Feasibility Study: Epidemiological cut-offs as a basis for veteran mental health population statistics and benchmarking

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Media enquiries contact DVA Media section

Email: Tel: +61 (0)2 62896203

No linked data currently exist that can directly show the overall prevalence of mental health conditions in veterans compared to population levels.

The DVA undertook this project to inform its policy and service programs about prevalence of illness and to try to measure levels of unmet need in the provision of mental health services to Veterans.

By using existing surveys of the Australian community, the DVA-ABS project builds on previous and ongoing research to determine appropriate epidemiological cut-offs for gauging treatment needs of veterans.

In 2010 the University of Adelaide, on behalf of Defence and DVA, undertook the 2010 ADF Mental Health Prevalence and Wellbeing Study (MHPWS) to research the wellbeing of ADF personnel.The researchers screened participantsto assess prevalence of Post-Traumatic Stress Disorder (PTSD), psychological distress and alcohol. Standard survey instrumentsused by the ADF were employed, including the Kessler Psychological Distress Scale, or K10.

To better identify those ADF members who might benefit from early intervention, the MHPWS recommended using screening cut-off values for the survey instruments. These could also then be used to accurately measure prevalence changes in mental health issues like PTSD over time.

Subsequently, the DVA commissioned the Epidemiological Cut-off Feasibility Study. It aimed to:

  • Explore the relationship between levels of psychological distress based on K10 and prevalence of mental health conditions
  • Assess the potentialfor K10 to identify whether anyone in the population who had ever served in the ADF had anxiety, affective or substance use disorders
  • Determine whether there are different epidemiological cut-off points for the general population and for those who had ever served in the ADF, and
  • Assess the feasibility of using epidemiological cut-offs as a proxy measure of prevalence of mental disorders in community surveys.

To leverage current data specifically related to mental health statusof DVA clients, this study examined existing data from a series of ABS population-level surveys.

Results are based on analysis of a series of 5 ABS data collections: the 1997 National Survey of Mental Health and Wellbeing of Adults, the 2007 Survey of Mental Health and Wellbeing (SMHWB) and National Health Surveys (NHS) in 2007–8, 2011–12 and 2014–15.

ABS surveys involve the total Australian population. To better understand health of Veterans, the 2007 SMHWB and the 2011–12 and 2014–15 surveyseach included a question establishingthose who have ever served in the Australian Defence Force (ADF).

The key findings showed that in 2007, 21% of those aged 16–85 years who had ever served in the ADF had a mental health disorder, compared with 20% of the whole Australian population of the same age.For those who had ever served, anxiety disorders(14.0%) were the most common, then affective disorders (8.3%) and substance disorders (4.7%). These were comparable to the general population (14.5%, 6.3% and 5.3% respectively).

For persons who have ever served in the ADF, the study showed the K10 to have excellent discrimination for predicting the existence of anxiety disorder, good discrimination for affective disorders and fair discrimination for substance use disorders. For the whole Australian population, the K10 was excellent for predicting affective disorders, good for anxiety disorders and fair for substance abuse disorders.

For combined affective, anxiety and substance use disorders, the screening cut-off for persons who had ever served in the ADF was found to be 18 (out of 50).This means that 18 would be the optimal cut-off point to estimate the true prevalence of these mental health disorders in deciding which of the ex-serving population may need diagnosis or treatment. This cut-off was slightly different than those found in the 2010 MHPWS, which found 19 for affective and 17 for anxiety and substance use disorders.By comparison, for the total Australian population, the optimal screening cut-offs were 21 for affective disorders, 19 for anxiety and 17 for substance use disorders. The higher levels in the general population may indicate that persons with increased psychological distress levels may be less likely to be associated with the presence of affective or anxiety disorders than in the ADF population.

For the population of those who had ever served in the ADF and the total Australian population, optimal epidemiological cut-offs using K10 derived from each survey predictedsimilar prevalence rates to the actual rates found in the same survey. The derived cut-offs from one survey, using more detailed diagnostic tools, could not predict accurate rates when applied to K10 data in other surveys. This is likely to be due to different methods used across surveys to ascertain mental health disorders ordifferent reporting patterns by respondents over time.

Media enquiries contact DVA Media section

Email: Tel: +61 (0)2 62896203