PSYCHIATRIC SERVICES ps.psychiatryonline.org September 201.docx

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September 2012 Vol. 63 No. 9 885555
Soldiers returning from combatoften face a postdeployment pe-
riod in which there is an in-
creased risk of readjustment stres-
sors, such as problems with family,
marriage, or employment. This peri-
od can also be marked by the onset of
posttraumatic stress disorder (PTSD).
Coping with the additional burden of
PTSD likely complicates soldiers’
ability to cope during the readjust-
ment period. Accordingly, research
has documented a relationship be-
tween PTSD and greater readjust-
ment stress among soldiers serving in
recent conflicts (1) or in previous
ones (2,3).
Many soldiers with a mental health
need do not seek care within the first
year of their readjustment period. An
estimated 23%–44% of returning sol-
diers with PTSD or other mental
health problems receive treatment
within the first year (4,5). Linking re-
turning soldiers who have PTSD with
treatment is a national priority be-
cause effective treatments for PTSD

are available (6,7) and PTSD suffer-
ers who seek treatment experience
symptom relief more quickly than
those who do not (8). Therefore, re-
search is needed to better understand
the process by which returning sol-
diers with PTSD seek treatment.
Readjustment stressors may be a
key motivator for treatment seeking.
Veterans returning from Operation
Enduring Freedom or Operation Iraqi
Freedom (OIF) often seek help for fi-
nancial, occupational, and other read-
justment concerns. A qualitative
study suggested that returning sol-
diers are most likely to seek mental
health treatment when problems
emerge within family and occupa-
tional roles (9). Accordingly, one
study showed that combat veterans
seeking care from the U.S. Depart-
ment of Veterans Affairs (VA) ex-
pressed most interest for services re-
lated to veterans’ benefits (83%) and
schooling, employment, or job train-
ing (80%) (1). Also, at least one study
Readjustment Stressors and Early Mental
Health Treatment Seeking by Returning
National Guard Soldiers With PTSD
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Dr. Interian, Dr. Kline, and Dr. Losonczy are affiliated with the
Department of Psychia-
try, UMDNJ–Robert Wood Johnson Medical School, 671 Hoes
Lane, D306, Piscataway,
NJ 08854-5635 (e-mail: [email protected]). They are also with
the Veterans Af-
fairs New Jersey Healthcare System, Mental Health and
Behavioral Sciences, Lyons, New
Jersey. Ms. Callahan is with the Bloustein Center for Survey
Research, Rutgers Univer-
sity, Piscataway.
Objectives: Readjustment stressors are commonly encountered
by vet-
erans returning from combat operations and may help motivate
treat-
ment seeking for posttraumatic stress disorder (PTSD). The
study ex-
amined rates of readjustment stressors (marital, family, and
employ-
ment) and their relationship to early mental health treatment
seeking
among returning National Guard soldiers with PTSD. Methods:
Partici-
pants were 157 soldiers who were surveyed approximately three
months
after returning from combat operations in Iraq and scored
positive on
the PTSD Checklist (PCL). The survey asked soldiers about
their expe-
rience with nine readjustment stressors as well as their use of
mental
health care in the three months after returning. Results: Many
read-
justment stressors were common in this cohort, and most
soldiers expe-

rienced at least one stressor (72%). Univariate analyses showed
that
readjustment stressors were related to higher rates of treatment
seek-
ing. These findings remained significant after multivariate
analyses ad-
justed for depression and PTSD severity but were no longer
significant
after adjustment for age and marital status. Conclusions:
Readjustment
stressors are common among soldiers returning from duty with
PTSD
and may be more predictive than PTSD symptom levels in
treatment
seeking. These effects appeared to be at least partially
accounted for by
demographic variables and the role of greater familial and
occupation-
al responsibilities among older veterans. Treatment seeking may
be mo-
tivated by social encouragement or social interference and less
by symp-
tom severity. (Psychiatric Services 63:855–861, 2012; doi:
10.1176/appi.
ps.201100337)
has found a positive association be-
tween mental health treatment seek-
ing and readjustment stress (5). How-
ever, because the study examined the
effect of readjustment stressors in a
sample with and without mental dis-
orders, it may be that readjustment
stressors are more common among

veterans with a mental disorder. Less
clear is whether these stressors differ-
entiate PTSD sufferers who go on to
seek treatment from those who do
not.
Therefore, research is needed that
further establishes the role of read-
justment stressors in treatment seek-
ing among PTSD sufferers, especially
given that those suffering from this
disorder may be more likely to be af-
fected by readjustment stress (1).
Such information can be valuable in
policy and program development.
Consistent with this aim, this study
examined the role of readjustment
stress as a predictor of mental health
care seeking among returning sol-
diers with likely PTSD. We hypothe-
sized that readjustment stressors are
significantly related to seeking mental
health care. This study built on the
existing literature by using survey re-
sponses obtained from members of
the New Jersey National Guard
(NJNG) during reintegration events
after a one-year deployment to Iraq.
The survey collected information
from veterans who did and did not
seek mental health care, both within
the Veterans Health Administration
and from community-based provi-
ders. Also, our analyses considered
only veterans who met criteria for
likely PTSD, in order to identify fac-

