Date of Award

Spring 5-20-2019

Degree Type

Dissertation

Degree Name

Doctor of Social Work (DSW)

First Advisor

Phyllis Solomon

Second Advisor

Rajeev Ramchand

Third Advisor

Sonya Norman

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.

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