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The potential stressors associated with military deployment are related to an increased risk of adverse mental health outcomes. Perceived exposure to combat has been found to be proportional to the severity of post-deployment posttraumatic stress disorder (PTSD). However, other perceived adversities during deployment, such as witnessing danger, distress, and hardship in the war zone, have been less systematically studied, but might play an equally substantial role for post-deployment mental health. The development and validation of scales that assess these related constructs are needed to distinguish their contribution to post-deployment risk of PTSD. We evaluated the validity of 10 items measuring perceived danger distributed to all deployed personnel with the Danish Defense since 1998. We hypothesize two scales: Exposure to Danger and Combat (EDC) and Witnessing Consequences of War (WCW). Two military cohorts deployed to Afghanistan in 2009 (Cohort 1, N = 276) and 2013 (Cohort 2, N = 273) were included. Questionnaire data was collected six months after homecoming, including deployment experiences and post-deployment reactions. We tested the construct validity of the 10 items of perceived danger with Rasch models (RM), focusing specifically on presence of subscales, and differential item functioning (DIF) across cohorts. We confirmed the existence of two separate subscales, EDCS and WCWS, both with adequate reliability. None of the subscales fitted a pure RM, but adequate fit was found for graphical log-linear RMs with evidence of DIF for the ECDS. However, adjusting the score to account for DIF had practically no effect, suggesting that the total non-adjusted mean score can be used in future cohort comparisons. Perceived exposure to combat and danger and witnessing consequences of war are related, but essentially distinct, concepts, each providing unique information about deployment adversities. Future studies should evaluate their shared and unique contribution to the risk of post-deployment PTSD.

The potential stressors associated with military deployment are related to an increased risk of adverse mental health outcomes. Perceived exposure to combat has been found to be proportional to the severity of post-deployment posttraumatic stress disorder (PTSD). However, other perceived adversities during deployment, such as witnessing danger, distress, and hardship in the war zone, have been less systematically studied, but might play an equally substantial role for post-deployment mental health. The development and validation of scales that assess these related constructs are needed to distinguish their contribution to post-deployment risk of PTSD. We evaluated the validity of 10 items measuring perceived danger distributed to all deployed personnel with the Danish Defense since 1998. We hypothesize two scales: Exposure to Danger and Combat (EDC) and Witnessing Consequences of War (WCW). Two military cohorts deployed to Afghanistan in 2009 (Cohort 1, N = 276) and 2013 (Cohort 2, N = 273) were included. Questionnaire data was collected six months after homecoming, including deployment experiences and post-deployment reactions. We tested the construct validity of the 10 items of perceived danger with Rasch models (RM), focusing specifically on presence of subscales, and differential item functioning (DIF) across cohorts. We confirmed the existence of two separate subscales, EDCS and WCWS, both with adequate reliability. None of the subscales fitted a pure RM, but adequate fit was found for graphical log-linear RMs with evidence of DIF for the ECDS. However, adjusting the score to account for DIF had practically no effect, suggesting that the total non-adjusted mean score can be used in future cohort comparisons. Perceived exposure to combat and danger and witnessing consequences of war are related, but essentially distinct, concepts, each providing unique information about deployment adversities. Future studies should evaluate their shared and unique contribution to the risk of post-deployment PTSD. ; Background: Depression is a common psychopathological outcome following military deployment. Previous studies have reported differing rates of post-deployment depression, indicating that the toll of war differs across missions. However, it is unclear to what degree the varying prevalence is due methodological differences. Studies comparing rates of depression across cohorts using the same methodology and ensuring measurement invariance are rare, leaving us with limited knowledge on the actual depression prevalence variance across missions. Objective: Applying Rasch models (RM), we aim to validate a measure of depression distributed to all personnel deployed with the Danish Defense since 1998. The main focus was establishing a sufficient sum score and measurement invariance relative to deployment cohort. Method: Two cohorts of the International Security Assistance Force (ISAF) deployed to Afghanistan in 2009 (ISAF7, N = 265) and 2013 (ISAF15, N = 271) were included. Participants filled out a questionnaire concerning their Psychological Reactions to International Missions (PRIM) approximately seven months after home-coming. The questionnaire included a 10-item scale of depression symptoms (PRIM-Depression). The validity of the PRIM-Depression was tested using RM with specific focus on differential item functioning (DIF) across the two cohorts. Results: The PRIM-Depression scale displayed excellent overall consistency and showed no problems with monotonicity or homogeneity. However, the full PRIM-Depression scale did not fit a pure RM. We therefore tested the fit of items to a graphical log-linear RM and found evidence of DIF for two items relative to cohort. We proceeded without these two items and tested the resulting 8-item version which fitted a pure RM without DIF on any of the exogenous variables. Conclusions: Our results suggest that the 10-item PRIM-Depression scale should be used to compare cohorts only with appropriate score equation. The 8-item version provides a sufficient statistic and can as such be applied using the raw score.