tors associated with help seeking, giv-
en the need for PTSD treatment.
With this sample, we describe the
prevalence of readjustment stressors,
their relationship to depressive and
PTSD symptoms, and their associa-
tion with early mental health treat-
ment seeking.
Methods
Participants
With support from the New Jersey
Department of Military and Veterans
Affairs, we collected data anony-
mously in September 2009 from
1,665 of 1,723 NJNG soldiers who
were attending postdeployment rein-
tegration events three months after
returning from a 12-month tour in
Iraq. Twenty-nine attendees at the
reintegration did not complete the
survey, and an additional 29 were ex-
cluded because of poor data quality
as judged by three independent
raters, yielding a response rate of
97%. The sample was surveyed as
part of a larger, longitudinal study as-
sessing the mental and physical
health effects of serving in the
NJNG. This study focused on the 179
NJNG soldiers who met criteria,
based on self-report, for PTSD at
three months postdeployment.
Data collection

Anonymous and self-administered
surveys were distributed to all NJNG
members attending the reintegration
events, which were held on four days
over two consecutive weekends. The
surveys were administered to soldiers
in groups of approximately 45–75.
Participation was voluntary, and
NJNG leadership was not aware of
soldiers’ survey completion status.
Soldiers received no monetary incen-
tive for participation. All research
procedures were approved by the
Rutgers University and VA New Jer-
sey Healthcare System Institutional
Review Boards.
Measures
PTSD was assessed with the PTSD
Checklist (PCL), which is a 17-item
self-report scale (10,11). This study
focused on respondents who pro-
duced a positive PTSD score (≥50).
This criterion has been used fre-
quently in PTSD research, including
studies with veterans (11,12), and has
been shown to have adequate sensi-
tivity and specificity with a PTSD di-
agnosis based on a structured psychi-
atric interview (13). We measured
PTSD severity as a continuous vari-
able based on the PCL score.
Depression was assessed with the
commonly used nine-item Patient
Health Questionnaire (PHQ-9) (14)

and analyzed as a continuous variable.
Readjustment stressors were assessed
with a nine-item scale that inquired,
using the following stem, whether a
number of stressors occurred: “Did
any of the following things trouble
you during your deployment to Iraq
or after you returned home?” Items
inquired about marriage, financial,
and family problems. The items for
this measure were developed on the
basis of qualitative interviews that
elicited common readjustment expe-
riences among New Jersey National
Guardsmen. Participants indicated
yes or no to each stressor, yielding a
score of 0–9, with acceptable internal
consistency (Cronbach’s α=.76).
Utilization of mental health care
Questions about mental health serv-
ice use inquired about visits that oc-
curred since returning home (post-
deployment). We first asked whether
participants had a visit with a “men-
tal health professional” for a “mental
health problem.” Respondents were
provided with examples of mental
health professionals, such as psy-
chologists, psychiatrists, social work-
ers, and counselors. Responses were
used to code for any mental health
visit postdeployment. Second, par-
ticipants were asked whether they
received a “doctor’s prescription” for

antidepressants, anxiolytics, mood
stabilizers, or sedatives. A response
of yes concerning any of these med-
ications was used to code “pre-
scribed a psychotropic postdeploy-
ment.” Given that pharmacotherapy
is often provided by non–mental
health physicians (that is, primary
care physicians), we defined any
mental health visit postdeployment
as either having a mental health visit
postdeployment or receiving a pre-
scription for a psychotropic postde-
ployment. This was the study’s key
outcome.
Analyses
All analyses were completed with
SPSS, version 16.0. Because of a 17%
missing value rate for the variables
pertaining to mental health visits, a
missing value analysis assessed
whether the missing values were re-
lated to age, gender, race-ethnicity,
and marital status and produced a
nonsignificant value of Little’s miss-
ing completely at random test. This
signified that the values were missing
randomly, and 22 cases with missing
values therefore were not analyzed.
Analyses first described rates of
mental health visits that had been
September 2012 Vol. 63 No. 9885566

made within three months postde-
ployment. Next, chi square analyses
examined whether demographic vari-
ables were significantly different
among those with or without any
mental health visit postdeployment.
Significant variables were later used
as covariates in the multivariate
analyses. Chi square analyses then
compared whether those having a
visit differed according to individual
readjustment stressors, as well as cat-
egories of cumulative number of
stressors reported. Correlations were
then generated to examine the rela-
tionship between readjustment stres-
sors with the PCL score (Spearman
rho), where PCL scores were catego-
rized into tertiles because of nonnor-
mal score distributions. Also, a Pear-
son correlation was generated be-
tween readjustment stress and PHQ-
9 scores. The final analysis used hier-
archical logistic regression to exam-
ine the association between readjust-
ment stress and any mental health
visit after controlling for the relevant
mental health and demographic
characteristics. The independent
variables were entered into the mod-
el in three blocks. Block 1 included
readjustment stress only. In block 2,
we added the mental health variables

