Psychiatry - July 2008 - (Page 56)

TABLE 4. Predicting failure at SFAS ROC coordinates of the curve: area under the curve=0.55; std error=0.02; asymp. sig: p<0.02 Positive if greater than or equal to the following: -1.00 .50 1.50 2.50 3.50 4.50 5.50 6.50 7.50 8.50 9.50 10.50 11.50 12.50 13.50 14.50 16.00 17.50 18.50 19.50 20.50 23.50 25.50 27.00 36.00 45.00 Sensitivity 1.000 .482 .386 .307 .246 .206 .175 .151 .129 .112 .094 .081 .070 .059 .053 .042 .033 .031 .024 .018 .015 .009 .007 .007 .002 .000 1-Specificity 1.000 .406 .308 .233 .189 .138 .097 .075 .057 .047 .035 .025 .022 .019 .016 .016 .006 .006 .006 .006 .006 .003 .003 .000 .000 .000 potential candidates knowledgeable about this relationship might cease to report such information. Future studies are underway to clarify this issue and to assess whether the propensity to dissociation may be more objectively assessed prior to stress exposure. A second limitation is related to the study population. The present study was limited to US military personnel. To our knowledge, the relationship between propensity to dissociation and success in selection programs for civilian professions exposed to high stress (such as search and rescue, law enforcement, or firefighting) have not yet been conducted. Thus, at present we do not know whether the findings have relevance to non-military professions. However, within the context of the current war, improved screening for military occupations may result in the identification of candidates who are at greater risk for stress-related difficulties; this capability might one day lead to improved primary intervention strategies or to better military job placement decisions.17,18 ACKNOWLEDGMENTS This study was made possible through a grant from the Department of Defence (author CAM) and by support from the National Center for PTSD. The views expressed in this manuscript are those solely of the authors and do not represent official views of the US Army, US Navy, or Department of Veterans Affairs. REFERENCES 1. Morgan III CA, Hazlett G, Wang S, et al. Symptoms of dissociation in humans experiencing acute uncontrollable stress: a prospective investigation. Am J Psychiatry. 2001;158:8;1239–1247. Bremner JD, Southwick S, Brett E, et al. Dissociation and posttraumatic stress disorder in Vietnam combat veterans. Am J Psychiatry. 1992;149:328-332. Bremner JD, Brett E. Trauma- making. Although they do not replace the decision-making capacity of professionals, Signal Detection Methods provide professions information about the probability that they will err in the predictions they make. Clearly the accuracy of such methods is directly related to the degree to which valid, normative databases for populations 56 Psychiatry 2008 [ J U L Y ] of interest have been established. The present study has several limitations. First, the CADSS data are self-report data and we currently do not know whether they reflect a unique factor or a more generic “first factor.” Although the subjective data was predictive of future success, if these data were actually used in selection programs, 2. 3.

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Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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