The critical warzone experiences (CWE) scale: Initial psychometric properties and association with PTSD, anxiety, and depression

Abstract

Objective-To develop and evaluate a Critical Warzone Experiences (CWE) scale, a brief measure of warzone experiences associated with the development of posttraumatic stress disorder (PTSD), anxiety, and depression.Method-The psychometric properties of the CWE were evaluated across three independent samples of Iraq/Afghanistan veterans (combined N = 392).Results-Despite its brevity (7 items), the CWE exhibited good internal consistency (average α = .83), good temporal stability (1-year test-retest reliability = .73), and a clear unidimensional factor structure in Study 1. Study 2 confirmed the CWE's factor structure through confirmatory factor analysis, and structural equation modeling demonstrated a strong association between the CWE and post-deployment mental health, β = .49, p < .001. Study 3 provided further support for the validity of the CWE by demonstrating that it was associated with PTSD diagnosis, clinicianrated PTSD symptom severity, and global functional impairment in an independent sample of Iraq/Afghanistan veterans (average validity coefficient = .59). 1Correspondence concerning this article should be sent to: Dr. Nathan A. Kimbrel, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705. Phone: (919) 286-0411, ext. 6759. Nathan.Kimbrel@va.gov. U.S. Department of Veterans Affairs VA Author ManuscriptVA Author Manuscript VA Author ManuscriptConclusion-While replication of these findings in more diverse samples is needed, the preliminary evidence from these studies indicates that the CWE is a brief, reliable, and valid measure of critical warzone experiences among Iraq/Afghanistan war veterans.In the aftermath of the Vietnam War, researchers began to intensively study the manner in which combat experiences might contribute to posttraumatic stress disorder (PTSD) and other types of mental health problems. As a result, several measures of combat exposure were created, including the widely-used 7-item Combat Exposure Scale (CES; Keane et a., 1989), which was validated with Vietnam veterans. More recently, considerably longer measures of combat exposure and other types of deployment experiences (e.g., post-battle experiences) have been developed, including the U.S. Army and Marine Corps Mental Health Advisory Team's Combat Experiences Scale (MHAT-CES).The MHAT-CES has been used in numerous studies of Iraq/Afghanistan veterans (e.g., Booth-Kewley, Larson, Highfill-McRoy, Garland, & Gaskin, 2010;Castro, Bienvenu, Hufmann, & Adler, 2000;Hoge et al., 2004;Hoge, Milliken, Auchterlonie, & Hoge, 2007;Meyer et al., 2013;Morissette et al., 2011;Wright, Cabrera, Eckford, Adler, & Bliese, 2012), including Hoge and colleagues ' (2004) seminal study on mental health problems among Iraq/Afghanistan veterans. Despite the widespread use of the MHAT-CES in published studies of Iraq/Afghanistan veterans, there has been significant variability in the manner in which this measure has been administered. Whereas some studies used versions of the MHAT-CES that contained as many as 44 items and...

Nonsuicidal self-injury and suicide attempts in Iraq/Afghanistan war veterans

“…A clinician administered TBI interview (Vasterling, 2008; Morissette et al, 2011) based on American Congress of Rehabilitation Medicine guidelines (Gerberding and Binder, 2003) was used to assess TBI. The Critical Warzone Experiences Scale (CWE; Kimbrel et al, 2014c) was used to assess combat exposure. Note that the PTSD, depression, alcohol dependence, TBI, NSSI, and SA variables used in the present analyses were all lifetime history variables.…”

Reinforcement sensitivity and social anxiety in combat veterans

“…The Critical Warzone Experiences scale (CWE; Kimbrel et al, 2014) is a 7-item measure of warzone experiences that are strongly associated with the development of psychopathology in Iraq/Afghanistan-era veterans. The CWE has good internal consistency, test-retest reliability, validity, and factor structure (Kimbrel et al, 2014).…”

“…The CWE has good internal consistency, test-retest reliability, validity, and factor structure (Kimbrel et al, 2014). In addition, Kimbrel et al (2015) have demonstrated that CWE scores are positively associated with a general measure of social anxiety symptomatology ( r = 0.36, p < .001) among Iraq/Afghanistan-era veterans.…”

An examination of the broader effects of warzone experiences on returning Iraq/Afghanistan veterans׳ psychiatric health

“…The Critical Warzone Experiences scale (Kimbrel et al, 2014) is a 7-item version of the widely-used U.S. Army and Marine Corps Mental Health Advisory Team's Combat Experiences Scale (MHAT-CES), which has been used in numerous studies of Iraq/ Afghanistan veterans (e.g., Hoge et al, 2004;Morissette et al, 2011;Guyker et al, 2013). Kimbrel and colleagues (2014) found that the Critical Warzone Experiences scale demonstrated good internal consistency (average α = 0.83), good test-retest reliability (r = 0.73), and good concurrent validity with longer measures of combat and warzone experiences (average r = 0.74).…”