Background: Depression is a common psychopathological outcome following military deployment. Previous studies have reported differing rates of post-deployment depression, indicating that the toll of war differs across missions. However, it is unclear to what degree the varying prevalence is due methodological differences. Studies comparing rates of depression across cohorts using the same methodology and ensuring measurement invariance are rare, leaving us with limited knowledge on the actual depression prevalence variance across missions. Objective: Applying Rasch models (RM), we aim to validate a measure of depression distributed to all personnel deployed with the Danish Defense since 1998. The main focus was establishing a sufficient sum score and measurement invariance relative to deployment cohort. Method: Two cohorts of the International Security Assistance Force (ISAF) deployed to Afghanistan in 2009 (ISAF7, N = 265) and 2013 (ISAF15, N = 271) were included. Participants filled out a questionnaire concerning their Psychological Reactions to International Missions (PRIM) approximately seven months after home-coming. The questionnaire included a 10-item scale of depression symptoms (PRIM-Depression). The validity of the PRIM-Depression was tested using RM with specific focus on differential item functioning (DIF) across the two cohorts. Results: The PRIM-Depression scale displayed excellent overall consistency and showed no problems with monotonicity or homogeneity. However, the full PRIM-Depression scale did not fit a pure RM. We therefore tested the fit of items to a graphical log-linear RM and found evidence of DIF for two items relative to cohort. We proceeded without these two items and tested the resulting 8-item version which fitted a pure RM without DIF on any of the exogenous variables. Conclusions: Our results suggest that the 10-item PRIM-Depression scale should be used to compare cohorts only with appropriate score equation. The 8-item version provides a sufficient statistic and can as such be applied using the raw score.

Background: Depression is a common psychopathological outcome following military deployment. Previous studies have reported differing rates of post-deployment depression, indicating that the toll of war differs across missions. However, it is unclear to what degree the varying prevalence is due methodological differences. Studies comparing rates of depression across cohorts using the same methodology and ensuring measurement invariance are rare, leaving us with limited knowledge on the actual depression prevalence variance across missions. Objective: Applying Rasch models (RM), we aim to validate a measure of depression distributed to all personnel deployed with the Danish Defense since 1998. The main focus was establishing a sufficient sum score and measurement invariance relative to deployment cohort. Method: Two cohorts of the International Security Assistance Force (ISAF) deployed to Afghanistan in 2009 (ISAF7, N = 265) and 2013 (ISAF15, N = 271) were included. Participants filled out a questionnaire concerning their Psychological Reactions to International Missions (PRIM) approximately seven months after home-coming. The questionnaire included a 10-item scale of depression symptoms (PRIM-Depression). The validity of the PRIM-Depression was tested using RM with specific focus on differential item functioning (DIF) across the two cohorts. Results: The PRIM-Depression scale displayed excellent overall consistency and showed no problems with monotonicity or homogeneity. However, the full PRIM-Depression scale did not fit a pure RM. We therefore tested the fit of items to a graphical log-linear RM and found evidence of DIF for two items relative to cohort. We proceeded without these two items and tested the resulting 8-item version which fitted a pure RM without DIF on any of the exogenous variables. Conclusions: Our results suggest that the 10-item PRIM-Depression scale should be used to compare cohorts only with appropriate score equation. The 8-item version provides a sufficient statistic and can as such be applied using the raw score.