Post-Deployment Readjustment Inventory: Reliability, Validity, and Gender Differences

Abstract

This article describes the development and psychometric properties of the Post-Deployment Readjustment Inventory (PDRI). Items were derived from interviews with post-deployed troops from Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) and clinicians. A diverse sample of 215 post-deployed men (183) and women (32) completed the PDRI, General Information Form, Brief Symptom Inventory (BSI), and Posttraumatic Checklist—Military version (PCL-M). The PDRI Global scale and six subscales (Career Challenges, Social Difficulties, Intimate Relationship Problems, Health Problems, Concerns About Deployment, and PTSD Symptoms) show excellent internal consistency and strong correlations with standardized measures. In addition, the PDRI detected unique patterns of readjustment for those who were exposed to various war stressors: military sexual trauma (MST), witnessing others injured/killed, and being injured. Gender differences revealed that women reported more MST and men reported more witnessing of others injured/killed. No gender differences were found on reports of symptoms or readjustment.

Introduction

Post-deployed veterans from Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) are presenting to the VA medical centers with a variety of emotional symptoms (e.g., consistent with posttraumatic stress disorder and depression) and difficulties readjusting into civilian life. Preliminary studies estimate that between 19 and 38% of these returning veterans are having emotional difficulties (Cozza, 2005; Hoge, Auchterlonie, & Milliken, 2006; Hoge et al., 2004; Kang & Hyams, 2005; Stimpson, Thomas, Weightman, Dunstan, & Lewis, 2003).

For various reasons it is often difficult for clinicians to accurately assess readjustment problems with open-ended questions. Service members returning from OIF/OEF (a) may be reluctant to disclose their symptoms (e.g., to avoid looking weak or concerns over possible loss of military career), (b) may not be able to identify problem areas, (c) may fear stigmatization, and (d) may feel pressure to be “normal” (Friedman, 2004; Hoge et al., 2004; Kang & Hyams, 2005). In addition, returning veterans from different cultural backgrounds may differ in how they manifest symptoms, how they describe them, how they may cope, what support systems they use, and whether they seek or stay in treatment (Department of Health and Human Services, 2001). Women may also feel pressure to continue appearances of “being tough” so they are not judged as less competent than men (Katz, Bloor, Cojucar, & Draper, 2007).

Symptom presentation may not fully surface until several months following return. Symptoms may be gradual and progressive (Cozza, 2005; Grieger et al., 2006) and such patterns of delayed symptoms seriously impede clinicians' efforts to facilitate readjustment. In one study, where OIF/OEF veterans presented with PTSD symptoms, less than 10% were identified and referred to treatment through standard screening processes (Hoge et al., 2006). Instead, most veterans seem to seek treatment only after readjustment problems become a serious hindrance in daily life.

If veterans are presented with a series of direct questions about specific symptoms and behaviors, they may be more likely to communicate their experiences. When veterans see questions about specific symptoms they have experienced, they become normalized (e.g., “I must not be the only one with this experience” or “I didn't realize this was important, but come to think of it, I do have this issue”). Also, the reality of today's healthcare system involves very busy clinicians. A typical doctor appointment is generally too brief to adequately address a multitude of symptoms or various domains of functioning.

The purpose of this study is to gather psychometric information on the newly developed Post-Deployment Readjustment Inventory (PDRI). The PDRI is designed to bridge this communication barrier by providing a variety of self-report questions on symptoms and level of functioning across a variety of domains. The PDRI takes approximately 10 minutes to complete and can be administered while patients are waiting for appointments. This could be an efficient way to help clinicians and evaluators gather vital information regarding veterans' experiences and, ultimately, to assist professionals to better serve the needs of post-deployed veterans. Although there are several validated measures of PTSD and emotional symptoms, there are no measures specifically validated and geared toward assessing readjustment issues in returning veterans from OIF/OEF.

