The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform
Maureen Murdoch - One of the best experts on this subject based on the ideXlab platform.
-
Reversals in initially denied Department of Veterans Affairs' PTSD disability claims after 17 years: a cohort study of gender differences.
BMC women's health, 2021Co-Authors: Maureen Murdoch, Michele Spoont, Nina A Sayer, Shannon M. Kehle-forbes, Siamak NoorbaloochiAbstract:BACKGROUND In 2011, the Department of Veterans Affairs (VA) strengthened its disability claims processes for military sexual trauma, hoping to reduce gender differences in initial posttraumatic stress disorder (PTSD) disability awards. These process improvements should also have helped women reverse previously denied claims and, potentially, diminished gender discrepancies in appealed claims' outcomes. Our objectives were to examine gender differences in reversals of denied PTSD claims' outcomes after 2011, determine whether disability awards (also known as "Service Connection") for other disorders offset any PTSD gender discrepancy, and identify mediating confounders that could explain any persisting discrepancy. METHODS From a nationally representative cohort created in 1998, we examined Service Connection outcomes in 253 men and 663 women whose initial PTSD claims were denied. The primary outcome was PTSD Service Connection as of August 24, 2016. Secondary outcomes were Service Connection for any disorder and total disability rating. The total disability rating determines the generosity of Veterans' benefits. RESULTS 51.4% of men and 31.3% of women were Service connected for PTSD by study's end (p
-
Using Simulated Data to Estimate the Impact of Different Types of Survey Missingness on Population Estimates and Odds Ratios: A Back-of-the-Envelope Approach
2020Co-Authors: Echo Gq Nelson, Maureen Murdoch, Siamak NoorbaloochiAbstract:Background: Total Survey Error is typically operationalized as non-response bias plus measurement error without considering sampling error’s contribution to total error. Bias’ impact on effect sizes is also not well described.Objective: To explore the risk of obtaining survey values importantly different from true population values through sampling error alone, to explore sampling error’s unique contribution to total survey error, and to identify how much non-response bias can be tolerated before odds ratios deviate significantly from the true value. Methods: Using R, we simulated a population of 20,000 “men” and “women” based on an actual population of Veterans. We assigned attributes of being exposed/unexposed to military combat or sexual trauma and of having or not having disability benefits for posttraumatic stress disorder (“Service Connection”). We then simulated multiple surveys using samples sizes and response rates commonly seen in survey research. Results: Through sampling error alone, individual sample prevalences differed from the true value by 10 full percentage points at probabilities between 2.7% (combat) and 55% (military sexual trauma) for sample sizes ≤ 300 (“men” and “women” combined). Mean sampling error frequently exceeded non-response bias. Across all sample size/response rate combinations (“men/women” combined), individual sampling errors ranged from -18.2% to 17.2% for combat, -40.9% to 41.8% for military sexual assault, and -45.9% to 69.1% for Service Connection. Modeling showed that biases as small as 1 percentage point within an individual cell of a 2X2 contingency table altered the odds ratio estimates between combat, military sexual trauma, and Service Connection substantially, whereas altering the marginal totals of the 2X2 table did not affect the odds ratio at all.Conclusions: Sampling error’s impact on total survey error can be substantial, while even small degrees of non-response bias can distort odds ratios. Back-of-the-envelope techniques could help investigators plan for and avoid these issues.
