Overview and Introduction to the Deployment Risk and Resilience Inventory-2 (DRRI-2)
Dawne Vogt, PhD, Brian N. Smith, PhD, Brian E. Walker, BA, Lynda A. King, PhD, Daniel W. King, PhD
March 19, 2013
The original Deployment Risk and Resilience Inventory (DRRI; King, King, Vogt, Knight, & Samper, 2006) is a suite of 14 distinct scales that can be used to assess key psychosocial risk and resilience factors with implications for the postdeployment health of servicemembers and veterans. Importantly, the scales that comprise the DRRI are not subscales that are summed to create a total “deployment experience” score; instead, they are distinct measures that address different but related factors that may contribute to postdeployment mental health. The DRRI addresses factors from the deployment period, such as combat exposure and sexual harassment, as well as risk and resilience factors from the predeployment and postdeployment period, such as prior life stress exposure and postdeployment social support, respectively.
Since being introduced to the deployment stress field in 2003, scales from the DRRI have been adopted for use in many studies, and the DRRI is now one of the most widely used instruments for assessing deployment-related risk and resilience factors. As evidence for this, a recent survey of the relevant literature revealed more than 100 peer-reviewed articles that reported using DRRI scales, many of which focused on the newest generation of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans.
Although the DRRI has proven useful to the field, it is well-established that the psychometric quality of measures may decline over time due to changes in the nature of the constructs assessed and the populations under study (Cook & Campbell, 1979). Because the DRRI was initially developed and validated in the context of the first Gulf War and there have been changes in the nature of warfare and the military population since that time, a revision of the DRRI was recently undertaken.
A primary focus of this revision was to update the content and language of items assessing combat and other warfare experiences to ensure their applicability across a variety of deployment circumstances (e.g., different eras of service) and subsets of the military population (e.g., women and men). This revision also involved expanding the coverage of key family-related factors throughout the predeployment, deployment, and postdeployment phases to better reflect the important role that family experiences play in servicemembers’ postdeployment mental health.
Finally, recognizing that the time burden of administering the full set of DRRI scales could be prohibitive to some investigations, an additional aim was to identify the minimum number of items needed to provide adequate construct coverage for each measure, thereby allowing several of the scales to be shortened. The revised set of scales is referred to as the DRRI-2. Table 1 includes a description of DRRI-2 scales.
| Table 1 |
|
| DRRI-2 Scales |
Description |
| Prior Stressors |
Exposure to highly stressful or traumatic events before deployment |
| Childhood Family Functioning |
Quality of family relationships in the family of origin in terms of both communication and closeness |
| Difficult Living and Working Environment |
Exposure to events or circumstances representing repeated or day-to-day irritations and pressures related to life during military deployment |
| Combat Experiences |
Exposure to combat-related circumstances such as firing a weapon, being attacked or fired on, and going on special missions and patrols that involve such experiences |
| Aftermath of Battle |
Exposure to the consequences of warfare, such as observing or handling human remains and interacting with detainees or prisoners of war |
| NBC Exposures |
Endorsed exposure to nuclear, biological, and chemical agents in the war zone, such as disease prophylaxis, environmental and weaponry-related agents
|
| Perceived Threat |
Fear for one's safety and well-being during deployment, especially as a response to potential exposure to circumstances of combat
|
| Preparedness |
Extent to which individuals perceive that they were prepared for deployment in terms of both having needed equipment and supplies and necessary training and preparation
|
| Deployment Support from Family and Friends |
Extent to which individuals perceive that they received emotional sustenance and instrumental assistance from family and friends at home during deployment |
| Unit Social Support |
Extent to which individuals perceive that they received assistance and encouragement from fellow unit members and unit leaders during deployment |
| General Harassment |
Exposure to harassment that is non-sexual but that may occur on the basis of one's biological sex or minority or other social status |
| Sexual Harassment |
Exposure to unwanted sexual contact or verbal conduct of a sexual nature from others during deployment |
| Concerns About Life and Family Disruptions |
Extent to which individuals were concerned that deployment would negatively affect other important life domains, including especially family-related concerns
|
| Family Stressors |
Exposure to stressful family experiences during the time of deployment, such as family adjustment issues, family illnesses and family financial problems
|
| Postdeployment Stressors |
Exposure to stressful life events after the deployment, including both generally stressful events that are unrelated to the deployment and events that may be related to efforts at reintegration
|
| Postdeployment Social Support |
The extent to which family, friends, and the community provide emotional sustenance and instrumental assistance after deployment
|
| Postdeployment Family Functioning |
Quality of postdeployment family relationships in terms of communication and closeness |
The DRRI-2 is the result of a multi-year psychometric endeavor that involved the application of both classical test theory (CTT) and item response theory (IRT) analytical strategies. This project included three key phases. Phase I began with an initial assessment of the content validity of DRRI scales based on a comprehensive literature review and focus groups with OEF/OIF veterans. These groups included both men and women, veterans deployed from active duty and National Guard/Reserves, and representation from all branches of service. Based on this information, several new scales were then constructed to address newly identified content domains, and new items were developed to more comprehensively represent content domains addressed within existing scales. In addition, items that were deemed to be less pertinent to contemporary veterans (e.g., items highly specific to the first Gulf War) were eliminated or rewritten to be more broadly relevant across veteran cohorts.