PTSD and depression. Block 3 in-
cluded all of the above variables plus
the statistically significant demo-
graphic variables.
Results
A total of 179 (11%) respondents
scored positive for PTSD, and our
analyses focused on the 157 who did
not have missing utilization data. The
rates for several types of mental
health visits are summarized in Table
1. Rates of treatment contact ranged
from 23% to 36% for the three-
month postdeployment period, de-
pending on the type of contact. Most
visits occurred with a mental health
professional, and the medications
most commonly prescribed were an-
tidepressants and sedatives.
Table 2 summarizes the rates of
having any mental health visit post-
deployment, according to demo-
graphic characteristics. Having a
mental health visit significantly dif-
fered by age and marital status. Pair-
wise comparisons showed that Na-
tional Guard soldiers who had any
were more likely to be married or liv-
ing with a partner (χ2=10.5, df=1, p<
.001) and separated, divorced, or
widowed (χ2=11.5, df=1, p<.001),
compared with those who were sin-

gle. Having a visit was also more like-
ly among soldiers ages 26–39 (χ2=4.1,
df=1, p<.05) and 40–70 (χ2=8.3, df=
1, p<.01), compared with those who
were ages 17–25.
Table 3 shows the relationship be-
tween any mental health visit postde-
ployment and PTSD severity, depres-
sion, and each of the individual read-
justment stressors. First, PTSD
symptom severity was not significant-
ly related to utilization of mental
health services. In contrast, having a
visit was associated with a higher
PHQ-9 depression score (greater de-
pression). Table 3 also shows that sig-
nificant negative life events were not
TTaabbllee 11
Mental health care utilization by 157 National Guard veterans
within three
months postdeploymenta
Care used postdeployment N %
Mental health visit 51 34
Prescribed a psychotropic 41 23
Any mental health visit (for psychotherapy or prescription) 57
36
Type of medication prescribedb

Antidepressant 25 14
Mood stabilizer 9 5
Anxiolytic 13 7
Sedative 29 16
a Some denominators are below 157 because of missing values.
b Soldiers may have received a prescription for more than one
psychotropic.
TTaabbllee 22
Demographic characteristics of 157 National Guard veterans
who did or did not
have a mental health visit within three months postdeploymenta
Any mental health visit postdeployment
No Yes All veterans
Characteristic N % N % N % p
Age .02
17–25 40 40 11 19 51 33
26–39 37 38 24 43 61 40
40–70 21 21 21 38 42 27
Race or ethnicityb
White 36 36 24 42 60 38 .50
Black 28 28 12 22 40 26 .34
Hispanic 27 27 16 28 43 27 .89
Other 9 9 5 9 14 9 .96
Gender .42
Male 77 77 47 83 124 79
Female 23 23 10 18 33 21

Marital status
Married or living as married 32 32 28 50 60 39 <.001
Never married 56 57 14 25 70 45
Divorced, separated, or
widowed 11 11 14 25 25 16
Education .77
High school or less 37 38 18 32 55 36
Some college 44 44 28 50 72 47
Bachelor’s degree or higher 18 18 10 18 28 18
a Some totals are below 157 because of missing values.
b Analyses compared one racial or ethnic group with all others
combined.
uncommon in this group. Events as
serious as job or business loss and
marital separation or divorce were re-
ported by 20% and 26% of the sam-
ple, respectively. Illustrating a cumu-
lative effect, higher levels of these
readjustment stressors were signifi-
cantly associated with having any
(χ2=8.7, df=2, p≤.05) (Figure 1). In
total, most soldiers experienced a
readjustment stressor, with only 28%
experiencing no stressors. Next, re-
sults showed a significant number of
readjustment stressors and a signifi-
cant correlation between them and
PCL score (analyzed in tertile cate-

gories; rs=.21, p≤.05) and PHQ-9
score (r=.26, p≤.001).
Finally, Table 4 presents the results
of multivariate models examining the
prediction of any mental health visit
postdeployment by level of readjust-
ment stressors. Model 1 shows that
National Guard soldiers with the
highest accumulation of readjustment
stressors were more likely to have any
mental health visit postdeployment.
Model 2 adjusted for the effects of
PTSD symptom severity and depres-
sion and found a mostly undimin-
ished, statistically significant effect
for readjustment stressors. This step
shows that depression was also relat-
ed to having a mental health visit.
PTSD severity was not statistically
significant. In model 3, which added
age and marital status variables, read-
justment stressors were no longer sig-
nificant but depression was.
Discussion
Key findings
The findings of this study, showing
relatively low rates of early treatment
seeking among returning soldiers, are
consistent with previous literature
(15). We found that only 34% of Na-
tional Guard veterans who scored
positive for PTSD had made a post-
deployment mental health visit and

that psychotropic medication had
been prescribed to only 23%. The
rates of medication usage in this study
were slightly lower than those report-
ed by Kehle and colleagues (16), in
which 30% of OIF National Guard
soldiers with PTSD received psy-
chotropic treatment. The rate differ-
ences between this study and those
reported by Kehle and colleagues
may be accounted for by the length of
time in which utilization was as-
sessed, which varied across the stud-
ies (three months versus up to six
months, respectively). The 11% of re-
spondents in our sample who scored
positive for PTSD was also compara-
ble with that found in the Kehle and
colleagues study.
Results were mixed in terms of
meeting the treatment needs of OIF
soldiers with PTSD. It is estimated
that 7% of the U.S. population with
PTSD seeks care within the first year
of onset, and our results show that
more OIF National Guard soldiers
were engaging with early mental
health care compared with their civil-
ian counterparts (17). This finding
provides some support for recent
policies, such as five-year access to
Veterans Health Administration care
among soldiers serving in Iraq or
Afghanistan, increased education and
awareness of combat-related stress,

