The Influence of Veteran Race and Psychometric Testing on Veterans Affairs Posttraumatic Stress Disorder (PTSD) Disability Exam Outcomes

• Published in: Psychological assessment 2017-06, Vol.29 (6), p.710-719
• Main Authors: Marx, Brian P., Engel-Rebitzer, Eden, Bovin, Michelle J., Parker-Guilbert, Kelly S., Moshier, Samantha, Barretto, Kenneth, Szafranski, Derek, Gallagher, Matthew W., Holowka, Darren W., Rosen, Raymond C., Keane, Terence M.
• Format: Article
• Language: English
• Subjects: Adult; African Americans - statistics & numerical data; Aged; Confidence intervals; Diagnosis; Diagnostic and Statistical Manual of Mental Disorders; Disabilities; Disability Evaluation; European Continental Ancestry Group - statistics & numerical data; Female; Health Disparities; Healthcare Disparities - statistics & numerical data; Human; Humans; Male; Middle Aged; Military Veterans; Post traumatic stress disorder; Posttraumatic Stress Disorder; Psychometrics; Psychometrics - statistics & numerical data; Quantitative psychology; Race; Racial and Ethnic Differences; Registries - statistics & numerical data; Stress Disorders, Post-Traumatic - diagnosis; Treatment Outcomes; United States; United States Department of Veterans Affairs - statistics & numerical data; Veterans; Veterans - statistics & numerical data; Young Adult
• ISSN: 1040-3590; 1939-134X
• DOI: 10.1037/pas0000378

This study examined the influence of veterans' race and examiners' use of psychometric testing during a Department of Veterans Affairs posttraumatic stress disorder (PTSD) disability examination on diagnostic and service connection status outcomes. Participants were 764 veterans enrolled in a national longitudinal registry. Current and lifetime PTSD diagnostic status was determined with the Structured Clinical Interview for DSM-IV (SCID) and was compared with PTSD diagnosis conferred upon veterans by their compensation and pension (C&P) examiners as well as with ultimate Veterans Affairs (VA) PTSD service connected status. The concordance rate between independent SCID current PTSD diagnosis and PTSD disability examination diagnosis was 70.4%, and between SCID lifetime PTSD diagnosis and PTSD disability examination diagnosis was 77.7%. Among veterans with current SCID diagnosed PTSD, Black veterans were significantly less likely than White veterans to receive a PTSD diagnosis from their C&P examiner (odds ratio [OR] = .39, p = .003, confidence interval [CI] = .20-.73). Among veterans without current SCID diagnosed PTSD, White veterans were significantly more likely than Black veterans to receive a PTSD diagnosis from their C&P examiner (OR = 4.07, p = .005, CI = 1.51-10.92). Splitting the sample by use of psychometric testing revealed that examinations that did not include psychometric testing demonstrated the same relation between veteran race and diagnostic concordance. However, for examinations in which psychometric testing was used, the racial disparity between SCID PTSD status and disability exam PTSD status was no longer significant. Results suggest that psychometric testing may reduce disparities in VA PTSD disability exam outcomes.