Naval Submarine Medical Research Laboratory

NSMRL REPORT 1193 16 October 1993

J

PSYCHIATRIC SCREENING FOR THE SUBMARINE SERVICE:

ENLISTED PERSONNEL

C. L. Schlichting

Released by:

P. K. Weathersby, CAPT, MSC, USN

Commanding Officer

Naval Submarine Medical Research Laboratory

19950210 016

Approved for public release; distribution unlimited
4

PSYCHIATRIC SCREENING FOR THE SUBMARINE SERVICE:

ENLISTED PERSONNEL

Christine L. Schlichting

Naval Submarine Medical Research Laboratory

Report 1193

NAVSEA Work Request

N0002493WR01142

Naval Medical Research and Development Command

Research Work Unit - 5306

Approved and released by

P. K. Weathersby, CAPT, MSC, USN

Commanding Officer

NavSubMedRschLab

tfl "v^

S-*

:&%:=

tf& *

Approved for public release; distribution unlimited
SUMMARY PAGE

THE PROBLEM

Psychiatric care is not available onboard submarines. In the stressful environment of a

submarine on patrol, it is important that the mental health of the crew be of the highest level.

Psychiatric screening for submarine service is, therefore, required.

THE FINDINGS

The Subscreen test for psychiatric screening of enlisted prospective submariners successfully

identifies approximately 75% of psychiatric drops from Basic Enlisted Submarine School

(BESS). Further research is needed to refine the test and to test its effectiveness for prediction

beyond BESS.

THE APPLICATION

Improved psychiatric screening for the submarine service.

ADMINISTRATIVE INFORMATION *

This investigation was conducted under Naval Medical Research and Development Command >

Research Work Unit 5306, NAVSEA Work Request N0002493WR01142, "Subscreen." The " *

views expressed in this report are those of the authors and do not reflect the official policy or

position of the Department of the Navy, Department of Defense, or the U.S. government. This

report was approved for publication on 16 Oct 1993 and designated Naval Submarine Medical

Research Report 1193.

u
ABSTRACT

A brief overview of 25 years of psychiatric screening of enlisted service members for submarine service in the United States Navy is presented. Current screening consists of administration

of a submarine specific test, Subscreen, to all prospective Basic Enlisted Submarine School

(BESS) candidates. Figures from 1991 and 1992 show that approximately 9.7% of these candidates are referred for more extensive testing at the Psychiatry Department of the Naval Hospital

Groton. Less that two percent of all candidates are subsequently dropped from Bess. Two measures of test performance, sensitivity (the ability of a test to yield a positive finding when the individual tested actually has the condition being tested for) and specificity (the ability of a test to

yield a negative finding when the individual tested does not have the condition) were studied.

Both sensitivity (75%) and specificity (92%) were very good for Subscreen, especially compared

to a test the USAF administers for similar purposes. Although some small changes will improve

test performance, in general, Subscreen remains an effective tool for screening for Submarine

Service.

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IV
PSYCHIATRIC SCREENING FOR THE SUBMARINE SERVICE:

ENLISTED PERSONNEL

History of subscreen

A submarine on patrol is a closed environment with limited access to the outside world

for prolonged periods. Onboard medical care

is available to treat most mild to moderate

medical conditions. Psychiatric care is, however, not available. In the sometimes stressful

environment of an operating submarine, it is

important that the mental health of both prospective and actual submariners be of the highest levels (Weybrew and Noddin, 1979).

Psychiatric screening for submarine service

was, therefore, instituted early in the development of the submarine service.

The early history ofscreening for submarine

duty has been described by Weybrew and

Youniss (1959). In the 1940s testing consisted of the Shock Fusion Time Test, New

London NDRC Confidential Questionnaire,

the NRC Neurotic Inventory and the Personal

Inventory (NDRC Project 44, Div. 7,1943).