and routine assessment of mental
health conditions (18,19). However,
the treatment utilization rate report-
ed for National Guard soldiers with
PTSD means that approximately two-
thirds were without any early mental
health treatment contact. Thus addi-
tional policies and strategies for
screening and referral should be con-
TTaabbllee 33
Posttraumatic stress disorder (PTSD) symptom severity and
readjustment
stressors among 157 National Guard veterans with and without
any
postdeployment mental health visit
Any mental health visit postdeployment
No Yes All veterans
Readjustment stressor N % N % N %
Marital problemsa 28 30 31 59 59 40
Decision to divorce or separate 20 21 18 34 38 26
Problems with childrenb 15 16 18 34 33 22
Job status worsened 28 29 21 40 49 33
Lost job or businessb 14 15 16 31 30 20
Serious financial problemsb 29 31 27 50 56 38
Problems paying mortgage 12 13 13 25 25 17
Bank began foreclosureb 2 2 6 12 8 6
Family member or loved one became

ill or passed awayb 25 26 23 43 48 32
PCL score (M±SD)c 58.9±8.7 60.6±7.3 59.5±8.2
PHQ-9 depression score (M±SD)b,d 20.6±5.9 23.7±6.4 21.7±6.2
a p<.001 for comparison between soldiers with and without any
b p<.05 for comparison between soldiers with and without any
c PTSD severity was derived from the PTSD Checklist (PCL).
Possible scores range from 17 to 85,
with a score above 50 indicating PTSD.
d Depression score derived from the nine-item Patient Health
Questionnaire. Possible scores range
from 0 to 27, with higher scores indicating greater depression.
FFiigguurree 11
Relationship between readjustment stressors and
postdeployment mental health
visits among 157 National Guard veterans
0
10
20
30
40
50

60
P
e
rc
e
n
ta
g
e
o
f
sa
m
p
le
No visit ≥1 visit
No stressors
1–2 stressors
≥3 stressors
sidered for improving treatment par-
ticipation rates.
In terms of this study’s key objec-
tive, we found that readjustment
stressors played a significant role in

early treatment seeking. Six out of
nine readjustment stressors were in-
dividually associated with having any
mental health visit in the univariate
analyses (Table 3). This effect was cu-
mulative, with higher numbers of
stressors being associated with higher
rates of service utilization. The associ-
ation between readjustment stressors
and mental health service use was in-
dependent of the severity of PTSD or
depression symptoms. As noted, this
relationship diminished considerably
on adjustment for age and marital sta-
tus. Also, depression levels remained
a significant predictor of service use,
even after adjustment for age and
marital status. The finding that de-
pression was a significant variable as-
sociated with help seeking is consis-
tent with previous research (5,20).
The loss of significance of readjust-
ment stress after analyses adjusted for
demographic characteristics is likely
due to our sample characteristics and
the relationship of readjustment
stress with age and with marital sta-
tus. Researchers have suggested that
readjustment stressors may be more
relevant for National Guard soldiers,
who tend to be older and have more
developed familial and occupational
roles than members of the active mil-
itary components (5).

The results of this study, along with
previous research, provide some sup-
port for this interpretation. First, our
sample of National Guard soldiers ap-
peared to be older compared with
samples from active-duty compo-
nents studied by Hoge and colleagues
(15) and others (21). Second, in our
somewhat older sample, individual
readjustment stressors were reported
at high levels, with each often report-
ed by more than 20% of the partici-
pants. For example, 20% had lost
their job or business, which compares
with an unemployment rate of 9.8%
in New Jersey during the period
when these data were collected (Sep-
tember 2009) (22). A similar rate
(28%) of job loss was found in a pre-
vious study with reserve-duty soldiers
with PTSD (23). Third, a previous
study using the same data set found
that readjustment stressors were
more common among National
Guard soldiers who were older and
either married or previously married
(24). Combined with our finding that
readjustment stressors were no
longer significant after analyses ad-
justed for age and marital status,
these observations lend support to
the view that National Guard soldiers
tend to be older and more susceptible
to the type of readjustment stressors

assessed in this study. This is because
they will likely have more involved
family and occupational roles that can
be affected by their symptoms.
Limitations
To interpret the loss of significance of
readjustment stress after adjustment
for demographic variables, one
should consider the types of readjust-
ment stressors captured by our scale.
Its items tap stressors that pertain
more to veterans who are or who have
been married. Note, however, that
the scale used in this study was based
on qualitative interviews with New
Jersey National Guardsmen and was
designed to capture the readjustment
stressors that were most salient to this
sample. Nevertheless, it is important
to interpret these findings in terms of
the specific readjustment stressors
that were assessed (marital problems
and job problems). Unmarried sol-
diers may experience stress in areas
that were not captured in our survey
of readjustment stressors, which
mainly inquired about marital, child,
and occupational difficulties. Future
studies should examine a broader ar-
ray of readjustment stressors to better
sort out their relationship to help
seeking among soldiers varying in age
range and marital status. A recently
published scale may improve our abil-

