and (b) whether perceived combat exposure moderated or mediated the effect of predeployment psychiatric diagnoses. Complete data were available for 7,514 Danish military personnel who answered questions on perceived combat exposure between 6–8 months after returning from their first deployment to the Balkans, Iraq, or Afghanistan. Data on all psychiatric diagnoses given at Danish hospitals, all medicine purchases, and all sickness absences were retrieved from nationwide research registers. Personnel with predeployment psychiatric diagnoses had a statistically significant higher risk for both postdeployment long‐term sickness absence, hazard ratio (HR) = 2.06, 95% CI [1.52, 2.80]; and postdeployment MHPs, HR = 2.38, 95% CI [1.73, 3.27], than personnel without a predeployment psychiatric diagnosis. Personnel with a predeployment psychiatric diagnosis demonstrated a higher risk of reporting high levels of perceived combat exposure. Perceived combat exposure was not found to moderate or mediate the effect of a predeployment psychiatric diagnosis on the two outcomes. Additional findings, limitations, and implications are discussed.

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“…Predictors for the current project were retrieved from a database containing responses to the Psychological Reactions to International Missions (PRIM) questionnaire, which has been routinely distributed since 1998 to all Danish soldiers 6 months after return from an international deployment with the Danish Defense. The questionnaire contains 125 individual items covering deployment experiences (reported at 6 months after returning home), postdeployment reactions, and postdeployment support as well as 5 validated scales: PTSD symptoms [ 26 ], depression symptoms [ 27 ], perceived danger [ 28 ], witnessing of war atrocities during deployment [ 28 ], and postdeployment social support [ 29 ]. A list of all items in the PRIM questionnaire, translated into English ( Multimedia Appendix 1 ), as well as their descriptive statistics including level of missingness ( Multimedia Appendix 2 and Multimedia Appendix 3 ) can be seen in the supplementary material.…”

Section: Methodsmentioning

confidence: 99%

Applicability of an Automated Model and Parameter Selection in the Prediction of Screening-Level PTSD in Danish Soldiers Following Deployment: Development Study of Transferable Predictive Models Using Automated Machine Learning

Karstoft¹,

Tsamardinos²,

Eskelund³

et al. 2020

JMIR Med Inform

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Background Posttraumatic stress disorder (PTSD) is a relatively common consequence of deployment to war zones. Early postdeployment screening with the aim of identifying those at risk for PTSD in the years following deployment will help deliver interventions to those in need but have so far proved unsuccessful. Objective This study aimed to test the applicability of automated model selection and the ability of automated machine learning prediction models to transfer across cohorts and predict screening-level PTSD 2.5 years and 6.5 years after deployment. Methods Automated machine learning was applied to data routinely collected 6-8 months after return from deployment from 3 different cohorts of Danish soldiers deployed to Afghanistan in 2009 (cohort 1, N=287 or N=261 depending on the timing of the outcome assessment), 2010 (cohort 2, N=352), and 2013 (cohort 3, N=232). Results Models transferred well between cohorts. For screening-level PTSD 2.5 and 6.5 years after deployment, random forest models provided the highest accuracy as measured by area under the receiver operating characteristic curve (AUC): 2.5 years, AUC=0.77, 95% CI 0.71-0.83; 6.5 years, AUC=0.78, 95% CI 0.73-0.83. Linear models performed equally well. Military rank, hyperarousal symptoms, and total level of PTSD symptoms were highly predictive. Conclusions Automated machine learning provided validated models that can be readily implemented in future deployment cohorts in the Danish Defense with the aim of targeting postdeployment support interventions to those at highest risk for developing PTSD, provided the cohorts are deployed on similar missions.

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Perceived danger during deployment: a Rasch validation of an instrument assessing perceived combat exposure and the witnessing of combat consequences in a war zone

Cited by 11 publications

References 50 publications

Combat Exposure and Risk of Suicide Attempt Among Danish Army Military Personnel

Combat Exposure and Risk of Suicide Attempt Among Danish Army Military Personnel

Effect of Predeployment Psychiatric Diagnoses on Postdeployment Long‐Term Sickness Absence and Mental Health Problems Among Danish Military Personnel

Applicability of an Automated Model and Parameter Selection in the Prediction of Screening-Level PTSD in Danish Soldiers Following Deployment: Development Study of Transferable Predictive Models Using Automated Machine Learning

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