-
changes in post traumatic stress disorder Service Connection among veterans under age 55 an 18 year ecological cohort study
Military Medicine, 2019Co-Authors: Maureen Murdoch, Shannon M Kehleforbes, Michele Spoont, Nina A Sayer, Siamak Noorbaloochi, Paul A ArbisiAbstract:Introduction Mandatory, age-based re-evaluations for post-traumatic stress disorder (PTSD) Service Connection contribute substantially to the Veterans Benefits Administration's work load, accounting for almost 43% of the 168,013 assessments for PTSD disability done in Fiscal Year 2017 alone. The impact of these re-evaluations on Veterans' disability benefits has not been described. Materials and methods The study is an 18-year, ecological, ambispective cohort of 620 men and 970 women receiving Department of Veterans Affairs PTSD disability benefits. Veterans were representatively sampled within gender; all were eligible for PTSD disability re-evaluations at least once because of age. Outcomes included the percentage whose PTSD Service Connection was discontinued, reduced, re-instated, or restored. We also examined total disability ratings among those with discontinued or reduced PTSD Service Connection. Subgroup analyses examined potential predictors of discontinued PTSD Service Connection, including Service era, race/ethnicity, trauma exposure type, and chart diagnoses of PTSD or serious mental illness. Our institution's Internal Review Board reviewed and approved the study. Results Over the 18 years, 32 (5.2%) men and 180 (18.6%) women had their PTSD Service Connection discontinued; among them, the reinstatement rate was 50% for men and 34.3% for women. Six men (1%) and 23 (2.4%) women had their PTSD disability ratings reduced; ratings were restored for 50.0% of men and 57.1% of women. Overall, Veterans who lost their PTSD Service Connection tended to maintain or increase their total disability rating. Predictors of discontinued PTSD Service Connection for men were Service after the Vietnam Conflict and not having a Veterans Health Administration chart diagnosis of PTSD; for women, predictors were African American or black race, Hispanic ethnicity, no combat or military sexual assault history, no chart diagnosis of PTSD, and persistent serious mental illness. However, compared to other women who lost their PTSD Service Connection, African American and Hispanic women, women with no combat or military sexual assault history, and women with persistent serious illness had higher mean total disability ratings. For both men and women who lost their PTSD Service Connection, those without a PTSD chart diagnosis had lower mean total disability ratings than did their counterparts. Conclusions Particularly for men, discontinuing or reducing PTSD Service Connection in this cohort was rare and often reversed. Regardless of gender, most Veterans with discontinued PTSD Service Connection did not experience reductions in their overall, total disability rating. Cost-benefit analyses could help determine if mandated, age-based re-evaluations of PTSD Service Connection are cost-effective.
-
Gender Differences in VA Disability Status for PTSD Over Time
Psychiatric services (Washington D.C.), 2014Co-Authors: Nina A Sayer, Michele Spoont, Siamak Noorbaloochi, Paul A Arbisi, Emily Hagel, Robert A. Rosenheck, Joan M. Griffin, Maureen MurdochAbstract:ObjectivePosttraumatic stress disorder (PTSD) is the most prevalent psychiatric condition for which veterans receive Service-connected disability benefits from the U.S. Department of Veterans Affairs (VA). Historically, women have been less likely than men to obtain PTSD disability benefits. The authors examined whether these gender disparities have been redressed over time and, if not, whether appropriate clinical factors account for persisting differences.MethodsThis longitudinal, observational study was based on a gender-stratified, nationally representative sample of 2,998 U.S. veterans who applied for VA disability benefits for PTSD between 1994 and 1998. The primary outcome was change in PTSD Service Connection over a ten-year period.ResultsForty-two percent (95% confidence interval [CI]=38%–45%) of the women and 50% (CI=45%–55%) of the men originally denied Service Connection for PTSD eventually received such benefits. Only 8% (CI=7%–10%) of women and 5% (CI=4%–6%) of men lost PTSD disability statu...
-
racial disparities in va Service Connection for posttraumatic stress disorder disability
Medical Care, 2003Co-Authors: Maureen Murdoch, James S Hodges, Diane C Cowper, Larry FortierAbstract:Background. “Service connected” veterans are those with documented, compensative conditions related to or aggravated by military Service, and they receive priority for enrollment into the Veterans Affairs (VA) health care system. For some veterans, Service Connection represents the difference betwee
Marc I Rosen - One of the best experts on this subject based on the ideXlab platform.