TTaabbllee 44
Multivariate analysis of predictors of postdeployment mental
health visits among 157 National Guard soldiers
Model 1 Model 2a Model 3b
Measure OR 95% CI OR 95% CI OR 95% CI
Readjustment stress (reference: none)c 1.29∗ ∗ 1.10–1.50
1.24∗ 1.05–1.47 1.17 .98–1.41
Axis I disorder
PTSD symptomsd — — 1.00 .95–1.01 1.00 .95–1.06
Depressive symptomse — — 1.10∗ 1.03–1.05 1.10∗ 1.02 –1.18
Age (reference: 17–25)
26–39 — — — — 2.05 .76–5.54
≥40 — — — — 2.72 .94–7.93
Marital status (reference: married or
living as married)
Never married — — — — .59 .23–1.49
Divorced, separated, or widowed — — — — 1.50 .52–4.36
a Adjusted for effects of posttraumatic stress disorder (PTSD)
severity and depression
b Adjusted for same variables as model 2, plus age and marital
status
c Participants answered yes or no to nine potential stressors.
d PTSD severity was derived from the PTSD Checklist.
e Depression severity was derived from the Patient Health

Questionnaire–9.
∗ p<.05
∗ ∗ p<.01
ity to study this issue, given its broad-
er range of stressors assessed (25).
The significance of readjustment
stressors in the rate of early treatment
seeking has useful implications for
services designed to treat PTSD
among soldiers. PTSD service deliv-
ery models may consider meaningful-
ly integrating interventions that help
with marital and family functioning,
as well as case management support
for addressing financial and occupa-
tional stressors. Also, motivation for
treatment can be built by linking the
goals of treatment to better function-
ing with family and occupation. Given
that PTSD treatment may be charac-
terized by considerable attrition, ad-
dressing these issues may improve
treatment retention rates by aligning
services with key motivators for seek-
ing treatment (20,26). Also, outreach
and awareness efforts can utilize
readjustment stressors as a point of
engagement, which would increase
the numbers of veterans who visit
with a professional and would be
more likely to be screened and re-

ferred to treatment. Future studies
can build on this research by examin-
ing the degree to which returning sol-
diers cite readjustment stressors as
their reason for seeking care. Future
studies can also examine the role that
family members play in encouraging
care seeking.
There are other limitations worth
noting. First, although the use of a
three-month postdeployment win-
dow was advantageous for studying
early treatment contact, it provided a
very limited window for examining
treatment continuity. Second, it is
critical that engagement occur within
a context of optimal treatment quali-
ty. Given the importance of treatment
quality, we caution that our data
could not describe involvement with
empirically supported psychothera-
pies for PTSD or other care quality
indicators, such as wait times (6,7,27).
We also did not have the data to de-
scribe the type of mental health visit
utilized or the type of professional
that was contacted (psychotherapy or
pharmacotherapy background, psy-
chologist, psychiatrist, or informal
source of care). Third, the data lacked
information on the soldiers’ perspec-
tives regarding PTSD and its treat-
ment. Such data are critical for un-
derstanding participants’ own reasons

for seeking care. Thus future studies
should clarify whether soldiers report
readjustment stressors as reasons for
seeking care. Fourth, it is likely that a
portion of soldiers with PTSD symp-
toms at postdeployment will recover
on their own. Our cross-sectional de-
sign did not allow for an estimate of
early mental health care seeking that
accounts for those who may have a
natural recovery (28). Yet it is impor-
tant to note that our PCL cutoff of
≥50 likely identified a cohort of vet-
erans with more severe PTSD symp-
toms that are less likely to naturally
remit. Still, future research can build
on the results of this study by incor-
porating a longitudinal design that
can describe the natural remission
among those who do not seek early
mental health care.
Conclusions
Readjustment stressors among re-
turning National Guard soldiers were
fairly common, with many soldiers re-
porting multiple occupational, finan-
cial, and family stressors. Readjust-
ment stressors generally were associ-
ated with having an early mental
health visit, and these effects ap-
peared to be accounted for by older
age and marital status. Most return-
ing soldiers with PTSD do not seek
early treatment, but rates of having a
mental health visit were more favor-

able in this population than in the
general population.
Acknowledgments and disclosures
This work was supported by a grant from the
New Jersey Department of Military and Veter-
ans Affairs.
The authors report no competing interests.
References
1. Sayer N, Noorbaloochi S, Frazier P, et al:
Reintegration problems and treatment in-
terests among Iraq and Afghanistan com-
bat veterans receiving VA medical care.
Psychiatric Services 61:589–597, 2010
2. Prigerson HG, Maciejewski PK, Rosen-
heck RA: Combat trauma: trauma with
highest risk of delayed onset and unre-
solved posttraumatic stress disorder symp-
toms, unemployment, and abuse among
men. Journal of Nervous and Mental Dis-
ease 189:99–108, 2001
3. Smith MW, Schnurr PP, Rosenheck RA:
Employment outcomes and PTSD symp-
tom severity. Mental Health Services Re-
search 7:89–101, 2005
4. Hoge CW, Castro CA, Messer SC, et al:
Combat duty in Iraq and Afghanistan,
mental health problems, and barriers to

