Quarterly PDHRA (DD2900) Health Screen Report, CY 2018 Quarter 2 Overall Assessment This calendar year (CY) quarterly report tracks major areas of concern as related to the EpiData Center Department by previous short-term reports, the media, and leadership requests by members s on the Post Deployment Health Reassessment (PDHRA). The report is generated for United States Navy (USN) and United States Marine Corps (USMC) service members by service component. The areas of focus are post-traumatic stress disorder (PTSD), major depressive disorder (MDD), alcohol use disorder, and suicide/homicide ideation. The report also highlights self-screens and s in all focused areas of behavioral health conditions. Figure 1 shows the number of service members who had a certified PDHRA from June 2017 through June 2018. The number of PDHRAs completed by USMC service members decreased by 51.5% from Q1 (N=4,095) to Q2 (N=1.988). The highest and lowest number of PDHRAs completed by USMC service members was identified in March 2018 (N=1,690) and June 2018 (N=484), respectively. The number of PDHRAs completed by USN service members decreased by 46.8% from Q1 (N=2,771) to Q2 (N=1,474). The highest and lowest number of PDHRAs completed by USN service members was identified in Janaury 2018 (N=1,245) and May 2018 (N=386), respectively. 1
Members EpiData Center Department Figure 1. Members Screened on the PDHRA, USMC & USN, June 2017 - June 2018 1800 1600 1400 1200 1000 800 600 400 200 0 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 USMC 972 724 1001 699 731 946 575 1055 1350 1690 936 568 484 USN 820 533 560 568 563 722 744 1245 893 633 452 386 636 Prepared by EpiData Center Department, NMCPHC on 09 July 2018. Data Source: edha PDHRA (DD2900) 2
Percentage of Positive Screens EpiData Center Department USMC Figure 2 shows the percentage of screens (see Methods section) for USMC service members for the four behavioral health conditions of interest: PTSD, MDD, alcohol use disorder, and suicide/homicidal risk. Throughout the 13-month reporting period, PTSD and MDD were consistently the most self-reported screens. The percentages of screens for PTSD and Alcohol use disorder increased from April 2018 to June 2018, while MDD decreased from April to May 2018 before increasing in June 2018. Throughout the reporting period, the percentage of screens for suicide/homicide risk remained stable and below 1.0%. None of the observed changes were statistically significant. Figure 2. PDHRA Positive Screens in USMC, June 2017 - June 2018 10.0% 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% PTSD MDD Alcohol( AUDIT-C) Suicide/Homicide Risk Month Prepared by EpiData Center Department, NMCPHC on 09 July 2018. Data Source: edha PDHRA (DD2900) 3
Percentage of Referrals EpiData Center Department Figure 3 below shows the percentages of s made for USMC service members who selfscreened and had indicated concern for each of the three selected behavioral health conditions: PTSD, MDD, and alcohol use disorder. The percentages for all behavioral health conditions remained at 50.0% or above throughout the 13-month time period. Figure 3. PDHRA Referrals in USMC, June 2017 - June 2018 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% PTSD MDD Alcohol ( AUDIT-C) Month Prepared by EpiData Center Department, NMCPHC on 09 July 2018. Data Source: edha PDHRA (DD2900) 4
Percentage of Positive Screens EpiData Center Department USN Figure 4 below shows the percentage of screens for USN service members for the four behavioral health conditions of interest: PTSD, MDD, alcohol use disorder, and suicide/homicidal risk. Throughout the 13-month reporting period, PTSD was consistently the most self-reported concern, followed by MDD. The percentages of screens for PTSD, and alcohol use disorder decreased from April to June and MDD remained stable in the second quarter. Throughout the reporting period, the percentage of screens for suicide/homicide risk remained stable and below 2.1%. Figure 4. PDHRA Positive Screens in USN, June 2017 - June 2018 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% PTSD MDD Alcohol( AUDIT-C) Suicide/Homicide Risk Prepared by EpiData Center Department, NMCPHC on 09 July 2018. Data Source: edha PDHRA (DD2900) Month 5
Percentage of Referrals EpiData Center Department Figure 5 below shows the percentages of s made for USN service members who selfscreened and had indicated concern for each of the three selected behavioral health conditions: PTSD, MDD, and Alcohol use disorder. Throughout the report period, the percentages of s for MDD and PTSD remained above 75%. Referrals for alcohol use disorder remained at 100% from July 2017 to February 2018 and fluctuated from 0 in March and May to 100% in April and June 2018. Figure 5. PDHRA Referrals in USN, June 2017 - June 2018 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% PTSD MDD Alcohol ( AUDIT-C) Month *No service members self-screened and had indicated concern for at least one of the four behavioral health conditions; therefore, none were eligible for a. Prepared by EpiData Center Department, NMCPHC on 09 July 2018. Data Source: edha PDHRA (DD2900) 6