-
brief counseling for veterans with musculoskeletal disorder risky substance use and Service Connection claims
Pain Medicine, 2019Co-Authors: Marc I Rosen, William C Becker, Anne C Black, Steve Martino, Ellen L Edens, Robert D KernsAbstract:OBJECTIVE High proportions of post-9/11 veterans have musculoskeletal disorders (MSDs), but engaging them in care early in their course of illness has been challenging. The Service Connection application is an ideal point of contact for referring veterans to early interventions for their conditions. DESIGN Among MSD claimants who reported risky substance use, we pilot-tested a counseling intervention targeting pain and risky substance use called Screening Brief Intervention and Referral to Treatment-Pain Module (SBIRT-PM). Veterans were randomly assigned in a 2:1:1 ratio to SBIRT-PM, Pain Module counseling only, or treatment as usual (TAU). METHODS Participants assigned to either counseling arm were offered a single meeting with a study therapist with two follow-up telephone calls as needed. Participants completed outcome assessments at four and 12 weeks after randomization. RESULTS Of 257 veterans evaluated, 101 reported risky substance use and were randomized. Counseling was attended by 75% of veterans offered it and was well received. VA pain-related Services were used by 51% of participants in either of the pain-focused conditions but only by 27% in TAU (P < 0.04). Starting with average pain severity ratings of 5.1/10 at baseline, only minimal changes in mean pain severity were noted regardless of condition. Self-reported risky substance use was significantly lower over time in the SBIRT-PM condition relative to the two other conditions (P < 0.02). At week 12, proportions of veterans reporting risky substance use were 0.39, 0.69, and 0.71 for the SBIRT-PM, Pain Module counseling, and TAU conditions, respectively. CONCLUSIONS SBIRT-PM shows promise as a way to engage veterans in pain treatment and reduce substance use.
-
Veterans' compensation claims beliefs predict timing of PTSD treatment use relative to compensation and pension exam
PloS one, 2018Co-Authors: Anne C Black, Sarah Meshberg-cohen, Andric Christopher Perez-ortiz, Thomas A. Thornhill, Marc I RosenAbstract:Introduction In this study we developed the Disability Beliefs Scale to assess Veterans’ beliefs that engaging in treatment, as well as other behaviors, would affect the likelihood of a Veteran’s being awarded disability-related benefits. We posited that Veterans with stronger beliefs that attending mental health treatment would facilitate a Service-Connection award would be more likely to attend PTSD treatment before their compensation and pension examinations for PTSD. Methods Electronic health records for 307 post-9/11-era Veterans applying for compensation and pension for Service-connected PTSD and engaging in a clinical trial of a treatment-referral intervention were analyzed for PTSD-specific and more general mental health treatment use around the time of their compensation examinations. All participants completed the Disability Beliefs Scale and other baseline assessments. Multilevel models assessed change in treatment use as a function of time relative to the C&P exam, compensation examination status (before or after), and the interaction between examination status and beliefs about treatment benefits. Results No main effects of time or examination status were observed. As hypothesized, beliefs about treatment benefits moderated the effect of examination status on PTSD treatment use. Veterans believing more strongly that mental health treatment would help a claim differentially attended PTSD treatment before the examination than after. The effect was not observed for general mental health treatment use. Conclusion The association between Veterans’ use of PTSD treatment and their Service-Connection examination status was moderated by beliefs that receiving treatment affects the Service-Connection decision. This suggests that factors reported to motivate seeking Service-Connection—finances, validation of Veterans’ experiences, and the involvement of significant others—might also help motivate Veterans’ use of effective PTSD treatments. However, the results reflect correlations that could be explained in other ways, and Service-Connection was one of many factors impacting PTSD treatment engagement.
-
Counseling Veterans Applying for Service Connection Status for Mental Health Conditions.
Psychiatric services (Washington D.C.), 2016Co-Authors: Sarah Meshberg-cohen, Jason C. Deviva, Marc I RosenAbstract:Veterans with mental health conditions that were either caused or aggravated by their military Service are eligible to receive Service-connected disability benefits from the Department of Veterans Affairs. The process of applying for Service Connection status is complex, and it is not surprising that veterans frequently develop beliefs about Service Connection that may not be accurate and that could interfere with treatment. The authors describe some of these beliefs and offer suggestions to clinicians for addressing them. Veterans may believe that their clinician is directly involved in Service Connection determination or that therapy notes will determine the outcome of the claim. Veterans may not understand the basis for award of Service Connection and may interpret rejection of their claim as reflecting disrespect for their Service or degree of distress. The authors argue that discussing these beliefs with veterans might enhance therapy by demonstrating familiarity with an important aspect of veterans’...