care. New England Journal of Medicine
351:13–22, 2004
5. Kehle SM, Polusny MA, Murdoch M, et al:
Early mental health treatment-seeking
among US National Guard soldiers de-
ployed to Iraq. Journal of Traumatic Stress
23:33–40, 2010
6. Foa EB, Hembree EA, Cahill SP, et al:
Randomized trial of prolonged exposure
for posttraumatic stress disorder with and
without cognitive restructuring: outcome
at academic and community clinics. Jour-
nal of Consulting and Clinical Psychology
73:953–964, 2005
7. Resick PA, Galovski TE, Uhlmansiek
MOB, et al: A randomized clinical trial to
dismantle components of cognitive pro-
cessing therapy for posttraumatic stress
disorder in female victims of interpersonal
violence. Journal of Consulting and Clini-
cal Psychology 76:243–258, 2008
8. Kessler RC, Berglund P, Demler O, et al:
Lifetime prevalence and age-of-onset dis-
tributions of DSM-IV disorders in the Na-
tional Comorbidity Survey Replication.
Archives of General Psychiatry 62:593–
602, 2005
9. Sayer NA, Friedemann-Sanchez G,
Spoont M, et al: A qualitative study of de-
terminants of PTSD treatment initiation in
veterans. Psychiatry: Interpersonal and Bi-

ological Processes 72:238–255, 2009
10. Weathers F, Litz B, Herman D, et al: The
PTSD Checklist (PCL): Reliability, Validi-
ty, and Diagnostic Utility. Presented at the
Annual Convention of the International
Society for Traumatic Stress Studies, San
Antonio, Tex, Oct 1993
11. Blanchard EB, Jones-Alexander J, Buckley
TC, et al: Psychometric properties of the
PTSD checklist (PCL). Behaviour Re-
search and Therapy 34:669–673, 1996
12. The Iowa Persian Gulf Study Group: Self-
reported illness and health status among
Gulf War soldiers: a population-based
study. JAMA 277:238–245, 1997
13. Weathers FW, Litz BT, Keane TM, et al:
The utility of the SCL-90-R for the diag-
nosis of war-zone related posttraumatic
stress disorder. Journal of Traumatic Stress
9:111–128, 1996
14. Kroenke K, Spitzer RL: The PHQ-9: a new
depression diagnostic and severity meas-
ure. Psychiatric Annals 32:1–7, 2002
15. Hoge CW, Castro CA, Messer SC, et al:
Combat duty in Iraq and Afghanistan,
mental health problems, and barriers to
care. New England Journal of Medicine
351:13–22, 2004
16. Kehle SM, Polusny MA, Murdoch M, et al:

Early mental health treatment-seeking
among US National Guard soldiers de-
ployed to Iraq. Journal of Traumatic Stress
23:33–40, 2010
17. Wang PS, Berglund P, Olfson M, et al:
Failure and delay of initial treatment con-
tact after first onset of mental disorders in
the National Comorbidity Survey Replica-
tion. Archives of General Psychiatry
62:603–613, 2005
18. Seal KH, Bertenthal D, Maguen S, et al:
Getting beyond “Don’t Ask; Don’t Tell”: an
evaluation of US Veterans Administration
postdeployment mental health screening
of veterans returning from Iraq and
Afghanistan. American Journal of Public
Health 98:714–720, 2008
19. National Defense Authorization Act of
2008, no HR 4986 (110 Cong 2008)
20. Seal KH, Maguen S, Cohen B, et al: VA
mental health services utilization in Iraq
and Afghanistan veterans in the first year
of receiving new mental health diagnoses.
Journal of Traumatic Stress 23:5–16, 2010
21. Thomas JL, Wilk JE, Riviere LA, et al: The

prevalence of mental health problems and
functional impairment among active com-
ponent and National Guard soldiers 3 and
12 months following combat in Iraq.
Archives of General Psychiatry 67:614–
623, 2010
22. Regional and State Employment and Un-
employment: September 2009. Washing-
ton, DC, Bureau of Labor Statistics, Oct
21, 2009. Available at www.bls.gov/news.
release/archives/laus_10212009.pdf
23. Riviere LA, Kendall-Robbins A, McGurk
D, et al: Coming home may hurt: risk fac-
tors for mental ill health in US reservists
after deployment in Iraq. British Journal of
Psychiatry 198:136–142, 2011
24. Kline A, Ciccone DS, Black C, et al: Suici-
dal ideation among National Guard troops
deployed to Iraq: the association with post-
deployment readjustment problems. Jour-
nal of Nervous and Mental Disease 199:
914–920, 2011
25. Sayer NA, Frazier P, Orazem RJ, et al: Mil-
itary to civilian questionnaire: a measure of
postdeployment community reintegration
difficulty among veterans using Depart-
ment of Veterans Affairs medical care.
Journal of Traumatic Stress 24:660–670,
2011
26. Spoont MR, Hodges J, Murdoch M, et al:

