[Formula: see text]Interpreting change on the neurobehavioral symptom inventory and the PTSD checklist in military personnel.
The purpose of this study was to examine the prevalence and stability of symptom reporting in a healthy military sample and to develop reliable change indices for two commonly used self-report measures in the military health care system.



Participants were 215 U.S. active duty service members recruited from Fort Bragg, NC as normal controls as part of a larger study. Participants completed the Neurobehavioral Symptom Inventory (NSI) and Posttraumatic Checklist (PCL) twice, separated by approximately 30 days.



Depending on the endorsement level used (i.e. ratings of 'mild' or greater vs. ratings of 'moderate' or greater), approximately 2-15% of this sample met DSM-IV symptom criteria for Postconcussional Disorder across time points, while 1-6% met DSM-IV symptom criteria for Posttraumatic Stress Disorder. Effect sizes for change from Time 1 to Time 2 on individual symptoms were small (Cohen's d = .01 to .13). The test-retest reliability for the NSI total score was r = .78 and the PCL score was r = .70. An eight-point change in symptom reporting represented reliable change on the NSI total score, with a seven-point change needed on the PCL.



Postconcussion-like symptoms are not unique to mild TBI and are commonly reported in a healthy soldier sample. It is important for clinicians to use normative data when evaluating a service member or veteran and when evaluating the likelihood that a change in symptom reporting is reliable and clinically meaningful.
a Department of Mental Health and Behavioral Sciences , James A. Haley VAMC , Tampa , FL , USA.|b Department of Psychiatry & Behavioral Neurosciences , University of South Florida , Tampa , FL , USA.|c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.
Heather G
HG
Belanger
c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.|d National Intrepid Center of Excellence , Bethesda , MD , USA.|e Walter Reed National Military Medical Center , Bethesda , MD , USA.|f University of British Columbia , Vancouver , Canada.
Rael T
RT
Lange
c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.|g Naval Hospital , Camp Pendleton , CA , USA.
Jason
J
Bailie
c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.|h Harvard Medical School , Boston , MA , USA.|i Spaulding Rehabilitation Hospital , Charlestown , MA , USA.|j Red Sox Foundation and Massachusetts General Hospital Home Base Program , Boston , MA , USA.
Grant L
GL
Iverson
c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.|k Womack Army Medical Center , Fort Bragg , NC , USA.
Jacques P
JP
Arrieux
c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.
Brian J
BJ
Ivins
c Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.|k Womack Army Medical Center , Fort Bragg , NC , USA.
Wesley R
WR
Cole
D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D057189:Checklist / Q000379:methods / Q000639:trends*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015203:Reproducibility of Results; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*
PTSD; Traumatic brain injury; concussion; mild TBI; military; reliable change