Predicting suicides after outpatient mental health visits in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

The 2013 US Veterans Administration/Department of Defense Clinical Practice Guidelines (VA/DoD CPG) require comprehensive suicide risk assessments for VA/DoD patients with mental disorders but provide minimal guidance on how to carry out these assessments. Given that clinician-based assessments are not known to be strong predictors of suicide, we investigated whether a precision medicine model using administrative data after outpatient mental health specialty visits could be developed to predict suicides among outpatients. We focused on male nondeployed Regular US Army soldiers because they account for the vast majority of such suicides. Four machine learning classifiers (naive Bayes, random forests, support vector regression and elastic net penalized regression) were explored. Of the Army suicides in 2004-2009, 41.5% occurred among 12.0% of soldiers seen as outpatient by mental health specialists, with risk especially high within 26 weeks of visits. An elastic net classifier with 10-14 predictors optimized sensitivity (45.6% of suicide deaths occurring after the 15% of visits with highest predicted risk). Good model stability was found for a model using 2004-2007 data to predict 2008-2009 suicides, although stability decreased in a model using 2008-2009 data to predict 2010-2012 suicides. The 5% of visits with highest risk included only 0.1% of soldiers (1047.1 suicides/100 000 person-years in the 5 weeks after the visit). This is a high enough concentration of risk to have implications for targeting preventive interventions. An even better model might be developed in the future by including the enriched information on clinician-evaluated suicide risk mandated by the VA/DoD CPG to be recorded

Beck Hopelessness Inventory

Defines Beck Hopelessness Inventory

Do DSM-5 Changes to PTSD Symptom Cluster Criteria Alter the Frequency of Probable PTSD When Screening Treatment-Seeking Canadian Forces Members and Veterans?

Introduction: DSM-5 diagnostic criteria revisions for post-traumatic stress disorder (PTSD) have raised concerns about PTSD prevalence – particularly the new requirement of one avoidance symptom. We examined the frequency of positive screening results for probable PTSD in treatment-seeking Canadian Armed Forces (CAF) personnel and Veterans when both DSM-5 and DSM-IV-TR symptom cluster criteria were applied. Methods: Previously collected data from 382 CAF personnel and Veterans were used to identify the frequency of positive screens using both sets of diagnostic criteria. Results: 71.2% (n=272) of participants screened positively for probable PTSD using DSM-5 symptom cluster criteria, compared to 77.7% (n=297) using DSM-IV-TR symptom cluster criteria. Percent agreement analyses found that negative percent agreement was 100.0%, positive percent agreement was 91.6%, and overall percent agreement was 93.5%. Discussion: The number of individuals who screened positively for probable PTSD using DSM-IV-TR criteria was higher than those who screened positively using DSM-5 criteria. The requirement of at least one avoidance symptom appears to have a noticeable impact on the frequency of positive screens for probable PTSD among treatment-seeking military personnel. This has important implications for pension adjudication and treatment entitlement. (article in English) Introduction : Les révisions liées aux critères diagnostiques du DSM-5 pour le trouble de stress post-traumatique (TSPT) ont engendré certaines inquiétudes quant à la prévalence du TSPT, en particulier en ce qui concerne le critère lié au symptôme d\u27évitement. Nous avons étudié la fréquence de résultats positifs suite au dépistage pour le TSPT utilisant les critères DSM-5 et DSM-IV-TR pour le personnel des Forces armées canadiennes (FAC) et les vétéran(s) qui font une demande de traitement. Méthodes : Des données recueillies antérieurement de 382 membres des FAC et vétéran(e)s ont été utilisées pour identifier la fréquence de résultats positifs suite au dépistage pour le TSPT utilisant les deux critères. Résultats : 71,2% (n=272) des participant(e)s soumis(es) au dépistage utilisant le DSM-5 ont reçu un résultat positif; comparativement, 77,7% (n=297) des participant(e)s soumis(es) au dépistage utilisant le DSM-IV-TR ont reçu un résultat positif. L\u27analyse du pourcentage de concordance a déterminé que le taux négatif de concordance était de 100,0%, le taux positif de concordance était de 91,6% et le taux global de concordance était de 93,5%. Discussion : Le nombre d\u27individus qui ont reçu un résultat positif en utilisant les critères DSM-IV-TR était plus élevé que le nombre d\u27individus qui ont reçu un résultat positif en utilisant les critères DSM-5. L\u27exigence du minimum d\u27un symptôme d\u27évitement semble avoir un impact important sur la fréquence de résultats positifs suite au dépistage pour le TSPT pour le personnel des FAC et les vétéran(s) qui font une demande de traitement. Ceci a des implications importantes pour les décisions relatives aux pensions d\u27invalidité et à l\u27accès au traitement