IMPACT OF DISCLOSURE OF MILITARY SERVICE HISTORY ON DIAGNOSIS OF PTSD

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Degree type
Doctor of Social Work (DSW)
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PTSD
Veteran
Military
Clinical decision-making
heuristics
posttraumatic stress disorder
diagnosis
Clinical and Medical Social Work
Clinical Epidemiology
Clinical Psychology
Counseling Psychology
Health Services Research
Mental Disorders
Other Psychiatry and Psychology
Psychiatric and Mental Health
Social and Behavioral Sciences
Social Work
Theory and Philosophy
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Abstract

Objective Variability in how clinicians diagnose PTSD has been studied across treatment settings. Research shows several factors impact diagnostic variability. The purpose of this study was to evaluate the extent to which disclosure of military service leads to an increase in diagnosis of PTSD when considering an otherwise vague symptom profile. We hypothesize veteran status will increase the likelihood of a PTSD diagnosis than status as a teacher. Methods Clinician were recruited online through professional message boards and listservs. Participants were randomly assigned a vignette (veteran or teacher status) and subsequently asked to make diagnostic judgments. Two vignettes, identical with the exception of veteran or teacher status, were employed to represent a vague symptom profile, unremarkable for any clear diagnostic symptoms. In order to evaluate for the specific impact of disclosure of military service, the vignettes excluded any discussion of trauma or stressors and included vague symptoms common to any number of affective disorders. Results A total of 366 clinicians participated in the study. Clinicians assigned to the Veteran vignette were 6-times more likely to diagnose the client with PTSD (Std. Residuals 4.1) than would be expected by chance. Conclusion and Implications Client characteristic of “Veteran” impacted the clinicians’ diagnostic decision. The findings from this study support a strong relationship between individuals’ veteran status and the initial diagnostic inference a clinician will make, specifically PTSD. Exploratory analysis of licensure status and DSM training suggested these variables had a moderating effect on diagnostic selection. There are several implications. The absence of a criterion A stressor is potentially undervalued for veteran clients. Results suggest more research is needed to understand clinician factors influencing diagnostic decision-making.

Advisor
Phyllis Solomon
Rajeev Ramchand
Sonya Norman
Date of degree
2019-05-20
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