In Phase II, both original and revised DRRI items were administered to a national sample of 469 male and female OEF/OIF veterans using a mail survey procedure. The primary aim of this phase of the project was to examine initial item and scale characteristics for new and modified DRRI scales and revise scales based on these results. Overall, findings supported the psychometric quality of the proposed DRRI-2 scales that resulted from this process. Specifically, evidence was provided for the internal consistency reliability of updated DRRI scales and expected associations were observed between these scales and a measure of PTSD symptom severity, providing support for criterion-related validity. However, IRT analyses pointed to the need for further revision to better capture the full construct continuum for several measures.
Phase III involved administering a revised set of scales to a second national sample of 1,046 male and female OEF/OIF veterans using the same mail survey procedure. Both CTT and IRT analyses were used to identify final items sets. A systematic evaluation of the psychometric quality of the final DRRI-2 scales (14 revised scales and 3 new scales) suggested that the revisions improved upon the inventory. Specifically, CTT analyses confirmed that the scales have high internal consistency reliability and the finalized scales showed moderate to strong bivariate associations with PTSD symptom severity, which were slightly larger, on average, than that observed for the original DRRI. In addition, an examination of incremental validity revealed that the new DRRI-2 scales added unique variance in the prediction of PTSD symptom severity above and beyond existing DRRI-2 scales, indicating that the inclusion of these measures provide for a more comprehensive assessment of deployment-related risk and resilience. Finally, as compared to the original DRRI scales, the DRRI-2 scales are 15% shorter, on average.
In summary, the DRRI-2 represents a psychometrically sound, yet efficient, suite of scales that can be used to capture predeployment, deployment, and postdeployment risk and resilience factors with implications for the postdeployment mental health and functioning of servicemembers and veterans. It is our hope that these measures will be used to further knowledge of the role that these factors play in postdeployment health and inform interventions aimed at reducing risk and enhancing resilience within these populations. Information on how to obtain DRRI-2 scales is available at http://www.ptsd.va.gov/professional/pages/assessments/list-drri-measures.asp.
About the Authors
Dawne Vogt, PhD, is a doctoral level research psychologist in the Women’s Health Sciences Division of the National Center for Posttraumatic Stress Disorder (PTSD) at VA Boston Healthcare System, and associate professor in the Division of psychiatry at Boston University School of Medicine. Her primary research interests are in risk and resilience factors for PTSD, gender differences in deployment stress and postdeployment mental health, and mental health stigma and other barriers to mental health treatment.
Brian Smith, PhD, is a doctoral level research psychologist in the Women’s Health Sciences Division of the National Center for PTSD at VA Boston Healthcare System, and assistant professor of psychiatry at Boston University School of Medicine. His program of research generally involves examining the social context of health-related behaviors, mechanisms and outcomes. He is particularly interested in the study of psychosocial factors associated with both psychological and physical reactions to stress, including the role of modifiable risk and resilience factors in the context of traumatic stress exposure.
Brian E. Walker, BA, is a bachelor’s level psychology research assistant for the Women’s Health Sciences Division in the National Center for PTSD. He obtained his bachelor’s degree from the State University of New York at New Paltz in New Paltz, NY.
Lynda A. King, PhD, is a research psychologist affiliated with the National Center for PTSD, VA Boston Healthcare System, and a Research Professor of Psychiatry and Psychology at Boston University. Her research focuses on psychometric theory and techniques, consequences of early adulthood trauma through the lifespan, and sex differences and gender-role attitudes within the context of violence and stress reactions.
Daniel W. King, PhD, is a quantitative psychologist affiliated with the National Center for PTSD, VA Boston Healthcare System, and a research professor of psychiatry and psychology at Boston University. His interests include the study of risk and protective factors for PTSD and related conditions, measurement issues in trauma research, and the analysis of longitudinal data.
References
Cook, T.D., & Campbell, D.T. (1979). Quasi-experimentation: Design and analysis issues for field settings. Chicago, IL: Rand McNally.
King, L.A., King, D.W., Vogt, D.S., Knight, J., & Samper, R.E. (2006). Deployment Risk and Resilience Inventory: A collection of measures for studying deployment-related experiences of military personnel and veterans. Military Psychology, 18, 89-120.