In addition, there is a paucity of information about women who served in OIF/OEF including the exposure to various war stressors and their unique experience of readjustment to civilian life. Katz et al. (2007) found that 10 of 18 post-deployed women (56%) reported military sexual trauma (MST) while serving in OIF/OEF. Of the 15 who completed questionnaires, a comparison between those with MST (n = 8) and those without (n = 7) revealed that those with MST had higher clinician symptom ratings and more difficulties with readjustment. This study only assessed a small sample of women and there were no comparisons with their male counterparts. Although objective clinician ratings were used, there were no standardized measures included. There is a need for research to focus on gender differences by comparing a larger sample of both women and men in terms of their unique experiences in war and readjustment to civilian life.

A PRELIMINARY IRAQ READJUSTMENT INVENTORY

A study examining readjustment issues in women returning from service in OIF/OEF resulted in a 16-item Iraq Readjustment Inventory (IRI; Katz et al., 2007). There was high internal consistency on the Global scale and the two subscales of Social Readjustment and Concerns About Deployment (a = .89, .87, .81, respectively) and high correlations with objective clinicians' ratings of the participants' symptoms (r = .79, .75, .53, respectively). The current study expanded this preliminary inventory to include a broader diversity of subscales (various domains of functioning).

Items for the expanded inventory were derived from a three phase process, including (a) interviewing post-deployed service men and women, (b) developing items assessing readjustment across a variety of domains, and (c) verifying face validity and contemporary wording by seeking feedback from post-deployed veterans, a team of clinical experts, and the research team.

Items were generated based on the interviews of 18 women who served in OIF/OEF (Katz et al., 2007) and discussion with our research team including a male OIF veteran. The team also checked face validity and range of items and made sure that the scoring scale matched each question and that each item was easy to understand. The criteria to evaluate items were similar to the criteria used in the development of the Deployment Risk and Resilience Inventory (DRRI) (King, King, & Vogt, 2003). (a) Was the item easy to read and understand? (b) Did the scoring make sense for the item? (c) Did the item seem face valid, consistent with the intent of what the item should assess? (d) Did the item ask only one question (not two things combined, such as “having trouble concentrating or feeling motivated)? And (e) Were the items leading or confounded with level of distress? Items were revised based on the team's input including item selection and wording. The items were then rechecked with the research team and a team of experts who specialize in the assessment and treatment of post-deployed veterans. The research team consisted of the authors of this article and the team of experts consisted of the PTSD Clinical Team at the VA Long Beach Healthcare System (two psychologists, psychiatrist, nurse, and social worker).

The current study expanded the 16-item preliminary inventory into 40 items with six subscales: Career Challenges, Social Difficulties, Intimate Relationship Problems, Health Problems, Concerns About Deployment, and PTSD Symptoms. It was also renamed the Post-Deployment Readjustment Inventory (PDRI) to assess readjustment issues in those who served in countries other than Iraq (e.g., Afghanistan).

This study examined the psychometric properties of the PDRI by administering the inventory to a diverse sample of post-deployed service men and women along with standardized measures of PTSD and symptoms. This study proposes to test the following hypotheses: (a) The PDRI has high internal consistency and convergent and predictive validity (e.g., the PDRI produces reliable scales, correlates with standardized measures of symptoms, and correlates with war stressors). (b) Exposure to various stressful war events produces unique patterns of readjustment (e.g., different domains of functioning are compromised). (c) Men and women report differences in their exposure to war stressors and differences in reported symptoms and readjustment difficulties.

METHOD

Participants

Two hundred thirty-seven OIF/OEF veterans were given questionnaires. Two hundred twenty-two questionnaires were received back. Seven questionnaires were not included because of incomplete data (e.g., they missed more than half of the items on at least one of the questionnaires). The final sample consisted of 215 participants (183 men and 32 women). The sample was ethnically diverse: 25 African American, 21 Asian, 84 Hispanic, 66 Caucasian, and 19 other or mixed ethnic groups. It also represented all branches of service: 110 Army, 16 Navy, 5 Air Force, 28 Marines, 1 Coast Guard, 37 National Guard, and 18 Reserves. There were no differences found in the results between different ethnicities or branches of service. The average age was 31.4 (range = 20–57 years, SD = 8.72) and average length of deployment was 12.1 months (range = 1–36 months, SD = 4.64; see Table 1 for a description of demographics).