Race and ethnicity as factors in mental
health service use among veterans with
PTSD. Journal of Traumatic Stress 22:
648–653, 2009
27. Monson CM, Schnurr PP, Resick PA, et al:
Cognitive processing therapy for veterans
with military-related posttraumatic stress
disorder. Journal of Consulting and Clini-
cal Psychology 74:898–907, 2006
28. Rothbaum BO, Foa EB, Riggs DS, et al: A
prospective examination of post-traumatic
stress disorder in rape victims. Journal of
Traumatic Stress 5:455–475, 1992
SSuubbmmiissssiioonnss ffoorr DDaattaappooiinnttss
CCoolluummnn IInnvviitteedd
Submissions to the journal’s Datapoints column are invited.
Datapoints encour-
ages the rapid dissemination of relevant and timely findings
related to clinical
and policy issues in psychiatry. National data are preferred.
Areas of interest in-
clude diagnosis and practice patterns, treatment modalities,
treatment sites, pa-
tient characteristics, and payment sources. The analyses should
be straightfor-
ward, so that the figure or figures tell the story. The text should
follow the stan-
dard research format to include a brief introduction, description
of the methods

and data set, description of the results, and comments on the
implications or
meanings of the findings.
Datapoints columns, which have a one-page format, are
typically 350 to 400
words of text with one or two figures. Because of space
constraints, submissions
with multiple authors are discouraged; submissions with more
than four authors
should include justification for additional authors.
Inquiries or submissions should be directed to column editors
Amy M. Kil-
bourne, Ph.D., M.P.H. ([email protected]), or Tami L. Mark,
Ph.D. (tami.
[email protected]).
Reproduced with permission of the copyright owner. Further
reproduction prohibited without
permission.
Running head: EVALUATION OF A QUALITATIVE STUDY
1
EVALUATION OF A QUALITATIVE STUDY
9
Evaluation of a Qualitative Study
First and Last Name
Capella University
Evaluation of a Qualitative Study

For this assignment you will locate an article from the peer-
reviewed scholarly journals in your field using one of the
databases available in the Capella University Library. This
assignment should be between 4 and 6 pages in length, double-
spaced using 12-point Times New Roman font, not counting the
title page and reference section.
You will notice the running head contains the words “evaluation
of a quantitative study” and it is presented in all capitals. Also,
notice that the words “running head” appear only on the first
page and just the running head itself appears on subsequent
pages.
Next, notice that the title on the second page above is centered
and capitalized but it is not in bold. This follows the example
on page 42 of the APA Manual and also a second example found
on page 54. Below you will notice that headings have been
provided for this assignment. They follow the protocols for
formatting level one and two headings found on page 62 and the
example presented on page 58 of the APA Manual. It is sound
practice to consult the APA Manual for formatting guidance.
In the section immediately under the title, you are to provide a
brief introduction to your assignment; however, you should not
create a heading that states “Introduction.” You should present
your introduction without a heading in order to comply with the
guidance offered on page 63 of the APA Manual. Your
introduction should tell the reader what the paper is about, such
as what study is being evaluated and how your evaluation will
proceed. A single brief paragraph is all that is required. You
can find more information about how to develop an introduction
at the Capella Writing Center.
Evaluation of the Research Problem

In most cases the research problem appears early on in a
research report. However, it is not always set off in its own
section with a clear heading identifying it. You may have to do
a bit of detective work to locate the description of the research
problem. In your own words, without using direct quotes,
summarize the research problem.
Evaluating the Significance of the Problem
Address the following questions.
Does the problem statement indicate a counseling issue to
study? You will have to make a judgment call as to whether or
not the research article addresses a counseling issue and explain
why or why not you have taken this position.
Has the author provided evidence that this issue is important?
Briefly describe the evidence presented in the discussion of the
research problem that demonstrates this is an important issue
deserving of being researched. Summarize in your own words,
not direct quotes, the evidence presented and explain your own
view of whether or not this is an important issue.
Evaluation of the Literature Review
Sometimes the literature review is nicely organized and set off
in its own section with thoughtful headings. In other instances,
comments on the literature associated with the research topic
are scattered throughout the research report. Develop your
evaluation of the literature review portion of the article.
Points to think about in your evaluation are how well the
author(s) tell the story of the topic by synthesizing the literature
they have reviewed, and what themes are present in the
literature review. Another point to consider is whether it

appears that the author(s) conducted an unbiased review of the
literature, presenting more than one possible point of view.
Evaluation of Research Purpose Statement and Questions
Qualitative is a broad approach to research, consisting of many
specific research designs. Examples are: grounded theory, case
study, narrative, phenomenological, and ethnographic. Each
research design has been developed to address certain kinds of
research questions. Researchers should explicitly state the name
of their chosen research design, but sometimes they do not.
Likewise, sometimes authors state their purpose statement and
research questions very clearly and sometimes they do not. Use
your growing knowledge to find these elements in the article
you are evaluating. Formal hypotheses are devices that are
used for statistical analyses, so they will probably not appear in
qualitative studies.
Research Design
Name the research design used and briefly, in your own words,
describe how this design is going to address what the
researchers want to know. For example, a phenomenological
design will explore the lived subjective experience of a group of
people who share an experience in common.
Research Purpose Statement
The research purpose statement declares the intent of the study.
An example is: The purpose of the study is to use
phenomenological research to explore the lived experience of
intentionally childfree Hispanic women. Identify the research
purpose statement, and offer your thoughtful opinion on how the
author(s) presented their purpose. If you found the purpose
statement lacking, be specific as to why.