Prepared 16 April 2018 DON Quarterly Screening Report PDHRA (DD2900), CY 2018 Quarter 2 Table 1. Post-Traumatic Stress Disorder (PTSD) Screen CY 2018 Q2 Branch Component Members Screened PDHRA w ith screen for PTSD symptoms total w ith screen PDHRA that have PTSD self screen concern for PTSD screen w ith concern PDHRA that had a screen concern w ith a group w ith a * PDHRA that had a screen concern w ith no group w ith no PDHRA that have PTSD self screen and concern already group already Active Duty 1,893 100 5.3% 8 8.0% 8 100.0% 0 0.0% 2 25.0% USMC Reserve 95 10 10.5% 5 50.0% 5 100.0% 0 0.0% 0 0.0% Other/Unknow n 0 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Total 1,988 110 5.5% 13 11.8% 13 100.0% 0 0.0% 2 15.4% Active Duty 921 72 7.8% 19 26.4% 18 94.7% 1 5.3% 7 36.8% USN Reserve 548 41 7.5% 21 51.2% 21 100.0% 0 0.0% 4 19.0% Other/Unknow n 5 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Total 1,474 113 7.7% 40 0.0% 39 97.5% 1 2.5% 11 27.5% * Combined group refers to screens concern Table 2. Depression Screen (PHQ-2) CY 2018 Q2 Branch USMC USN Component Members Screened PDHRA w ith a PHQ2 score of 2 or greater total w ith PHQ2 Score of 2 or greater PDHRA that have PHQ2 Score of 2+ and concern for Depression screen w ith concern PDHRA that had a screen concern w ith a group w ith a * PDHRA that had a screen concern w ith no group w ith no PDHRA that have screen concern already group already Active Duty 1,893 93 4.9% 7 7.5% 6 85.7% 1 14.3% 1 14.3% Reserve 95 3 3.2% 2 66.7% 2 100.0% 0 0.0% 0 0.0% Other/Unknow n 0 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Total 1,988 96 4.8% 9 9.4% 8 88.9% 1 11.1% 1 11.1% Active Duty 921 44 4.8% 12 27.3% 11 91.7% 1 8.3% 6 50.0% Reserve 548 28 5.1% 17 60.7% 16 94.1% 1 5.9% 3 17.6% Other/Unknow n 5 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Total 1,474 72 4.9% 29 40.3% 27 93.1% 2 6.9% 9 31.0% * Combined group refers to screens concern Table 3. Alcohol Screen (taken from AUDIT-C) CY 2018 Q2 Branch Component Members Screened PDHRA w ith AUDIT- C screen total w ith screen PDHRA that have AUDIT-C screen concern for Alcohol Use screen w ith concern PDHRA that had either a AUDIT-C screen and concern w ith a group w ith a * PDHRA that had AUDIT-C screen and concern with no group w ith no PDHRA that have AUDIT- C screen and concern already group already Active Duty 1,893 49 2.6% 20 40.8% 20 100.0% 0 0.0% 0 0.0% USMC Reserve 95 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Other/Unknow n 0 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Total 1,988 49 2.5% 20 40.8% 20 100.0% 0 0.0% 0 0.0% Active Duty 921 8 0.9% 2 25.0% 2 100.0% 0 0.0% 0 0.0% USN Reserve 548 3 0.5% 1 33.3% 1 100.0% 0 0.0% 0 0.0% Other/Unknow n 5 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Total 1,474 11 0.7% 3 27.3% 3 100.0% 0 0.0% 0 0.0% * Combined group refers to screens concern 9
Table 4. Suicide/Homicide Risk Screen CY 2018 Q2 Branch Component Members Screened PDHRA w ith screen for suicidal/ homocidal risk total w ith screen PDHRA w ith screen for suicide/homocide risk endorsing current risk to self or others screen w ith concern Active Duty 1,893 4 0.2% 4 100.0% USMC Reserve 95 1 1.1% 1 0.0% Other/Unknow n 0 0 0.0% 0 0.0% Total 1,988 5 0.3% 5 100.0% Active Duty 921 3 0.3% 3 100.0% USN Reserve 548 2 0.4% 2 0.0% Other/Unknow n 5 0 0.0% 0 0.0% Total 1,474 5 0.3% 5 100.0% 11
Methods The electronic Deployment Health Assessment (edha) database was used to identify PDHRAs that were certified during the report quarter. Using this methodology, a member may have multiple forms included in the quarterly report, if they completed multiple forms with different certified dates. Each area of interest has a self-reported section, a report section, and a section. If a member is already, said member will only be counted in the column regardless of status. The following paragraphs explain how screening results in each of the five selected behavioral health conditions were calculated for each version of the assessment. Screening result criteria were defined using literature reviews and authors own validated scoring system on the screens. Please contact the EpiData Center for more information. PDHRA Version 3 Post-Traumatic Stress Disorder (PTSD): - A screen for self-reported PTSD was calculated using question 13 in the selfreport section. Question 13 is identified as the Primary Care PTSD Screen (PC-PTSD) and is said to be endorsed if a member answers at least two of the four questions Yes. - Question 16f and 9c on