Measures

General Information Form

The General Information Form consisted of six demographic questions: (a) age; (b) gender; (c) length of stay in Iraq, Kuwait, or Afghanistan; (d) ethnicity; (e) branch of service; and (f) frequency of use of alcohol or drugs since return from deployment (on a 5-point Likert-type scale, where 1 = not at all, and 5 = daily). Participants also completed five items assessing exposure to three war stressors: MST, being injured, and witnessing others injured or killed. The questions for MST were (a) “Did you experience unwanted verbal comments of a sexual nature (pressure for dates, threats, cat-calls)?” (b) “Did you experience unwanted physical sexual advances (unwanted touching, grabbing, cornering)?” and (c) “Were you sexually assaulted, attempted, or completed rape (forced sex, or agreed to have sex out of fear)?” All questions regarding MST were answered (on a 5-point Likert-type scale, where 1 = not at all, and 5 = daily). Additional questions assessing war stressors were (a) “Were you injured?” (on a 5-point Likert-type scale, where 1 = not at all, and 5 = severely) and (b) “Did you witness others injured or killed?” (on a 5-point Likert-type scale, where 1 = not at all, and 5 = daily).

TABLE 1 Frequencies, Means, Standard Deviations of Demographic Data

	Means (SD)
	Total	Males	Females
Age	31.4 (8.72)	31.7 (8.61)	30.0 (9.30)
Length of deployment	12.1 (4.64)	12.0 (4.51)	12.6 (5.34)
	Yes	Yes	Yes
% Witnessed	63.7	77.2	43.8
% Injured	53.5	56.3	37.5
% MST	16.3	13.1	34.4
% Substance use	74.3	77.0	65.6

Post-Deployment Readjustment Inventory

On the PDRI, respondents were asked to complete 40 items by stating “how true each item was since their return from deployment” on a 5-point Likert-type scale, where 1 = not at all true, and 5 = extremely true. Scales were developed conceptually and refined by psychometric procedures for a final inventory of 36 items (procedure described below) including a Global scale of readjustment (all items) and six subscales: Career Challenges consisting of five items (e.g., “Feeling pressure to work,” “Wanting to work but not able to,” and “Having difficulty finding a job”), Social Difficulties consisting of seven items (e.g., “Others don't understand what I went through,” “Feeling alienated or alone,” “Not fitting in socially,” and “Feeling pressure to be ‘back to normal’;”), Intimate Relationship Problems consisting of five items (e.g., “Not wanting to be touched or hugged,” “My partner/family does not understand me,” and “Difficulty returning to my role in my family”), Health Concerns consisting of five items (e.g., “My body not functioning like it used to,” “Having chronic pain,” and “Having health problems”), Concerns About Deployment consisting of six items (e.g., “Worried about other soldiers who are still deployed,” “Mourning the loss of fellow soldiers,” and “Missing the structure of being deployed”), and PTSD Symptoms consisting of eight items (e.g., “Having nightmares of difficulty sleeping,” “Being easily irritated with others,” and “Feeling tense, jittery or anxious”). See Table 2 for means and standard deviations, Table 3 for the items of each scale, and Table 3 for the items of each scale and scoring.

Scoring for the PDRI consists of summing the items of each scale. Scores range as follows: Global (36 to 180), Career Challenges (5 to 25), Social Difficulties (7 to 35), Intimate Relationship Problems (5 to 25), Health Concerns (5 to 25), Concerns About Deployment (6 to 30), and PTSD Symptoms (8 to 40).

Posttraumatic Checklist–Military Version (Weathers, Huska, & Keane, 1991)

This is a widely used 17-item inventory with items consistent with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; Americal Psychiatric Association [APA], 1994) criteria for PTSD. Items are answered on a 5-point Likert-type scale, where 1 = not at all, and 5 = extremely. The scale has good reliability based on test–retest reliability (r = 0.96 at 2–3 days and r = .88 at 1 week; Blanchard, Jones-Alexander, Buckley, & Forneris, 1996; Ruggiero, Del Ben, Scotti, & Rabalais, 2003) and internal consistency (α = 0.94 and 0.97; Blanchard et al.; Weathers, Litz, Herman, Huska, & Keane, 1993). The PCL also correlates positively with the Mississippi PTSD scale (convergent validity r = .85 and .93; Weathers et al.).