The first three of these were eliminated due to

length of presentation, lack of specificity or

low reliability. The Personal Inventory

showed low discriminability between normal

and "unsuitable" individuals (Weybrew and

Youniss, 1959; Weybrew, 1959). Weybrew

and Youniss, therefore, developed the Personal Inventory Barometer (PIB) as a psychiatric screening tool (Weybrew and Youniss,

1959; Weybrew, 1959). This test used all of

the questions from the Taylor Manifest Anxiety Scale (Taylor, 1953), but changed the response format to multiple choice rather than

True-False responding. Additional questions

were added to assess internal validity, attitudes toward submarine life and duty, motivation, suicide ideation, and depression.

The Personal Inventory Barometer became

the single psychiatric screening tool used at

the U.S. Naval Submarine School for submarine candidates (Weybrew and Noddin, 1969).

The PIB, virtually unchanged, was given to

all Basic Enlisted Submarine School (BESS)

students for approximately 25 years. Demographics, ethical, and social characteristics of

society are always in a process of change.

Definitions of psychological health also have

changed over the last quarter century. In the

early 1980's it was recognized that, due to its

age, the PIB might no longer be a valid measure of psychological adjustment in incoming

students. Work began to develop a new

screening test At the same time, an analysis

of causes for premature loss of non-nuclear

trained individuals from submarine service

was also undertaken (Bryant, 1986). This

study showed that early losses were related to

problems in BESS, middle losses were related

to behavioral and psychological problems during deployment and later losses (greater than

3 years service) were related to misconduct.

Motivation was not considered.

Bryant and Noddin developed a test that came

to be known as Subscreen. Subscreen currently incorporates sixty percent of the questions from the original PIB but also includes

additional questions from the literature on

stress and adjustment and questions developed after consultation with BESS instructors

and psychologists at the Naval Hospital Psychiatric Clinic. Subscreen and the PIB were

administered simultaneously for several

BESS classes. After this testing showed that

both tests recommended the same people for

further psychiatric evaluation and were therefore redundant, use ofthe PIB was discontinued. Test-retest reliability for the PIB was .80

(Weybrew and Youniss, 1959); test-retest reliability measures for Subscreen are unavailable. One reason for reviewing the

development and testing of Subscreen is that
most of this work has been undocumented or

unpublished. In the text that follows, the

original sources of information are included

and noted as unpublished.

Subscreen is given to all BESS students the

first week they are at Submarine School. It

takes approximately one hour to administer to

the students. It is used to screen individuals

for psychiatric problems that would preclude

successful service in the submarine force. Students whose scores are above established limits are referred to the Psychiatry Department

of the Naval Hospital Groton for psychiatric

evaluation. Approximately nine percent of

the students are referred. Following this

evaluation the psychologist gives a recommendation to the Medical Department of the Submarine School. BESS 1992 summary records

show that individuals may be recommended

for return to BESS (75%), transfer to surface

fleet (9.1%), or discharge (15.9%) from the

Navy.

THE SUBSCREEN TEST

Subscreen contains 240 items scored on 5

scales comprised of 28 independent subscales

and procedural scores. Items that are highly

correlated and assess particular aspects of

functioning, such as affect or socialization

comprise a scale. The scales and subscales are

listed in Appendix A.

The individual items are scored with five response categories. Four points are assigned

for strongly agree, 3 for agree, 2 for disagree

and 1 for strongly disagree. Questions that

are worded in a negative manner are reverse

scored. Neutral responses are evaluated separately. As of 1992, all scores for an individual are converted to Z scores based on

population means and standard deviations

from approximately 6000 BESS students.

Prior to that date, Z scores were based on

means and standard deviations from approximately 800 BESS students tested in 1986. A

Z score is a measure of how far an individual

score deviates from the average answer.

The scoring also includes further information

concerning unusual response profiles, missing

responses and indicates individuals who respond in the affirmative to questions relating

to suicide and negative attitudes toward use of

nuclear weapons. Two other scores measure

how an individual describes himself. One,

"Good Impression", contains items typically

endorsed by someone trying to impress others. The other, "Distortion", a lie score, is

also included on the scoring protocol. Factor

scores are derived for Vulnerability, Motivation, Depression-suicide, Efficacy (competence), Manipulation and Social Isolation.

