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首页> 外文期刊>American journal of public health >Use of the Air Force Post-Deployment Health Reassessment for the Identification of Depression and Posttraumatic Stress Disorder: Public Health Implications for Suicide Prevention
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Use of the Air Force Post-Deployment Health Reassessment for the Identification of Depression and Posttraumatic Stress Disorder: Public Health Implications for Suicide Prevention

机译：空军部署后健康评估的使用，以识别抑郁症和创伤后应激障碍：预防自杀的公共卫生意义

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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. The conflicts in Iraq and Afghanistan represent the longest wartime engagement in US military history. 1 Their impact on military members is only beginning to be understood, and the effects are likely to reverberate for decades. Because of the protracted nature of these conflicts, military members and veterans may have increased mental health needs. 2 As of 2009, 1.6 million US military members had deployed in support of Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom. Of these, an estimated 300?000 have returned with a mental health condition, such as depression or posttraumatic stress disorder (PTSD). 3 Exposure to violent combat is often a precursor to emotional dysfunction, most notably an increased risk of PTSD and depression, 4–6 that may lead to suicidal behavior, including suicide attempts and ideation. The relatively high rates of depression and PTSD and the marked increase in military suicide rates from 2005 to 2009 have made mental health issues the source of significant concern for the military. 6–8 In response to the physical and emotional hazards of deployment and the increasing frequency of suicides among military members that some believe are a consequence of prolonged and repeated deployments, 6,7,9,10 the US Department of Defense established a robust program to screen and track deployment-related physical and psychiatric illnesses. 11,12 Thus, all military members are currently required to complete the Post-Deployment Health Assessment, which is part of a broader military health monitoring system, immediately on their return from deployment. A nearly identical screening tool, the Post-Deployment Health Reassessment (PDHRA), is administered 90 to 180 days later. 13 Additional screening may occur at the discretion of medical providers or military members’ commanders. 14 The PDHRA has been used since 2005 to assess the health of military members in the months after a deployment. 14 It was augmented in 2008 by broadening questions about traumatic brain injury (TBI) and alcohol misuse. 15 Although significant resources have been dedicated to identifying postdeployment health and mental health issues, the efficacy of the screening and assessment instruments has not been established. 16,17 Postdeployment assessments were developed by consensus in professional working groups and rapidly deployed in response to a congressional mandate. 16 No scaling or testing of the assessments was or has been conducted before or since implementation; 16 therefore, their reliability and validity have not been established. Specifically, whether the PDHRA is an effective tool for identifying military members at risk for developing mental health concerns after a deployment is not known. To address this gap, we evaluated the PDHRA’s effectiveness in identifying military members at risk for depression and PTSD and identified ways to improve its sensitivity and specificity. In addition, we assessed the relationship between deployment and other factors associated with depression and PTSD to further understand factors that might increase the risk of negative outcomes, including suicide, after a deployment.
机译：目标。要求军事人员在完成部署后90至180天后完成部署后健康评估以及部署后健康重新评估（PHDRA），我们评估了PDHRA在确定创伤后应激障碍（PTSD）和抑郁症方面的敏感性和特异性经过美国空军人员的军事部署。方法。我们计算了PDHRA对抑郁症和PTSD的敏感性和特异性，并开发了一种结构模型来建议可能的改善方法。结果。对于抑郁症，敏感性和特异性分别为0.704和0.651; PTSD分别为0.774和0.650。几个变量对抑郁症和创伤产生了直接的显著作用，表明修饰可以增加其敏感性和特异性。结论。 PDHRA在识别患有抑郁症和PTSD的飞行员方面是中等有效的。它确定了许多没有诊断出精神健康状况的飞行员的行为健康问题。其低水平的特异性可能会导致减少护理障碍和增加支持服务，这是预防自杀的公共卫生方法的关键组成部分，因为飞行员在部署后经历了亚急性的危难程度，这可能部分是导致自杀率降低的原因。部署后的飞行员。伊拉克和阿富汗的冲突是美国军事历史上最长的战时交锋。 1它们对军人的影响才刚刚开始被理解，而且这种影响可能会回荡数十年。由于这些冲突的旷日持久，军人和退伍军人可能对心理健康的需求有所增加。 2截至2009年，已部署了160万美国军人，以支持“持久自由行动”（阿富汗）和“伊拉克自由行动”。其中，估计有300,000人患有精神疾病，例如抑郁症或创伤后应激障碍（PTSD）。 3暴力战斗通常是情绪失调的前兆，最明显的是PTSD和抑郁的风险增加，4-6可能导致自杀行为，包括自杀企图和想法。从2005年到2009年，抑郁症和PTSD的患病率相对较高，军事自杀率显着上升，这使心理健康问题成为军方引起严重关注的根源。 6-8为了应对部署的身体和情感上的危害以及军人中自杀的频率增加，有人认为这是长期和反复部署的结果，美国国防部6,7,9,10建立了一个强有力的计划筛选和跟踪与部署有关的身体和精神疾病。 11,12因此，当前要求所有军事人员在从部署返回后立即完成部署后健康评估，该评估是更广泛的军事健康监控系统的一部分。 90到180天后，实施了几乎完全相同的筛查工具，即部署后健康评估（PDHRA）。 13根据医疗提供者或军事人员的指挥官的判断，可能还会进行其他检查。 14自2005年以来，PDHRA已用于在部署后的几个月中评估军事人员的健康状况。 14在2008年，由于拓宽了有关颅脑外伤（TBI）和滥用酒精的问题，这一问题得到了加强。 15尽管已投入大量资源来确定部署后的健康和心理健康问题，但尚未建立筛选和评估工具的效力。 16,17部署后评估是由专业工作组协商一致制定的，并根据国会的授权迅速部署。 16在实施之前或之后，没有进行过评估的扩展或测试;因此，尚未确定其可靠性和有效性。具体来说，PDHRA是否是一种有效的工具，可以用来识别部署后有发展精神健康问题风险的军事人员。为了弥补这一差距，我们评估了PDHRA在识别可能患有抑郁症和PTSD的军事人员方面的有效性，并确定了提高其敏感性和特异性的方法。此外，我们评估了部署与抑郁症和PTSD相关的其他因素之间的关系，以进一步了解部署后可能增加负面结果（包括自杀）风险的因素。

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