TABLE 2 Means and Standard Deviations of the PDRI and Symptoms Scales

	Number Items	Mean (SD)
		Total	Males	Females
Global scale	36	103 (38.4)	100 (39.0)	97.1 (34.8)
Career Challenges	5	11.8 (5.49)	11.8 (5.49)	11.5 (5.59)
Health Concerns	5	12.9 (6.08)	13.1 (6.12)	11.7 (5.81)
Intimate Relationship	5	11.3 (5.50)	11.3 (5.56)	11.3 (5.23)
Social Difficulties	7	19.1 (8.01)	19.1 (8.01)	19.0 (8.11)
Concerns About Iraq	6	15.2 (6.14)	15.3 (6.31)	14.7 (5.11)
PTSD symptoms	8	22.4 (9.13)	22.6 (9.19)	21.3 (8.83)
PCL-M	17	43.3 (20.2)	44.1 (20.4)	38.6 (18.8)
BSI	18	35.8 (17.53)	36.5 (17.9)	31.6 (14.6)

TABLE 3 Post-Deployment Readjustment Inventory

Not at all	Slightly	Somewhat	Considerably	Extremely
1	2	3	4	5
Scoring is the sum of the following items: Career = 1, 6, 13, 23, 34; Health = 2, 8, 11, 14, 30; Intimate relationship = 5, 15, 17, 31, 35; Social readjustment = 3, 7, 19, 22, 25, 27, 33; Concerns about deployment = 9, 12, 16, 28, 36, 26; PTSD symptoms = 4, 10, 18, 20, 21, 24, 29, 32; Total score = sum of all scales
Please rate how true each of the following is since your return from deployment by writing the number that corresponds to the scale above.
—	1. Feeling pressure to work	—	19. I've changed or others have changed
—	2. Having chronic pain	—	20. Feeling tired and worn out
—	3. Feeling pressure to be “back to normal”	—	21. Being easily irritated with others
—	4. Feeling tense, jittery, or anxious	—	22. Something was kept secret while I was away
—	5. Difficulty returning to my role in my family	—	23. Having difficulty finding a job
—	6. Feeling unmotivated to work	—	24. Having frequent thoughts about deployment
—	7. Not fitting in socially	—	25. Others don't understand what I went through
—	8. Having health problems	—	26. Feeling useless since returning from deployment
—	9. Worried about others who are still deployed	—	27. Feeling alienated or alone
—	10. Avoiding social situations or crowded places	—	28. My life is on hold (could be redeployed)
—	11. My body not functioning like it used to	—	29. Having difficulty completing tasks
—	12. Mourning the death of fellow service members	—	30. Having lots of medical appointments
—	13. Wanting to work but not being able to	—	31. My partner/family does not understand me
—	14. Feeling like I am deteriorating	—	32. Having nightmares or difficulty sleeping
—	15. Not wanting to be touched or hugged	—	33. Not wanting to talk about my experiences
—	16. Missing structure and focus of being deployed	—	34. Not knowing what to do next
—	17. Having demands from my partner or family	—	35. Wanting to avoid intimate time with others
—	18. Having difficulty concentrating	—	36. Everything seems trivial since deployment

Brief Symptom Inventory (Derogatis, 2001)

This is an 18-item instrument used to measure symptoms of psychological distress. Items are answered on a 5-point Likert-type scale, where 0 = not at all, and 4 = extremely. The instrument has good internal consistency (α = 0.89). It also has good convergent validity with the longer version of this measure, the Symptom Checklist–90 (r = from .91 to .96; Asner-Self, Schreiber, & Marotta, 2006).