-
Work Outcomes After Benefits Counseling Among Veterans Applying for Service Connection for a Psychiatric Condition
Psychiatric services (Washington D.C.), 2014Co-Authors: Marc I Rosen, Anne C Black, Steve Martino, Karen Ablondi, Lisa Mueller, Kristin L. Serowik, Ben Hur Mobo, Robert A. RosenheckAbstract:Objective:This study’s objective was to determine the efficacy of benefits counseling in a clinical trial. There has been concern that disability payments for psychiatric disorders reduce incentives for employment and rehabilitation. Benefits counseling, with education about opportunities to work and the financial implications of work on receipt of disability benefits, may counter these disincentives.Methods:This single-blind, six-month randomized clinical trial enrolled 84 veterans who had applied for Service-connected compensation for a psychiatric condition. Veterans were randomly assigned to either four sessions of benefits counseling or of a control condition involving orientation to the U.S Department of Veterans Affairs health care system and Services. Days of paid work and work-related activities were assessed at follow-up visits by using a timeline follow-back calendar.Results:Veterans assigned to benefits counseling worked for pay for significantly more days than did veterans in the control grou...
Siamak Noorbaloochi - One of the best experts on this subject based on the ideXlab platform.
-
Reversals in initially denied Department of Veterans Affairs' PTSD disability claims after 17 years: a cohort study of gender differences.
BMC women's health, 2021Co-Authors: Maureen Murdoch, Michele Spoont, Nina A Sayer, Shannon M. Kehle-forbes, Siamak NoorbaloochiAbstract:BACKGROUND In 2011, the Department of Veterans Affairs (VA) strengthened its disability claims processes for military sexual trauma, hoping to reduce gender differences in initial posttraumatic stress disorder (PTSD) disability awards. These process improvements should also have helped women reverse previously denied claims and, potentially, diminished gender discrepancies in appealed claims' outcomes. Our objectives were to examine gender differences in reversals of denied PTSD claims' outcomes after 2011, determine whether disability awards (also known as "Service Connection") for other disorders offset any PTSD gender discrepancy, and identify mediating confounders that could explain any persisting discrepancy. METHODS From a nationally representative cohort created in 1998, we examined Service Connection outcomes in 253 men and 663 women whose initial PTSD claims were denied. The primary outcome was PTSD Service Connection as of August 24, 2016. Secondary outcomes were Service Connection for any disorder and total disability rating. The total disability rating determines the generosity of Veterans' benefits. RESULTS 51.4% of men and 31.3% of women were Service connected for PTSD by study's end (p
-
Using Simulated Data to Estimate the Impact of Different Types of Survey Missingness on Population Estimates and Odds Ratios: A Back-of-the-Envelope Approach
2020Co-Authors: Echo Gq Nelson, Maureen Murdoch, Siamak NoorbaloochiAbstract:Background: Total Survey Error is typically operationalized as non-response bias plus measurement error without considering sampling error’s contribution to total error. Bias’ impact on effect sizes is also not well described.Objective: To explore the risk of obtaining survey values importantly different from true population values through sampling error alone, to explore sampling error’s unique contribution to total survey error, and to identify how much non-response bias can be tolerated before odds ratios deviate significantly from the true value. Methods: Using R, we simulated a population of 20,000 “men” and “women” based on an actual population of Veterans. We assigned attributes of being exposed/unexposed to military combat or sexual trauma and of having or not having disability benefits for posttraumatic stress disorder (“Service Connection”). We then simulated multiple surveys using samples sizes and response rates commonly seen in survey research. Results: Through sampling error alone, individual sample prevalences differed from the true value by 10 full percentage points at probabilities between 2.7% (combat) and 55% (military sexual trauma) for sample sizes ≤ 300 (“men” and “women” combined). Mean sampling error frequently exceeded non-response bias. Across all sample size/response rate combinations (“men/women” combined), individual sampling errors ranged from -18.2% to 17.2% for combat, -40.9% to 41.8% for military sexual assault, and -45.9% to 69.1% for Service Connection. Modeling showed that biases as small as 1 percentage point within an individual cell of a 2X2 contingency table altered the odds ratio estimates between combat, military sexual trauma, and Service Connection substantially, whereas altering the marginal totals of the 2X2 table did not affect the odds ratio at all.Conclusions: Sampling error’s impact on total survey error can be substantial, while even small degrees of non-response bias can distort odds ratios. Back-of-the-envelope techniques could help investigators plan for and avoid these issues.
