The validity of military screening for mental health problems: diagnostic accuracy of the PCL, K10 and AUDIT scales in an entire military population

Abstract

Depression, alcohol use disorders and post-traumatic stress disorder (PTSD) are serious issues among military personnel due to their impact on operational capability and individual well-being. Several military forces screen for these disorders using scales including the Kessler Psychological Distress Scale (K10), Alcohol Use Disorders Identification Test (AUDIT), and Post-traumatic Stress Disorder Checklist (PCL). However, it is unknown whether established cutoffs apply to military populations. This study is the first to test the diagnostic accuracy of these three scales in a population-based military cohort. A large sample of currently-serving Australian Defence Force (ADF) Navy, Army and Air Force personnel (n = 24,481) completed the K10, AUDIT and PCL-C (civilian version). Then, a stratified sub-sample (n = 1798) completed a structured diagnostic interview detecting 30-day disorder. Data were weighted to represent the ADF population (n = 50,049). Receiver operating characteristic (ROC) analyses suggested all three scales had acceptable sensitivity and specificity, with areas under the curve from 0.75 to 0.93. AUDIT and K10 screening cutoffs closely paralleled established cutoffs, whereas the PCL-C screening cutoff resembled that recommended for US military personnel. These self-report scales represent a cost-effective and clinically-useful means of screening personnel for disorder. Military populations may need lower cutoffs than civilians to screen for PTSD.

Reproductive coercion among women living with HIV

“…29,30 The PTSD Checklist Civilian Version (PCL-C) was used to assess for past month PTSD symptoms. 31,32 …”

Use of a two‐phase process to identify possible cases of mental ill health in the UK military

“…Similarly, a study in the Australian military (validating against a structured diagnostic interview detecting 30‐day disorder) found sensitivity and specificity of 0.30 and 0.97, respectively, at PCL‐C cutoff 50, with an optimal screening cutoff (i.e. one which maximized the total of sensitivity and specificity) of 29, for which sensitivity and specificity were 0.79 and 0.78, respectively (Searle et al, ). Functional impairment has been demonstrated at levels below the cutoff of 50 (Rona et al, ).…”

“…A score of eight is the usual cutoff, and has been validated against a number of diagnostic measures, but shows highly variable sensitivity and specificity dependent on the nature of and prevalence in the underlying sample (Reinert and Allen, , ); this value is too common to be of value among the UK Armed Forces, which show a high prevalence of alcohol misuse (Fear et al, ). Given the difference in alcohol usage and drinking cultures of different forces, international comparisons with other screening programmes with respect to AUDIT are problematic; for reference, however, among the Australian Defence Force the optimal epidemiological cutoff was 20, while the optimal screening cutoff was eight (Searle et al, ).…”

“…of 0.30 and 0.97, respectively, at PCL-C cutoff 50, with an optimal screening cutoff (i.e. one which maximized the total of sensitivity and specificity) of 29, for which sensitivity and specificity were 0.79 and 0.78, respectively (Searle et al, 2015). Functional impairment has been demonstrated at levels below the cutoff of 50 (Rona et al, 2009).…”

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“…This 17‐item PTSD screening instrument (Weathers et al, ) asks respondents to rate the extent to which they have been bothered by PTSD symptoms during the previous 30 days using a 5‐point scale (1 = not at all , 5 = extremely ). Items include problems and complaints that people sometimes have in response to stressful experiences, such as “repeated, disturbing memories, thought, or images of a stressful experience” and “feeling distant or cut off from other people.” The PCL is one of the most frequently used screening instruments for PTSD in military populations—it has demonstrated good reliability (Blanchard, Jones‐Alexander, Buckley, & Formeris, ) and is well validated in military populations (Searle et al, ; Wilkins, Lang, & Norman, ). Unlike the military version of the PCL, the civilian version measures prior military service PTSD symptomatology.…”