These factors are also listed in Appendix A.

The "Z" attached to each subscale score used

in these factors indicates the individual's Z

score used in the calculation.

Until early 1994, referrals to the Psychiatric

Clinic were determined by a single individual

(Mr. Noddin) with considerable experience in

this area. In his absence, all Subscreen results

were sent to the Psychiatric Clinic where a

clinical psychologist reviews them. Heaton

(unpublished, 1991) investigated whether a

personal computer based expert system could

be developed to follow the same rules that

were used by Mr. Noddin to decide which

cases to refer. She was able to develop a set

of 31 rules which could reproduce referrals

with a high degree of both sensitivity (98.9%)

and specificity (96.8%). These rules are applied to the answers to two questions, the Z

scores of 15 subscales and the percentage of

missing and neutral responses. None ofthe

submarine specific motivation subscales were

used as a basis for referral by the screening

psychologist and none are included in the expert system. The rules developed by Heaton

are the current basis for referral by the

NSMRL tester. A computer decision algo-
rithm has not been implemented in the scoring

routine. An on-going NSMRL project is comparing an expert system to a neural nets approach for determining referrals.

The Psychiatry Department at the Naval Hospital Groton considered using the Minnesota

Multiphasic Personality Inventory (MMPI) or

another commercial test (J. Wallace, personnel communication, 1992) and is satisfied

with Subscreen as a screening test. Interview

of the clinical psychologist at the Psychiatry

Department revealed that using standard scoring protocols the MMPI yielded "too high" a

rate of referrals to the department and also

took much longer to administer (2-3 hours)

than Subscreen. A revision of the original

MMPI, the MMPI-2, is currently used at the

Psychiatry Department as a clinical instrument to provide further information to the clinician on referred individuals. The MMPI

has also been found by the Canadian Forces

to be inappropriate as an assessment tool for

psychological fitness of applicants for Canadian Submarine service (Okros, 1989) for the

same reasons. The same conclusion was

reached by the US Air Force (Bloom, 1983).

While use of revised norms would reduce the

number referred, it would still take longer to

administer and score the tests. Other established tests such as the California Psychological Inventory, Taylor Manifest Anxiety Test

and the Gordon Personal Profile have not

been tested for this specific use. The Air

Force and the Navy are currently using the

NEO-Personality Test Five Factor Inventory

(Crawford and Fiedler, 1991) as the second

step of basic recruit screening. Another important consideration is that the MMPI-2 and

other commercial tests do not address either

Navy or submarine specific motivation issues.

Reliability of subscreen subscales

Katz and Rexer (unpublished, 1990) assembled a data set of approximately 6000 men

who took Subscreen at BESS between June

1986 and February 1990. The internal consistency of the subscales was assessed. New

means and standard deviations for the

subscales were also calculated. The reliability

of subscales is measured by performing an

item analysis on the components of the

subscale. This analysis determines to what degree the items that make up a subscale are related (correlated). Cronbach's alpha,

equivalent to the average split-half correlation, was used as the measure ofreliability of

the subscales (Cronbach, 1951). Alpha scores

can range from 0 to 1.0. The higher the number the greater the reliability. Table 1 shows

the mean, standard deviations, number of

questions in the subscale and the alpha statistics for each subscale.

These data show that most of the subscales

have reasonably high reliability (over .70).

Only three subscales, Uncertain about Submarines (UNS), Problems Submarine School

(PSS), and Self-Criticism (SCR), showed low

reliability. One subscale, Coercive Attitudes

(COE), showed a large number of failures to

respond. Five other subscales showed problems with one or two items. These were Unconditional Acceptance of Submarines (UCS),

Social Isolate (SOI), Impulsive (IMP), Dependency (DEPND), and Competency

(COM). Katz and Rexer conclude these could

all be improved by deletion or modification of

these problem items. This process would increase the reliability of the associated

subscales and not affect the overall utility of

Subscreen.

