Substance S

Screening scales were included in the AAS for eight DSM-IV disorders that have been found in previous general population studies to be significant predictors of suicidality (Nock et al., 2008 (link); Nock et al., in press ; Nock et al., 2009 (link)). These include two mood disorders (major depressive episode, mania/hypomania), three anxiety disorders (panic disorder with or without agoraphobia, generalized anxiety disorder, PTSD), and three externalizing disorders (adult attention-deficit hyperactivity disorder, intermittent explosive disorder, substance use disorder).
Symptom questions in most CIDI-SC scales ask respondents about the frequency of particular symptoms over the 30 days before interview using the response options all or almost all of the time, most of the time, some of the time, a little of the time, and none of the time. Each CIDI-SC scale has an embedded skip logic whereby all respondents are administered one or more entry questions and then either skipped if they fail to endorse these questions or continue to a series of follow-up questions if they endorse the entry question(s). This approach was designed to reduce overall scale administration time and respondent burden while minimizing the number of true positives incorrectly skipped out by the entry questions. Respondents who fail to endorse any of the entry questions are asked a total of 46 questions across all eight scales combined, while respondents who endorse every single question are asked an additional 82 questions.
The CIDI-SC major depressive episode (MDE) scale begins with four entry questions that ask about being sad, depressed, or discouraged; having little or no interest or pleasure in things; and feeling down on yourself, no good, or worthless (Kessler et al., 2012 ). Respondents who report that at least one of these symptoms occurred at least some of the time in the past 30 days are administered 10 additional questions to assess the inclusion criteria of MDE. The some of the time threshold, while low for a DSM-IV diagnosis of MDE (which requires depressive symptoms to last most of the day nearly every day for two weeks or longer), was chosen because we wanted to collect information not only on threshold cases but also on subthreshold manifestions of MDE. A similar attempt to collect information about subthreshold symptoms was made in selecting stem question skip rules for each of the other screening scales.
The CIDI-SC mania-hypomania (MHM) scale focuses on subthreshold hypomania as well as mania and hypomania based on evidence that subthreshold hypomania can be highly impairing (Merikangas et al., 2007 (link)). In addition, the questions focus on lifetime rather than 30-day prevalence due to the fact that recent bipolar disorder (BPD) can manifest as either MHM or as MDE. As described in more detail elsewhere (Kessler et al., 2006a (link); Kessler et al., 2012 ), the single MHM entry question begins with a vignette describing a hypomanic episode and then asks respondents if they ever had an episode of this sort at any time in their life. A positive response is followed by four questions about the frequency of core MHM symptoms during a typical intense episode of this sort. These symptoms include being much higher, happier, or optimistic than usual; much more irritable than usual; so hyper or wound up that you felt out of control; and having thoughts race through your mind so fast you could hardly keep track of them. Respondents who report that at least one of these symptoms occurrs at least some of the time during a typical intense episode are then administered six additional questions about the inclusion criteria of MHM and are then asked about episode recency to assess 30-day prevalence of MHM. Lifetime rather than 30-day MHM is evaluated here due to the rarity of 30-day MHM in the AAS sample.
The CIDI-SC panic disorder (PD) scale includes two entry questions about lifetime atacks of panic, anxiety, or strong fear that came on very suddenly and made you feel very frightened or uneasy; and attacks of heart pounding or chest pain that came on very suddenly and made you feel very frightened or uneasy (Kessler et al., 2012 ). A positive response to either entry question is followed by one additional question on how often these attacks are triggered (i.e., occur in situations where the respondent has a strong fear – like a fear of snakes or heights – or where the respondent is in real danger – like a car accident) versus untriggered (i.e., occur without provocation “out of the blue”). Respondents who report ever having untriggered attacks are then administered 13 additional questions to assess the remaining DSM-IV inclusion criteria of PD. Lifetime rather than 30-day PD is evaluated here due to the rarity of 30-day PD in the AAS sample.
The CIDI-SC generalized anxiety disorder (GAD) scale includes five entry questions about 30-day frequency of being anxious or nervous; worried about a number of different things; more anxious or worried than other people in your same situation; worried about things most other people don’t worry about; and having trouble controlling your worry or anxiety (Kessler et al., 2012 ). Respondents who report any of these symptoms at least some of the time are administered an additional nine questions to assess the remaining DSM-IV inclusion criteria of GAD along with a final question to assess persistence of symptoms. As a minimum duration of six months is required to meet DSM-IV criteria of GAD, the CIDI-SC assesses duration of symptoms, although the concordance data reported here are for symptoms in the 30-days before interview.
As noted above, PTSD is assessed in the AAS with the PCL. The PCL Civilian version (Weathers et al., 1993 ) was used in Army STARRS because we covered traumatic experiences both in and out of the line of duty. This is a 17-question scale that assesses the 17 DSM-IV Criterion B-D symptoms of PTSD. Although there are no entry questions in the PCL, AAS respondents are first asked 15 questions about traumatic experiences (TEs) that might have happened to them during deployments and 15 additional questions about TEs that might have happened at to them at any other time in life. Only respondents who report at least one of these 30 TEs are administered the PCL. The PCL questions ask how much respondents were bothered in the past 30 days by symptoms associated with any of the TEs they ever experienced. Response categories are extremely, quite a bit, moderately, a little bit, and not at all.
The CIDI-SC adult attention-deficit/hyperactivity disorder (ADHD) scale includes four entry questions found in previous research to provide an optimal short inclusion screen for ADHD in the adult general population (Kessler et al., 2010a (link)). Respondents who report at least two of these symptoms at least some of the time in the past six months then receive an additional 8 questions shown in a number of previous studies to detect adult ADHD with good accuracy (Kessler et al., 2007 ; Kessler et al., 2010a (link); Kessler et al., 2009 (link)).
The CIDI-SC intermittent explosive disorder (IED) scale includes one entry question about lifetime attacks of anger when the respondent all of a sudden … lost control and either broke or smashed something worth more than a few dollars, hit or tried to hurt someone, or threatened someone (Kessler et al., 2006b (link)). A positive response is followed by 6 additional questions that assess the remaining DSM-IV inclusion criteria of IED. As the assessment of IED followed the same logic as the assessment of PD, lifetime rather than 30-day IED is evaluated here in parallel with the evaluation of PD.
The CIDI-SC assessment of substance use disorder (SUD), finally, begins with 12 entry questions about quantity-frequency of alcohol use, illicit drug use, and prescription drug misuse, where the latter is defined as use either without a doctor’s prescription, more than prescribed, or to get high, buzzed, or numbed out. Prescription drug misuse is included in the assessment based on evidence that it is considerably more common than illicit drug use in the Army (Bray et al., 2010 (link)). Respondents who report any of these types of substance use are then administered the four CIDI-SC questions about DSM-IV substance abuse in the 30 days before interview and eight additional questions to screen for substance dependence in the 30 days before interview including five from the Severity of Dependence Scale (Gossop et al., 1995 (link)) and three additional CIDI-SC questions. Substance use disorders (i.e., either abuse or dependence) are assessed only once for alcohol and/or drugs combined.