-
changes in post traumatic stress disorder Service Connection among veterans under age 55 an 18 year ecological cohort study
Military Medicine, 2019Co-Authors: Maureen Murdoch, Shannon M Kehleforbes, Michele Spoont, Nina A Sayer, Siamak Noorbaloochi, Paul A ArbisiAbstract:Introduction Mandatory, age-based re-evaluations for post-traumatic stress disorder (PTSD) Service Connection contribute substantially to the Veterans Benefits Administration's work load, accounting for almost 43% of the 168,013 assessments for PTSD disability done in Fiscal Year 2017 alone. The impact of these re-evaluations on Veterans' disability benefits has not been described. Materials and methods The study is an 18-year, ecological, ambispective cohort of 620 men and 970 women receiving Department of Veterans Affairs PTSD disability benefits. Veterans were representatively sampled within gender; all were eligible for PTSD disability re-evaluations at least once because of age. Outcomes included the percentage whose PTSD Service Connection was discontinued, reduced, re-instated, or restored. We also examined total disability ratings among those with discontinued or reduced PTSD Service Connection. Subgroup analyses examined potential predictors of discontinued PTSD Service Connection, including Service era, race/ethnicity, trauma exposure type, and chart diagnoses of PTSD or serious mental illness. Our institution's Internal Review Board reviewed and approved the study. Results Over the 18 years, 32 (5.2%) men and 180 (18.6%) women had their PTSD Service Connection discontinued; among them, the reinstatement rate was 50% for men and 34.3% for women. Six men (1%) and 23 (2.4%) women had their PTSD disability ratings reduced; ratings were restored for 50.0% of men and 57.1% of women. Overall, Veterans who lost their PTSD Service Connection tended to maintain or increase their total disability rating. Predictors of discontinued PTSD Service Connection for men were Service after the Vietnam Conflict and not having a Veterans Health Administration chart diagnosis of PTSD; for women, predictors were African American or black race, Hispanic ethnicity, no combat or military sexual assault history, no chart diagnosis of PTSD, and persistent serious mental illness. However, compared to other women who lost their PTSD Service Connection, African American and Hispanic women, women with no combat or military sexual assault history, and women with persistent serious illness had higher mean total disability ratings. For both men and women who lost their PTSD Service Connection, those without a PTSD chart diagnosis had lower mean total disability ratings than did their counterparts. Conclusions Particularly for men, discontinuing or reducing PTSD Service Connection in this cohort was rare and often reversed. Regardless of gender, most Veterans with discontinued PTSD Service Connection did not experience reductions in their overall, total disability rating. Cost-benefit analyses could help determine if mandated, age-based re-evaluations of PTSD Service Connection are cost-effective.
-
Gender Differences in VA Disability Status for PTSD Over Time
Psychiatric services (Washington D.C.), 2014Co-Authors: Nina A Sayer, Michele Spoont, Siamak Noorbaloochi, Paul A Arbisi, Emily Hagel, Robert A. Rosenheck, Joan M. Griffin, Maureen MurdochAbstract:ObjectivePosttraumatic stress disorder (PTSD) is the most prevalent psychiatric condition for which veterans receive Service-connected disability benefits from the U.S. Department of Veterans Affairs (VA). Historically, women have been less likely than men to obtain PTSD disability benefits. The authors examined whether these gender disparities have been redressed over time and, if not, whether appropriate clinical factors account for persisting differences.MethodsThis longitudinal, observational study was based on a gender-stratified, nationally representative sample of 2,998 U.S. veterans who applied for VA disability benefits for PTSD between 1994 and 1998. The primary outcome was change in PTSD Service Connection over a ten-year period.ResultsForty-two percent (95% confidence interval [CI]=38%–45%) of the women and 50% (CI=45%–55%) of the men originally denied Service Connection for PTSD eventually received such benefits. Only 8% (CI=7%–10%) of women and 5% (CI=4%–6%) of men lost PTSD disability statu...