Procedure

Post-deployed troops were recruited at VA enrollment fairs at the following locations: the VA Long Beach Healthcare System, Los Alamitos (Joint Training Center for reservists of all branches), and Irvine and Bandini Army bases. We were invited to attend these fairs but agreed not to ask participants about our study until after they completed their VA paperwork. It is estimated that approximately 10% of others at these events agreed to participate in our study. Nonparticipants stated they could not because they had to go back to training (e.g., did not have the time), were tired after spending 4–5 hours taking assessments (e.g., overwhelmed by paperwork), and only a few stated they were not interested. Participants were also recruited at the VA Long Beach Healthcare System in patient waiting rooms (e.g., waiting for an appointment, lab results, or pharmacy at the VA) or walking around the medical center. The number recruited in this manner was approximately 40% of the sample. Although fewer participants were recruited in this manner, the percentage that agreed to participate was much higher, approximately 50%. Several nonparticipants said they would like to participate but had appointments, were tired, or not interested. The rest did not want to participate for the reasons already mentioned. The study was explained to potential participants and those who agreed were given an informed consent form and a packet of questionnaires consisting of the PDRI, a General Information Form, the Brief Symptom Inventory (BSI), and the Posttraumatic Checklist–Military version (PCL-M). To ensure confidentiality, participants were asked to place their signed consent forms in one envelope and their completed questionnaires in another.

RESULTS

Reliability for the PDRI

Internal consistency analyses were conducted on the items corresponding to the conceptual scales of the PDRI. Items that reduced reliability (alpha coefficient) were deleted from the scale. Four items were dropped because they reduced scale reliabilities and had a lower item-total correlation than the other items. The item “Coping with being disfigured or injured” was removed from the Health Concerns scale and the items “Worried about the Iraqi people,” “Feeling I have unfinished business in Iraq,” and “Feeling the war was unnecessary” were removed from the Concerns About Deployment scale.

Subscales were correlated with each other with a range from .68 to .88, suggesting that the scales measure unique constructs, although there is some interdependence (see Table 4). Analyses revealed high internal consistency for the 36-item Global scale (α = .97) and for the 6 subscales Career Challenges, Health Problems, Intimate Relationship Problems, Social Difficulties, Concerns About Deployment, and PTSD Symptoms (α = .84, .90, .85, .90, .82, 92, respectively). Because this study included a one-time administration, we were unable to obtain test–retest reliabilities.

Convergent Validity

To test convergent validity, the PDRI was correlated with the BSI, the PCL-M, and the item for substance abuse. The PDRI was highly correlated with both the BSI and PCL-M (e.g., with Global scale: r = .82, .90, respectively; see Table 5 for correlations with the PRDI subscales). One hundred and seven people reported using alcohol or drugs on a monthly basis or more frequently and 36 participants reported using daily. The question included “pain medication” so it is not clear how many were appropriately using medication versus abusing drugs or alcohol. Nonetheless, the PDRI was correlated with substance use (e.g., Global scale: r = .35, p < .001; see Table 5 for correlations with PDRI subscales).

Predictive Validity

Because numerous analyses were conducted on this data set, to avoid spurious positive findings, the alpha level of significance was set at p < .01 for the following tests. Consistent with the hypothesis that war stress would be correlated with difficulty in readjustment, the PDRI was significantly correlated with all three war stressors, military sexual trauma (e.g., Global scale: r = .26, p < .001), being injured (e.g., Global scale: r = .40, p < .001), and witnessing others injured or killed (e.g., Global scale: r = .23, p < .001; see Table 5 for correlations with PDRI subscales). To compare whether those with war stress had more difficulties with readjustment, a series of MANOVAs was conducted where war stress (e.g., MST, being injured, and witnessing others injured or killed) were independent variables and PDRI scales were dependent variables. Each war stress will be discussed separately.

TABLE 4 Correlations Between PDRI Readjustment Scales

	Global	Career	Health	Intimacy	Social	Concerns	PTSD
Global	—
Career Challenges	.88*	—
Health Concerns	.84*	.68*	—
Intimacy	.91*	.76*	.73*	—
Social	.94*	.82*	.75*	.85*	—
Concerns Iraq	.91*	.77*	.68*	.77*	.84*	—
PTSD	.95*	.81*	.78*	.85*	.88*	.84*	—