Research Questions
Research questions may be stated as questions or declarative
statements. They have a specific focus. An example is: what
is the lived experience of intentionally and permanently
childfree Hispanic women? Sometimes the research questions
are clearly identified in a research report, other times you have
to look for them, and sometimes they are not presented at all.
Examine your article and list the research questions if they are
presented. Offer your opinion on how well the research
question was developed. There may be more than one research
question. Evaluation of Data Collection Plan
In your own words, without using direct quotes, describe how
participants were selected for this study. Identify the type of
sampling strategy that was used in this research study. It will
probably be explicitly stated in the article, using terms such as
convenience, purposeful or snowball. Explain why you have
taken this position (other than, it says so in the article). Offer
your opinion of how the selection of participants could be
improved in order to produce a stronger study. Go beyond
simply saying the sample could be larger, which would not
demonstrate your growing knowledge of the purpose of specific
sampling strategies. Remember, the purpose of sampling is
different for qualitative studies than it is for quantitative
studies. In qualitative studies, the goal is not to be able to
generalize findings from the sample to the population.
Selection of Participants
In your own words without using direct quotes, describe how
participants were selected for this study. Offer your
assessment of what type of sampling was used in this research
report. Offer your opinion of how the selection of participants

could be improved in order to produce a stronger study.
Gaining Permission
Qualitative research is usually more intrusive than quantitative
research because qualitative researchers typically spend more
time at the research site and engage with the participants more
directly than quantitative researchers. As a result, qualitative
researchers have to be more sensitive and thoughtfully respect
individual participants and research sites. Briefly summarize
how the researchers gained permission to enter the research site
and also how they obtained informed consent from the research
participants to gather data. Offer an evaluation of whether or
not the researchers gained permission according to ethical
standards. If this is not described in the research report, offer a
brief explanation of how you would have gained permission and
consent if you were conducting the research project.
Determining the Data to Collect
In your own words, without using direct quotes, briefly describe
the data that was collected in order to fulfill the study’s purpose
and answer the research questions. The primary forms of data in
qualitative research are observations, interviews and
questionnaires, documents, and audiovisual materials. Which of
these forms of data were collected? Were any other forms of
data collected? Offer an evaluation of the appropriateness of the
data that was collected in order for meeting the study’s goals.
Recording Data
Data recording protocols are usually forms designed by
qualitative researchers to record information during interviews
and observations. Did the researcher(s) describe the protocols
they used? If so, what were they? Offer an evaluation of the
effectiveness of these protocols. If they are not described, what

protocols would you recommend for this study? Evaluation of
Data Analysis and Interpretation Plan
In order to develop this section you may refer to the sections of
the course text which address data analysis and interpretation
for specific qualitative research designs. Most of the data
collected by qualitative researchers involves transcripts of
interviews and field notes. Some kind of coding of the data
takes place. There are many specific procedures for coding and
analyzing the data. Two specific strategies are thematic
analysis and the constant comparative method.
Preparing and Organizing Data for Analysis
In your own words, briefly describe how the researcher(s)
prepared and organized their data for analysis. Offer an
evaluation of the effectiveness of this process. If this is not
described in the research report, explain how you would have
done it.
Exploring and Coding the Data
In your own words, briefly describe how the researcher(s)
explored and coded the data. Offer an evaluation of the
effectiveness of this process. If this is not described in the
research report, explain how you would have done it.
Using Codes to Build Description and Themes
In your own words, briefly describe how the researcher(s) built
description and themes. Offer an evaluation of the effectiveness
of the process. If this is not described in the research report,
explain how you would have done it.Representing and
Reporting Findings

Typically qualitative findings are presented in tables, figures
and narrative. In your own words, briefly describe how the
researcher(s) reported their findings. Offer your opinion of how
effectively you feel their findings were presented and offer
suggestions for improvement.
Interpreting Findings
Qualitative researchers must step back and form larger
meanings about the phenomenon under investigation based on
their personal views, comparisons with past studies described in
the literature, or both. Offer an evaluation of the
meaningfulness of the interpretation provided in the research
report. Briefly summarize the limitations of the study pointed
out by its author(s). If no limitations are offered, present what
you consider to be its limitations.
Validating the Accuracy of the Findings
Typically, qualitative researchers rely on three techniques to
validate their findings: triangulation, member checking, and
external auditing. Briefly summarize how the researchers
validated their findings. Offer an evaluation of the effectiveness
of the process. If they do not describe how this was done,
explain how you would have validated the findings.
Evaluation of Ethical and Culturally Relevant Strategies
Qualitative research typically involves entering the research site
for an extended period of time, and extensively interacting with
participants. Interviews may involve collecting in-depth and
highly personal information. In your opinion, how well did the
researcher(s) address ethical issues? If the research report does
not provide this information, what steps would you have taken
if you were doing the research?
Conclusion

Offer your overall assessment of the quality of the research
report. Explain how you could use the information in the
research report to inform your own work in the counseling
profession. Complete the reference section below using proper
APA formatting.
References
Use this area to list the resources you cited in your paper. The
reference below provides an example citation for an article. For
more information about References, see chapter 7 in the APA
6th Edition Manual. Delete this text before submitting your
assignment.
Author, A. A., Author, B. B., & Author, C. C. (year). Title of
article. Title of Periodical, volume#(issue#), xx–xx.

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