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DHI 09-086 – HSR&D Study

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DHI 09-086
Validation of Modified DRRI Scales in a National Sample of OEF/OIF Veterans
Dawne S Vogt PhD BA
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: April 2010 - September 2012

BACKGROUND/RATIONALE:
The Deployment Risk and Resilience Inventory (DRRI) is one of the most widely used instruments for assessing deployment-related risk and resilience factors among war Veterans. Because there have been changes in the nature of warfare and the military population since the DRRI was initially developed in the context of the first Gulf War, a revision was recently undertaken to enhance the DRRI's applicability across a variety of deployment circumstances and subsets of the military population. Focus areas for this revision included an updated assessment of combat-related experiences and expanded coverage of key family environment-related factors across the deployment cycle. In addition, recognizing that the time burden of administering the full set of DRRI scales could be prohibitive to some investigations, an additional focus of this research endeavor was to identify the minimum number of items needed to provide adequate construct coverage for each scale, thereby allowing several of the scales to be shortened.

OBJECTIVE(S):
The overall objective of this project, which involved two waves of data collection, was to conduct a systematic psychometric investigation of modified DRRI scales in a national sample of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans. The objectives for Wave I were to examine initial item and scale characteristics for new and modified DRRI scales, and evaluate the psychometric quality of these measures vis-a-vis the original DRRI scales. The objectives for Wave II were to document scale characteristics for the finalized scales (DRRI-2), and examine the validity of finalized DRRI-2 scales.

METHODS:
In Wave I, original and revised DRRI items and scales were administered to a national sample of 469 male and female OEF/OIF Veterans. To examine initial item and scale characteristics, Classical Test Theory (CTT) and Item Response Theory (IRT) analyses were applied. In Wave II, finalized DRRI-2 scales and health measures were administered to a second sample of 1046 male and female OEF/OIF Veterans. A multi-step mail survey procedure was used for both waves of data collection. Women and National Guard/Reservist personnel were oversampled to comprise 50% of the sample population for both Wave I and Wave II data collection.

FINDINGS/RESULTS:
Results of Wave I data collection supported the psychometric quality of revised and newly developed DRRI scales. Specifically, evidence was provided for the internal consistency reliability of proposed DRRI-2 scales, and scales demonstrated expected associations with a measure of PTSD symptom severity. However, IRT analyses pointed to the need for further revision to better capture the full construct continuum of several scales. Based on both CTT and IRT results, revised versions of each scale were prepared for the second wave of data collection.

In Wave II, CTT analyses confirmed that the scales show high internal consistency reliability (alpha coefficients averaging .88), values that were slightly higher than those observed for the original DRRI. Moreover, the scales showed moderate to strong associations with PTSD symptom severity (correlations averaging .39), which were somewhat higher, on average, compared to the original DRRI. In addition, an examination of incremental validity revealed that the new DRRI-2 scales added unique variance in the prediction of PTSD symptom severity above and beyond existing DRRI-2 scales, indicating that the inclusion of these scales may provide for a more comprehensive assessment of deployment-related risk and resilience. Evidence was also provided for the discriminative validity of DRRI-2 scales, vis-a-vis their ability to discriminate between veteran subgroups. Finally, as compared to the original DRRI scales, the DRRI-2 scales are 15% shorter, on average.

In summary, a systematic evaluation of the psychometric quality of the final DRRI-2 scales suggested that the revisions improve upon the inventory. The final inventory includes scales to assess two pre-deployment factors (Prior Stressors and Childhood Family Functioning), twelve features of the deployment (Preparedness, Combat Experiences, Aftermath of Battle, Nuclear, Biological, and Chemical (NBC) Exposures, Perceived Threat, Difficult Living and Working Environment, Sexual Harassment, General Harassment, Family Stressors, Concerns about Life and Family Disruptions, Deployment Support from Family and Friends, Unit Social Support,), and three post-deployment factors (Postdeployment Family Functioning.Postdeployment Social Support and Postdeployment Stressors). These scales may either be used in concert or individually, depending on the needs on the researcher. If administered in its entirety, the DRRI-2 takes approximately 30 to 40 minutes to complete. The time required to complete the individual scales ranges from approximately 1-2 minutes (e.g., sexual harassment and deployment support from family and friends) to 2-3 minutes (e.g., prior stressors and combat experiences). Information on how to obtain the DRRI-2, as well as a manual that accompanies this set of scales, is available at: http://www.ptsd.va.gov/professional/pages/assessments/list-drri-measures.asp.

IMPACT:
The long-term goal of this project is to provide an updated suite of scales to assess factors that increase risk for PTSD and other health problems among military personnel who experience deployment. The DRRI-2 represents a psychometrically sound, yet efficient, suite of scales that can be used to capture pre-deployment, deployment, and post-deployment risk and resilience factors with implications for the post-deployment mental health and functioning of Servicemembers and Veterans. It is our hope that these scales will be used to further knowledge of the role that these factors play in Veterans' post-deployment health and inform efforts to reduce risk and enhance resilience within this population. Specifically, findings based on the DRRI-2 can facilitate a more in-depth understanding of the training and preparedness needs of military personnel who experience deployment, as well as factors that contribute to their adjustment following return from deployment. In turn, this knowledge can inform interventions aimed at stress inoculation within both Servicemember and Veteran populations.

PUBLICATIONS:

Journal Articles

  1. Maskin RM, Iverson KM, Vogt D, Smith BN. Associations between intimate partner violence victimization and employment outcomes among male and female post-9/11 veterans. Psychological trauma : theory, research, practice and policy. 2019 May 1; 11(4):406-414.
  2. DiMauro J, Renshaw KD, Smith BN, Vogt D. Perceived Support From Multiple Sources: Associations With PTSD Symptoms. Journal of traumatic stress. 2016 Aug 1; 29(4):332-9.
  3. Muralidharan A, Austern D, Hack S, Vogt D. Deployment Experiences, Social Support, and Mental Health: Comparison of Black, White, and Hispanic U.S. Veterans Deployed to Afghanistan and Iraq. Journal of traumatic stress. 2016 Jun 1; 29(3):273-8.
  4. Langdon KJ, Fox AB, King LA, King DW, Eisen S, Vogt D. Examination of the dynamic interplay between posttraumatic stress symptoms and alcohol misuse among combat-exposed Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans. Journal of affective disorders. 2016 May 15; 196:234-42.
  5. Smith BN, Vaughn RA, Vogt D, King DW, King LA, Shipherd JC. Main and interactive effects of social support in predicting mental health symptoms in men and women following military stressor exposure. Anxiety, stress, and coping. 2013 May 30; 26(1):52-69.
Book Chapters

  1. Vogt DS, King LA, King DW. Risk pathways for PTSD: Making sense of the literature. In: Resick PA, Keane TM, Friedman MJ, editors. Handbook of PTSD: Science and practice. New York, NY: Guilford Press; 2012. Chapter 2. 99-115 p.
Conference Presentations

  1. Wells SY, Smith BY, Vaughn RA, DiLeone B, Wang JM, Vogt DS. Family-related Factors during Deployment and Postdeployment Mental Health Symptoms in Male and Female OEF/OIF Veterans. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2012 Nov 3; Los Angeles, California.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Epidemiology, Etiology, Diagnosis
Keywords: Clinical Diagnosis and Screening, Deployment Related, Operation Enduring Freedom, Reintegration Post-Deployment, Risk factors
MeSH Terms: none

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