the section was used to identify possible concern for PTSD and whether a member was already under professional care for PTSD respectively. - Referrals for PTSD include the following categories from question 17 on the section: behavioral health, mental health and substance abuse. Traumatic Brain Injury (TBI): - TBI related questions are not included on PDHRA version 3 form. Depression (MDD): - Question 14 of the self-report section is the Patient Health Questionnaire 2 questions (PHQ2) for depression. Each question assessed depressive symptoms and was scored on a 0-3 level. If either question was answered with a 2 ( More than half the days ) or 3 ( Nearly every day ) it was considered a self-reported depression screen. - Question 19g and 10c on the section was used to identify possible concern for depression and whether a member was already under professional care for depression respectively. - Referrals for depression include the following categories from question 17 on the section: behavioral health, mental health and substance abuse. 12
Alcohol Dependence (AUDIT-C): - Question 12a 12c is the shorter version of the Alcohol Use Disorders Identification Test (AUDIT), known as the AUDIT alcohol consumption questions (AUDIT-C). Questions 12a and 12c are tallied (0 4) and question 12b is tallied (1-5). The tallied questions are then summed to calculate the overall score. A score of at least 8 is defined as an endorsed screen needing a. - Question 17e and 8b on the section was used to identify possible concern for alcohol dependence and whether a member was already under professional care for alcohol dependence respectively. - Referrals for alcohol dependence include the following categories from question 17 on the section: behavioral health, mental health, substance abuse. Also included is question 8b on the form where the can directly refer a suspected alcohol problem. Suicide/Homicide Ideation: - While there is no specific self-reported question for suicide/homicide ideation on the PDHRA, question 13 of the section was used to identify potential risk to self and others. - Question 14 of the section assesses the risk of self-harm or violence conveyed by the service members. - Question 16i and 16j on the section was used to identify possible concern for suicide/homicide ideation. Tables 1, 2&3 Interpretation - service members screened (Column 3): the number of service members with the most recent PDHRA form that was certified in the report quarter. - Positive screen (Column 4): represents the number of service members that met the case definition of a screen for the behavioral health condition. - Percentage of total with screens (Column 5): this is the number of screens for the behavioral health condition, divided by the number of service members screened, multiplied by 100. - Positive screen concern (Column 6): the number of service members that screened indicated concern for the condition. - Percentage of screen concern (Column 7): the number of screens concern, divided by the number of service members that screened for the condition, multiplied by 100. 13
- screens concerns with a (Column 8): s among those who screened indicated concern for the condition. - Percentage of s (Column 9): s among those who screened and indicated concern for the condition, divided by the number of service members who screened indicated concern for the condition, multiplied by 100. - Combined groups with no s (Column 10): service members who screened indicated concern for condition but were not referred. - Percentage of groups with no s (Column 11): service members who screened indicated concern but were not referred, divided by the number of service members who screened indicated concern, multiplied by 100. - Combined group (Column 12): number of service members who screened indicated concern for the behavioral health condition, but are already. - Percentage (Column 13): group divided by the number service members who screened indicated concern for the condition, multiplied by 100. Table 4 Interpretation - service members screened (Column 3): the number of service members with the most recent PDHRA form that was certified in the report quarter. - Positive screen (Column 4): represents the number of service members that met the case definition of a screen for suicide/homicide risk. - Percentage of total with screens (Column 5): this is the number of screens for suicide/homicide risk, divided by the number of service members screened, multiplied by 100. - Positive screen concern (Column 6): the number of service members that screened for suicide/homicide risk indicated member s current risk to self and others. - Percentage of screen concern (Column 7): the number of screens concern, divided by the number of service members that screened for suicide/homicide risk, multiplied by 100. 14