TABLE 5 Correlations Between PDRI Readjustment Scales, Symptoms, and War Events

	PCL-M	BSI	SA	MST	Injured	Witnessing
Global	.90**	.85**	.35**	.26**	.40**	.23**
Career Challenges	.75**	.76**	.30**	.20*	.26**	.10
Health Concerns	.74**	.73**	.33**	.14	.48**	.29**
Intimacy	.82**	.77**	.31**	.29**	.29**	.20*
Social	.85**	.77**	.32**	.29**	.35**	.19*
Concerns Iraq	.81**	.75**	.30**	.16	.37**	.24**
PTSD	.90**	.82**	.34**	.24**	.37**	.21*
PCL-M	—	.86**	.32**	.22**	.35**	.24**
BSI		—	.28**	.22**	.32**	.18*
SA			—	.06	.21*	.12

Military Sexual Trauma and Readjustment

Thirty-five people (16.3% of the total sample) reported MST: 22 (12.2%) men and 13 (40%) women. Two men and two women reported attempted or completed physical sexual assaults or rape and the others reported having unwanted physical advances or sexual harassment. Of the 35 with MST, 15 people reported sexual harassment or unwanted advances on a weekly or daily basis during their tour of duty.

Those with MST reported more symptoms and difficulties with readjustment, Wilks' Lambda, F(7, 207) = 6.0, p < .001. Individual analyses revealed that those who reported MST had significantly higher scores on Global Readjustment, F(1, 213) = 14.95, p < .001; Intimate Relationship Problems, F(1, 213) = 19.76, p < .001; Social Difficulties, F(1, 213) = 20.12, p < .001; PTSD Symptoms, F(1, 213) = 12.58, p < .001; and Career Challenges, F(1, 213) = 9.20, p < .01. No differences were found on Health Problems or Concerns About Deployment (see Table 6 for means/standard deviations).

Being Injured and Readjustment

One hundred and fifteen participants (53% of total sample): 104 (57%) men and 11 (34%) women reported being injured. Of the total sample, 15.8% reported being injured considerably or severely (19 considerably, 15 severely). Participants who reported being injured had significantly more difficulties with readjustment on all PDRI scales, Wilks' lambda, F(7, 207) = 12.46, p < .001 (see Table 7 for means/standard deviations).

TABLE 6 MANOVA Comparing Readjustment for Those With and Without MST

Yes = 35, No = 180	Yes M/SD	No M/SD	F-test
Wilks' lambda			F(7, 207) = 6.00**
Global	(122.51/32.82)	(95.96/37.96)	F(1, 213) = 14.95**
Career Challenges	(14.31/5.16)	(11.29/5.43)	F(1, 213) = 9.20*
Health Concerns	(14.83/5.94)	(12.53/6.05)	F(1, 213) = 4.24
Intimacy	(14.97/5.18)	(10.94/5.29)	F(1, 213) = 19.76**
Social	(24.40/6.51)	(18.04/7.87)	F(1, 213) = 20.12**
Concerns Iraq	(17.43/5.36)	(14.73/6.20)	F(1, 213) = 5.77
PTSD	(27.31/7.72)	(21.49/9.10)	F(1, 213) = 12.58**

Witnessing Others Injured or Killed and Readjustment

One hundred thirty-seven participants (64%), 123 (67%) men and 14 (44%) women, reported witnessing others who were injured or killed. Those who reported witnessing others injured or killed had significantly more difficulties with readjustment, Wilks' lambda F(7, 207) = 4.60, p <. 001, than those who did not. Those who did reported significantly higher scores on Global Readjustment, F(1, 213) = 11.83, p < .001; Health Concerns, F(1, 213) = 20.01, p < .001; Concerns About Deployment, F(1, 213) = 12.91, p < .001; Intimate Relationship Problems, F(1, 213) = 9.26, p < .01; Social Difficulties, F(1, 213) = 8.01, p < .01; and PTSD Symptoms, F(1, 213) = 9.66, p < .01. No differences were found on Career Challenges (see Table 8 for means and standard deviations).

