Examination of the PC-PTSD in previously deployed Air Force Medical Service personnel

This study assessed the performance of the PC-PTSD in diagnosing postdeployment posttraumatic stress disorder (PTSD) in a cohort of Air Force Medical Services personnel (N = 18,530). The prevalence of PTSD in the cohort was 5.18% based on medical record data. The area under the receiver operating characteristic curve was 0.69, indicating poor classification accuracy. Sensitivity was 47.55%, specificity was 90.68%, positive predictive value was 21.79%, and negative predictive value was 96.94%. The positive and negative likelihood ratios were 5.10 and 0.58, respectively. Several risk factors were found to be associated with a diagnosis of postdeployment PTSD: being a nurse, being enlisted in the medical service career field, being enlisted in the mental health service career field, those over age 30, being a member of the Active Duty service component, and having one’s first deployment be to Iraq. Being an officer was found to be a protective characteristic. These factors could potentially improve screening for PTSD among Air Force healthcare personnel.     

The Performance of the AUDIT-C and the Examination of Risks Associated With Postdeployment Alcohol Misuse in Air Force Medical Service Personnel

This study assessed the performance of the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) in diagnosing a postdeployment alcohol disorder in a cohort of Air Force Medical Services personnel (N = 13,353). The prevalence of alcohol disorders in this population of previously deployed military healthcare personnel was 1.26% based on medical record data. Assessing the AUDIT-C as a screening tool, the following characteristics were found: sensitivity was 23.81%, specificity was 91.48%, positive predictive value was 3.44%, and negative predictive value was 98.95%. The positive and negative likelihood ratios were 2.80 and 0.83, respectively. Classification accuracy of the AUDIT-C was improved by accounting for officer status and female gender. The area under the receiver operating characteristic curve was 0.69 for the multivariable model, indicating poor to fair classification accuracy. However, this model was significantly improved over the univariate model. Thus, taking rank and gender into account when conducting screening may improve the utility of the AUDIT-C.     

The Performance of the PHQ-2 and the Examination of Risks Associated With Postdeployment Depression in Air Force Medical Service Personnel

This study assessed the performance of the 2-item Patient Health Questionnaire (PHQ-2) in identifying postdeployment depressive disorders in a cohort of Air Force Medical Services personnel (N = 18,398). The prevalence of depressive disorders in the cohort was 9.00% based on medical record data. The area under the receiver operating characteristic curve was 0.56, indicating very poor classification accuracy. Sensitivity was 15.53%, specificity was 95.57%, positive predictive value was 25.75%, and negative predictive value was 91.97%. The positive and negative likelihood ratios were 3.51 and 0.88, respectively. Several risk factors associated with postdeployment depressive disorders were identified that could potentially improve screening in this population.     

Voluntary euthanasia and the right to die: a dialogue with Derek Humphry

Both the terminally ill and those responsible for their care may experience conflict and limited freedom of choice with respect to the right to die. Derek Humphry, founder of the Hemlock Society, shares his personal experience, as well as his efforts to educate the public and stimulate legal reform. He has dedicated more than a decade of prime professional years to this highly charged universal problem.     

Female and male intravenous drug users not-in-treatment: Are they at differential risk for AIDS?

We describe and compare the drug-use patterns of ethnically diverse (45% white, 39% African American, 15% Hispanic) female and male intravenous drug users (IVDUs) not-in-treatment. Focusing on a group of hard-to-reach and economically disadvantaged IVDUs, we were able to document drug use patterns and practices that have been shown to place them at increased risk for AIDS. We were also able to examine if women IVDUs were at differential risk for AIDS in comparison to men IVDUs. Results indicated that female IVDUs practices may place them differentially at risk for contracting HIV because they were more likely than male IVDUs to share needles. When female IVDUs shared needles, they were also more likely than male IVDUs to share needles with a spouse or sexual partner. We argue that these results may be tied to gender role socialization and have important implications for designing interventions for female IVDUs.This research was supported by Grant DA01070 from the National Institute on Drug Abuse to the second author.     

Associations Between Family Environment, Parenting Practices, and Executive Functioning of Children with and Without ADHD

We examined the relationships between executive functioning, family environment, and parenting practices in children diagnosed with ADHD as compared to children without ADHD. Participants were parents (N = 134) of 6- to 12-year-old ADHD and non-ADHD-diagnosed children. Compared to the control group, parents of children diagnosed with ADHD reported their children as exhibiting greater problems with behavioral control and metacognitive abilities, and described their family environments as less organized and higher in family conflict. Family environment and parenting practices were not correlated with behavioral control or metacognitive abilities in children with ADHD. In children without ADHD, higher levels of family cohesion, organization, and expressiveness, and lower levels of family conflict, were significantly correlated with greater behavioral control. Higher levels of family cohesion and organization were significantly and positively associated with regulation of metacognitive abilities in children without ADHD. In general, aspects of the family environment and parental limit setting appear to be associated with the development of executive functions in children not diagnosed with ADHD; however, family environment and parenting practices were not associated with executive functions in children diagnosed with ADHD.