Screening for Depression and Psychological Distress in a Currently Serving Military Population: The Diagnostic Accuracy of the K10 and the PHQ9.

This study is the first to examine the diagnostic accuracy of two depression screening scales-the Kessler Psychological Distress Scale (K10) and the Patient Health Questionnaire (PHQ)-in an entire regular-serving military population. Currently serving Australian Defence Force personnel (n = 24,481) completed the K10 and PHQ9. Then a targeted subsample (i.e., the analysis sample, n = 1,730) completed a diagnostic interview to identify DSM-IV 30-day disorder. Weighted results represented the entire population (N = 50,049). Both scales similarly showed a good ability to discriminate between personnel with and without depressive disorders. Optimal cutoffs (19 for K10, 6 for PHQ9) showed high sensitivity and good specificity, and were similar to though slightly lower than those recommended in civilian populations. Both scales appear to be valid screens for depressive disorder in the military, using the cutoffs identified. As both performed similarly, scale choice may depend on other factors (e.g., availability of norms).

Effective and ineffective coping strategies in a low-autonomy work environment.

The authors examined the effectiveness of different coping strategies in buffering the negative effects of uncontrollable stressors and predicting mental health symptoms in a low-autonomy work environment using a longitudinal design. Soldiers in training indicated the extent to which they engaged in various coping strategies to deal with stressors related to the training environment at 4 different points in time. Factor analyses of soldiers in 2 different countries (i.e., United States and Australia) yielded 5 coping dimensions: active coping, acceptance of demands, seeking social support, humor, and denial/self-criticism. Among U.S. soldiers in basic training, acceptance of demands and denial/self-criticism interacted with the magnitude of basic-training stressors to predict mental health symptoms (depression and anxiety) at 3 different points during training while controlling for symptoms at the immediate prior time period. Acceptance buffered soldiers from the negative effects of the stressors, whereas denial/self-criticism exacerbated the effects of the stressors. The results of LGC models also indicated that the slopes of acceptance and active coping were negatively related to the slope of mental health symptoms across training, whereas the slope for denial/self-criticism was positively related to the slope of symptoms. Active coping was less predictive of functioning in the face of stressors and in the prediction of symptoms over time. The results demonstrated that in a low-autonomy occupational setting, acceptance coping was more effective in facilitating good mental health outcomes compared with other coping strategies considered important in prior research (e.g., active coping).

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

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.

The Australian Defence Force Mental Health Prevalence and Wellbeing Study: design and methods.

BACKGROUND: The Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study (MHPWS) is the first study of mental disorder prevalence in an entire military population. OBJECTIVE: The MHPWS aims to establish mental disorder prevalence, refine current ADF mental health screening methods, and identify specific occupational factors that influence mental health. This paper describes the design, sampling strategies, and methodology used in this study. METHOD: At Phase 1, approximately half of all regular Navy, Army, and Air Force personnel (n=24,481) completed self-report questionnaires. At Phase 2, a stratified sub-sample (n=1,798) completed a structured diagnostic interview to detect mental disorder. Based on data from non-responders, data were weighted to represent the entire ADF population (n=50,049). RESULTS: One in five ADF members met criteria for a 12-month mental disorder (22%). The most common disorder category was anxiety disorders (14.8%), followed by affective (9.5%) and alcohol disorders (5.2%). At risk ADF sub-groups were Army personnel, and those in the lower ranks. Deployment status did not have an impact on mental disorder rates. CONCLUSION: This study has important implications for mental health service delivery for Australian and international military personnel as well as contemporary veterans.