Katz and Rexer (unpublished, 1990) also

found differences between the means and

standard deviations for subscales obtained for

the original 1986 sample and for the larger

sample they used. Ten of the subscales

showed response patterns that suggested that

the original scoring program should be revised. The Z scores for each subscale were
calculated using the original means and standard deviations. Ifthe original values were

still accurate the mean Z scores for each

subscale for the new sample should be zero.

Rather small departures were found for some

subscales while considerably larger changes

were found for others. Departures from a Z

equal to zero were found for Impulsive (IMP)

(.144), Social Isolate (SOI) (.056), Nervous or

Worrying (ANX) (.054), Unusual Thoughts

(BTH) (-.062), Claustrophobic Feelings

(CLA) (-.063), Uncertainty About Subs

Table 1

Reliabilityfor Subscreen Subscales

No. of Alpha

Subscale Mean (M) SD Questions Reliability

Procedural

Distortion 23.34 3.0 8 .71

Good Impression 38.8 3.7 12 .79

Submarine Specific Motivation

Mistake Joining Subs 13.9 3.5 8 .80

Uncertain About Subs* 14.2 2.4 6 .46

Conditional Acceptance Subs 9.6 2.4 5 .72

Unconditional Acceptance Subs*** 24.7 3.5 8

4

6

.76

Problems Submerging 7.9 1.8 .67

Problems Submarine School* 14.4 1.6 -.01

Affective

Physical Well Being 15.0 9.2 9 .73

Low Situational Control 21.5 3.8 10 .76

Nervous or Worrying 24.6 4.0 11 .77

Depressed Mood 16.1 3.9 9 .86

Socialization

Coercive Attitudes** 28.6 4.1 14 .72

Aggressive/Destructive 17.11 3.2 9 .73

Problems Home/School 20.8 4.2 11 .76

Social Isolate*** 25.3 3.7 12 .63

Impulsive*** 27.7 3.8 12

9

.65

Social Support 28.1 3.3 .68

Additional

Unusual Thoughts 15.5 3.0 8 .73

Unusual Physical Complaints 9.6 2.2 6 .77

Suicidal Thoughts 9.1 2.4 6 .78

Claustrophobic Feelings 11.5 2.3 6

6

4 H

.74

Problems Nuclear 10.1 2.5 .63

Dependency*** 25.7 3.6 11

9

7

.67

Self-Criticism* 21.6 2.3 .14

Competency*** 21.6 2.4 .60

* Subscales with low reliability

** Subscale with failures to respond

*** Problems with one ortwo specific questions used in subscale
(UNS) (.398), Problems Nuclear (NUC)

(.071), Problems Submarine School (PSS)

(.384), Dependency (DEPND) (-.063), and

Self-Criticism (SCR) (-.134). The new means

and standard deviations were incorporated

into the scoring program currently in use in

1992.

Subscreen and Psych Drops

Overall Performance

The majority of submarine candidates volunteer for submarine service either at the time

they are recruited or following completion of

Basic Recruit Training. Volunteers are also

accepted from other segments of the Navy.

Most BESS students, therefore, are younger

than 20 years of age and in the lowest three

military paygrades. Losses from BESS occur

due to psychiatric disqualification and for

medical, academic and motivational reasons.

Subscreen was developed to screen BESS students for motivational, affective and social

problems that would preclude successful service in the submarine force. Although the test

was developed with numerous scales, some of

these scales (motivation) are not used in the

decision process. Only three scales and a few

additional items on Subscreen are currently

used by NSMRL to refer students to the Psychiatric Department. These scales are composed of questions that measure affect and

socialization. Subscales that measure unusual

thoughts (bizarre cognition), unusual physical

complaints, and claustrophobia are also used.

These are listed under additional subscales in

Appendix A. Positive answers to questions

concerning suicide and negative feelings

about serving in a force with nuclear weapons

are also immediate grounds for referral. Although part of the scoring protocol includes

factor scores with the weights as determined

by multiple regression analysis, these are not

currently used in the decision process for referral.