TABLE 7 MANOVA Comparing Symptoms and Readjustment for Those With and Without Being Injured

Yes = 115, No = 100	Yes M/SD	No M/SD	F-test
Wilks' lambda			F(7, 207) = 12.46**
Global	(114.71/36.15)	(83.68/34.05)	F(1, 213) = 41.61**
Career Challenges	(13.13/5.59)	(10.24/4.97)	F(1, 213) = 15.84**
Health Concerns	(15.61/5.60)	(9.80/5.06)	F(1, 213) = 62.98**
Intimacy	(12.82/5.59)	(9.65/4.91)	F(1, 213) = 19.23**
Social	(21.70/7.46)	(16.06/7.57)	F(1, 213) = 30.22**
Concerns Iraq	(17.26/6.17)	(12.77/5.18)	F(1, 213) = 32.86**
PTSD	(25.54/8.48)	(18.87/8.86)	F(1, 213) = 32.78**

Gender Differences

Exposure to war events and scores of readjustment and symptoms were compared between men and women. The overall MANOVA was not significant, nor were any of the scales of readjustment or symptoms. However, they did differ on type of exposure to war stressors. Independent samples t-tests revealed that women reported a higher rate of MST than men t(213) = -3.06, p < .01 (women M = 1.34, SD = .48; men M = 1.13, SD = .34), and men reported a higher rate of witnessing others injured or killed than women, t(213) = 3.10, p < .01 (men M = 2.37, SD = 1.36; women M = 1.59, SD = .84).

Beyond a Measure of PTSD

As stated, the PDRI global scale and the PTSD subscale were both highly correlated with the PCL-M (r = .90), suggesting that the PDRI is a sensitive measure of PTSD. It would be expected that those with PTSD would have more difficulties in readjustment. To test this, the PCL-M was split into scores above and below the mean (M = 43). As expected, those with higher scores of PTSD reported higher scores on the PDRI, t(213) = 18.06, p < .001. To test whether the PDRI measures readjustment beyond simply measuring PTSD, the variance of PTSD was controlled (e.g., partial correlation) and PDRI subscales were first correlated with each other and then correlated with war stressors. When PTSD was partialled out of the analyses, the subscales had lower correlations with each other with a range of .20 to .53 (see Table 9). When correlated with war stressors, the PDRI continued to detect unique patterns of readjustment. MST was significantly related to Intimate Relationship Problems (r = .22, p < .01) and Social Difficulties (r = .26, p < .001); being injured was significantly related to Health Problems (r = .42, p <. 001) and Concerns About Deployment (r = .20, p < .01); and witnessing others injured or killed was significantly related to Concerns About Deployment (r = .23, p < .01). These findings suggest that not only are the subscales independent constructs, but that the PDRI assesses information regarding specific readjustment problems for those with and without PTSD (see Table 9).

TABLE 8 MANOVA Comparing Symptoms and Readjustment for Those With and Without Witnessing Others Injured/Killed

Yes = 137, No = 78	Yes M/SD	No M/SD	F-test
Wilks' lambda			F(7, 207) = 4.60**
Global	(106.91/38.96)	(88.64/34.60)	F(1, 213) = 11.83*
Career Challenges	(12.19/5.60)	(11.08/5.26)	F(1, 213) = 2.05
Health Concerns	(14.25/6.10)	(10.55/5.32)	F(1, 213) = 20.01**
Intimacy	(12.19/5.78)	(9.86/4.66)	F(1, 213) = 9.26*
Social	(20.23/8.07)	(17.06/7.53)	F(1, 213) = 8.01*
Concerns Iraq	(16.28/6.22)	(13.23/5.52)	F(1, 213) = 12.91**
PTSD	(23.87/9.26)	(19.92/8.38)	F (1, 213) = 9.66*

DISCUSSION

The results of this study support the hypotheses that the PDRI Global scale and six subscales have strong internal consistency and high correlations with standardized measures of symptoms and PTSD.

Although the PDRI appears to be a valid measure of PTSD (e.g., PCL-M correlated .90 with the PDRI Global scale and PTSD subscale), it also assesses information on a variety of domains of functioning (e.g., the remaining five subscales). Conceptually, it is expected that there would be some interdependence between the subscales (e.g., those with severe mental or physical injuries or those with PTSD would likely have difficulties across all domains of functioning). Indeed those with scores above the mean on the PCL-M reported more difficulties on the PDRI compared to those with scores lower than the mean.