Brian P. Marx - One of the best experts on this subject based on the ideXlab platform.
-
The influence of veteran race and psychometric testing on veterans affairs posttraumatic stress disorder (PTSD) disability exam outcomes.
Psychological Assessment, 2017Co-Authors: Brian P. Marx, Michelle J. Bovin, Derek D. Szafranski, Eden Engel-rebitzer, Matthew W. Gallagher, Darren W. Holowka, Kelly S. Parker-guilbert, Samantha J. Moshier, Kenneth Barretto, Raymond C. RosenAbstract:This study examined the influence of veterans' race and examiners' use of psychometric testing during a Department of Veterans Affairs posttraumatic stress disorder (PTSD) disability examination on diagnostic and Service Connection status outcomes. Participants were 764 veterans enrolled in a national longitudinal registry. Current and lifetime PTSD diagnostic status was determined with the Structured Clinical Interview for DSM-IV (SCID) and was compared with PTSD diagnosis conferred upon veterans by their compensation and pension (C&P) examiners as well as with ultimate Veterans Affairs (VA) PTSD Service connected status. The concordance rate between independent SCID current PTSD diagnosis and PTSD disability examination diagnosis was 70.4%, and between SCID lifetime PTSD diagnosis and PTSD disability examination diagnosis was 77.7%. Among veterans with current SCID diagnosed PTSD, Black veterans were significantly less likely than White veterans to receive a PTSD diagnosis from their C&P examiner (odds ratio [OR] = .39, p = .003, confidence interval [CI] = .20-.73). Among veterans without current SCID diagnosed PTSD, White veterans were significantly more likely than Black veterans to receive a PTSD diagnosis from their C&P examiner (OR = 4.07, p = .005, CI = 1.51-10.92). Splitting the sample by use of psychometric testing revealed that examinations that did not include psychometric testing demonstrated the same relation between veteran race and diagnostic concordance. However, for examinations in which psychometric testing was used, the racial disparity between SCID PTSD status and disability exam PTSD status was no longer significant. Results suggest that psychometric testing may reduce disparities in VA PTSD disability exam outcomes. (PsycINFO Database Record
-
Validity of posttraumatic stress disorder Service Connection status in Veterans Affairs electronic records of Iraq and Afghanistan Veterans.
The Journal of clinical psychiatry, 2016Co-Authors: Brian P. Marx, Michelle J. Bovin, Derek D. Szafranski, Eden Engel-rebitzer, Matthew W. Gallagher, Darren W. Holowka, Paula P. Schnurr, Raymond C. Rosen, Terence M. KeaneAbstract:OBJECTIVE This study examined the extent to which veterans' posttraumatic stress disorder (PTSD) Service Connection (SC) status corresponded to their PTSD diagnostic status, as determined by a semistructured diagnostic interview. METHOD Participants were 834 veterans in the Veterans After-Discharge Longitudinal Registry (Project VALOR), an observational registry of veterans with and without PTSD who are enrolled in the Veterans Affairs (VA) health care system. PTSD diagnostic status was confirmed using the Structured Clinical Interview for DSM-IV (SCID). RESULTS Concordance between PTSD SC status and current and lifetime PTSD diagnosis was 70.2% and 77.2%, respectively. Individuals with PTSD SC were twice as likely as those without PTSD SC to have a current SCID PTSD diagnosis (OR = 2.11 [95% CI, 1.47-3.04]; P < .001) and almost 3 times as likely to have a lifetime SCID PTSD diagnosis (OR = 2.72 [95% CI, 1.67-4.41]; P < .001). For current PTSD, results showed a slightly higher proportion of false positives-individuals who did not meet SCID criteria but who did have SC for PTSD-than false negatives-individuals who met SCID criteria but did not have SC for PTSD. For lifetime PTSD, the proportion of false negatives was approximately twice the proportion of false positives. CONCLUSIONS PTSD diagnostic and SC status are discordant for a significant minority of veterans. Findings revealed that both the number of veterans who are Service connected without meeting criteria for PTSD and the number of veterans who meet PTSD criteria but have not been granted SC status are concerning.