Figure 1 shows the results of the multiple regression analysis performed by Katz and

Rexer (1990) to predict psychiatric drop

status from BESS in a cohort of approximately 650 of the more recent cases from the

same file used to analyze the reliability of the

subscales. The coefficient of determination,

BESS PSYCH DROP = 0 - NORMAL

1-PSYCH DROP

AFFECTTVE VARTABLE SCORE r

L

= .128 df= 484

PSYCH DROP = .029 + .031 (PWL) + .028 (SUI) + .014 (LOC) - .015 (BTH)

MOTIVATION VARTABLE SCORE r

2

= .146 d/=486

PSYCH DROP = .033 - .031 (UCS) + .022 (NUC) + .025 (MJS)

SOPTATIZATTON SCORE r

2

= .074 #=501

PSYCH DROP = .029 + .027 (PHS) + .024 (SOI)

Figure 1. Multiple regression to predict BESS psych drops (Katz and Rexer, 1990).
r

2

, ranges from 0 to 1.0. It is close to 1.0 if

the variables in the variable set are good predictors of psychiatric drop status. The Affective, Motivation and Socialization results for

Subscreen are shown. These A reflect the

criteria used to refer individuals for evaluation. Because the affective and socialization

scores are primarily used for these referrals

they show the highest predictive values; because motivational scores are not used as a basis for referral, they show the lowest. These

results should be looked at somewhat critically as only 13 psychiatric drops were included in the analysis. As would be expected

the r

2

are low under these circumstances.

the individual does not have the condition.

Different screening levels or cutoff scores for

what is considered a positive finding can be

developed depending on the relative importance of detecting the condition and falsely declaring the condition. Positive predictive

value of a test is the probability that a person

who has a positive test has the condition.

Prevalence of the condition in the population

affects positive predictive value. Negative

predictive value is the probability that a person who has a negative test does not have the

condition. Appendix B contains a more complete description ofthese measures and their

calculation.

The Naval Submarine Medical Research Laboratory (Schlichting and Noddin, unpublished,

1992) recently evaluated all psychiatric drops

from BESS for FY91 and FY92. A total of

3360 students were screened using Subscreen

inFY91;2166inFY92. Slightly less than

10% were referred to the Psychiatry Department for evaluation; 1.7% of the total 5526

were dropped through the use of Subscreen.

An additional .6% were dropped through

other referrals. Subscreen referrals constitute

75% ofthe psychiatric drops from BESS for

the two years. Comparable figures for AFMET, the Air Force Screening program, show

that only 22% of the Psychiatric drops during

the first six weeks of USAF training were

identified by their testing protocol (Crawford

and Fiedler, 1991; E. Fiedler personal communication, 1992). The final percentage ofrecruits dropped for psychiatric reasons is much

lower, .4%, for Air Force basic training versus 2.3% for Submarine School students.

To evaluate screening tests one can compute

several measures oftest performance (Woolson, 1987). Sensitivity is the ability of a test

to yield a positive finding when the individual

tested actually has the condition for which he

or she is being tested. Specificity is the ability ofthe test to yield a negative finding when

The combined Subscreen data for FY91 and

FY92 described above showed a sensitivity of

75%, a specificity of 92%, a positive predictive value of 17.4%, and a negative predictive

value of 99.4%. Comparable AFMET data

for the period 1975 to 1982 for Air Force basic recruits shows a sensitivity of 22%, specificity of 98.9%, a positive predictive value of

26.9% and a negative predictive value of

98.9%. While Subscreen is better at identifying people with psychiatric problems, AFMET is better at identifying people who do

not have a psychiatric problem.