TABLE 9 Correlations Between PDRI Scales and War Stressors Controlling for PTSD as Measured by the PCL-M

	Global	Career	Health	Intimacy	Social	Concerns	PTSD
Global	—
Career	.69**	—
Health	.59**	.28*	—
Intimacy	.68**	.39**	.33**	—
Social	.78**	.52**	.34**	.53**	—
Concerns Iraq	.69**	.42**	.20	.32*	.49**	—
PTSD	.74**	.46**	.38**	.45**	.49**	.45**	—
MST	.16	.11	.00	.22*	.26**	.01	.08
Witnessing	.03	−.11	.11	−.07	.06	.23*	.03
Being Injured	.19*	.07	.42**	.03	.05	.20*	.08

However, the subscales of the PDRI detected unique patterns of readjustment for those with and without PTSD as demonstrated by the correlations with war stressors (e.g., MST, being injured, and witnessing others injured or killed). These patterns appear to be specific to type of war stress (e.g., MST was related to difficulties with Intimacy, Social Difficulties, and PTSD but not Health Problems or Concerns About Deployment; and witnessing others injured or killed was related to difficulties in Health Problems and Concerns About Deployment but not Career Challenges). The patterns of readjustment difficulties were still evident when controlling for PTSD, suggesting that those who were exposed to various types of war stress have unique patterns of difficulties with readjustment even if they do not have PTSD. Further research is needed to determine whether these patterns replicate.

What is compelling is that the PDRI may be an excellent measure to assess post-deployment readjustment difficulties for all returning veterans regardless of whether they meet criteria for PTSD. If veterans do not have PTSD, their readjustment problems may go undetected by the healthcare system. It is possible that, for some, their issues will resolve naturally, but for others, these issues left untreated may escalated into a cascade of negative consequences. The PDRI offers a way to assess for readjustment difficulties regardless of symptom-based diagnoses.

The PDRI may also be a promising measure to assess progress in psychotherapy. As acute symptoms of PTSD subside, other readjustment difficulties may persist. The PDRI may be a sensitive measure to detect these problem areas and to help therapists direct interventions toward the specific areas of need. Future research is needed to test the clinical utility of this measure. Findings also suggest that assessing exposure to various types of war stress may be helpful to detect specific problems with readjustment.

This study supported the hypothesis that there are gender differences regarding exposure to war stressors. Women reported more military sexual trauma than men, which is consistent with previous findings (Goldzweig, Balekian, Rolon, Yano, & Shekelle, 2006). Men witnessed more people killed or injured than women. This may be explained by differences in roles while in combat. However, there were no gender differences on items assessing injuries, symptoms, or readjustment difficulties.

LIMITATIONS AND FUTURE RESEARCH

Although the results of this study are promising, several limitations should be acknowledged. The results were based on a moderate sized sample, from a single geographical area, and all measures were self-report. It is necessary to replicate these findings with diverse samples to further establish reliability, validity, and normative scoring (e.g., with various branches, Reservists, and National Guard). It would also be beneficial to include items with reverse scoring to test for valid responding, a larger sample of females, more demographic information (e.g., multiple deployments, place of deployment, type of military job, and education), and other possible factors that could influence post-deployment readjustment such as pre-military trauma and perceived social support. Also, test–retest reliability is needed. Future research should also address the clinical utility of the PDRI testing factors such as ease of using the measure in a busy clinic, usefulness to a clinician or evaluator (e.g., does information from the PDRI help practitioners detect problem areas and aid in decision making?), and whether scores on the PDRI improve with psychotherapy.

CONCLUSION

Although there are several inventories to assess PTSD, there is a need to improve assessment of a broad range of readjustment issues quickly and effectively. Results of this study suggest that the PDRI is not simply a measure of PTSD but rather a multidimensional measure that assesses both PTSD and specific areas of readjustment for those with or without PTSD. The PDRI appears to have good reliability and validity. The PDRI also seems to be sensitive in detecting unique patterns of readjustment depending on exposure to various war stressors. The PDRI appears to be a promising measure that could potentially be implemented on a wide-scale basis. Further validation studies are warranted.

Notes

*p < .001.

*p < .01.

**p < .001.

*p < .01.

**p < .001.

*p < .01.

**p < .001.

*p < .01.

**p < .001.

*p < .01.

**p < .001.