Raymond C. Rosen - One of the best experts on this subject based on the ideXlab platform.
-
The influence of veteran race and psychometric testing on veterans affairs posttraumatic stress disorder (PTSD) disability exam outcomes.
Psychological Assessment, 2017Co-Authors: Brian P. Marx, Michelle J. Bovin, Derek D. Szafranski, Eden Engel-rebitzer, Matthew W. Gallagher, Darren W. Holowka, Kelly S. Parker-guilbert, Samantha J. Moshier, Kenneth Barretto, Raymond C. RosenAbstract:This study examined the influence of veterans' race and examiners' use of psychometric testing during a Department of Veterans Affairs posttraumatic stress disorder (PTSD) disability examination on diagnostic and Service Connection status outcomes. Participants were 764 veterans enrolled in a national longitudinal registry. Current and lifetime PTSD diagnostic status was determined with the Structured Clinical Interview for DSM-IV (SCID) and was compared with PTSD diagnosis conferred upon veterans by their compensation and pension (C&P) examiners as well as with ultimate Veterans Affairs (VA) PTSD Service connected status. The concordance rate between independent SCID current PTSD diagnosis and PTSD disability examination diagnosis was 70.4%, and between SCID lifetime PTSD diagnosis and PTSD disability examination diagnosis was 77.7%. Among veterans with current SCID diagnosed PTSD, Black veterans were significantly less likely than White veterans to receive a PTSD diagnosis from their C&P examiner (odds ratio [OR] = .39, p = .003, confidence interval [CI] = .20-.73). Among veterans without current SCID diagnosed PTSD, White veterans were significantly more likely than Black veterans to receive a PTSD diagnosis from their C&P examiner (OR = 4.07, p = .005, CI = 1.51-10.92). Splitting the sample by use of psychometric testing revealed that examinations that did not include psychometric testing demonstrated the same relation between veteran race and diagnostic concordance. However, for examinations in which psychometric testing was used, the racial disparity between SCID PTSD status and disability exam PTSD status was no longer significant. Results suggest that psychometric testing may reduce disparities in VA PTSD disability exam outcomes. (PsycINFO Database Record
-
Validity of posttraumatic stress disorder Service Connection status in Veterans Affairs electronic records of Iraq and Afghanistan Veterans.
The Journal of clinical psychiatry, 2016Co-Authors: Brian P. Marx, Michelle J. Bovin, Derek D. Szafranski, Eden Engel-rebitzer, Matthew W. Gallagher, Darren W. Holowka, Paula P. Schnurr, Raymond C. Rosen, Terence M. KeaneAbstract:OBJECTIVE This study examined the extent to which veterans' posttraumatic stress disorder (PTSD) Service Connection (SC) status corresponded to their PTSD diagnostic status, as determined by a semistructured diagnostic interview. METHOD Participants were 834 veterans in the Veterans After-Discharge Longitudinal Registry (Project VALOR), an observational registry of veterans with and without PTSD who are enrolled in the Veterans Affairs (VA) health care system. PTSD diagnostic status was confirmed using the Structured Clinical Interview for DSM-IV (SCID). RESULTS Concordance between PTSD SC status and current and lifetime PTSD diagnosis was 70.2% and 77.2%, respectively. Individuals with PTSD SC were twice as likely as those without PTSD SC to have a current SCID PTSD diagnosis (OR = 2.11 [95% CI, 1.47-3.04]; P < .001) and almost 3 times as likely to have a lifetime SCID PTSD diagnosis (OR = 2.72 [95% CI, 1.67-4.41]; P < .001). For current PTSD, results showed a slightly higher proportion of false positives-individuals who did not meet SCID criteria but who did have SC for PTSD-than false negatives-individuals who met SCID criteria but did not have SC for PTSD. For lifetime PTSD, the proportion of false negatives was approximately twice the proportion of false positives. CONCLUSIONS PTSD diagnostic and SC status are discordant for a significant minority of veterans. Findings revealed that both the number of veterans who are Service connected without meeting criteria for PTSD and the number of veterans who meet PTSD criteria but have not been granted SC status are concerning.