Internal Performance

Analysis of variance was performed on each

Subscreen subscale and factor for the FY91 results to determine whether there were significant differences among all the actual

Psychiatric drops identified by Subscreen

(n=55), a random sample of the individuals referred by Subscreen who were not dropped

for psychiatric reasons (n=101), all those

dropped for psychiatric reasons who were not

referred by Subscreen (n=21), and a random

sample of those who were not referred by Subscreen and not dropped for psychiatric reasons (n=142).
Table 2.

Univariate E-Tests with (3^15) Degrees ofFreedom

VARIABLE £

AGE .41 .74

EDUCATION 2.63 .05

PROFILE 20.03 .001

NEUTRAL% 5.90 .001

MISSING% .34 .79

PROB 49.70 .001

Procedural

Distortion 19.35 .001

Good Impression 16.53 .001

Classification 46.24 .001

Extreme Scores .22 .88

Submarine Specific Motivation

Mistake Joining Subs 62.44 .001

Uncertain About Subs 67.42 .001

Conditional Acceptance Subs 7.6 .001

Unconditional Acceptance Subs 64.89 .001

Problems Submerging 54.42 .001

Problems Submarine School 21.42 .001

Affective

Physical Well Being 43.39 .001

Low Situational Control 72.36 .001

Nervous or Worrying 53.08 .001

Depressed Mood 68.18 .001

Socialization

Coercive Attitudes 29.27 .001

Aggressive/Destructive 31.97 .001

Problems Home/School 57.8 .001

Social Isolate 29.65 .001

Impulsive 32.29 .001

Social Support 24.27 .001

Additional

Unusual Thoughts 58.46 .001

Unusual Physical Complaints 31.31 .001

Suicidal Thoughts 65.74 .001

Claustrophobic Feelings 45.78 .001

Problems Nuclear 26.88 .007

Dependency 19.13 .001

Self-Criticism 24.13 .001

FACTORS

Vulnerability 77.53 .001

Negative Motivation 92.86 .001

Depression/Suicide 59.24 .001

Competence 13.35 .001

Manipulation 32.61 .001

Isolation/Social Support 40.51 .001
Table 3.

Subscreen Z Scores.

Subscreen

Psych Drop

Yes

Yes

No

Yes

Yes

No

No

No

Scale

Procedural

Classification

Extreme Scores

Distortion (Lie)

Good Impression

3.13*

.12

-.94*

-1.18*

.36

-.03

.37

.09

.73**

.06

-.50*

-.46**

.00

.01

.16

.02

Submarine Specific Motivation

Mistake Joining Subs

Uncertain About Subs

Conditional Submarine

Uncond. Submarine/Pro SubSchool

Problems Submerging

2.68*

2.02*

2.28*

-2.21*

1.18*

.41

.47

.79

.42

.62

.67**

.97*

.58

-.45**

.54

-.04

.15

.30

.19

.17

Affective

Physical Well-being

Low Situational Contro

Nervous or Anxious

Depressed Mood

1.67*

1.79*

1.43*

1.91*

-.28

.06*

.04

.14

.39

1.02*

.93*

.97*

-.17

-.21

-.21

-.24

Socialization

Coercive Attitudes

Aggressive/Destructive

Problem Home or School

Social Isolate

Impulsive

Social Support

1.30**

1.13**

1.50*

1.07**

1.03**

-1.15**

-.03

-.01

.14

0

.10

.11

94**

!83**

1.00*

.85**

.96**

-.83**

-.1

.27

-.15

-.20

-.10

.12

Additional

Unusual Thoughts

Unusual Physical Complaints

Suicide

Claustrophobia

Problems with Nuclear

Dependency

Self-criticism

1.46*

1.56*

2.13*

1.78*

1.80*

.84**

.01

-.11

.43

.12

.20

.32

.00

-.17

.84*

.52

1.01*

.58

.58

.61**

.65*

-.30

-.05

-.25

-.23

.08

-.28

-.35

* Group differs from all others at p < .05

** Group differs from No/Yes and No/No at p<.05

The groups did not differ in age, education,

number of neutral responses, number of extreme scores or number of missing responses.

For all other subscales and factors there were

statistically significant differences across the

groups at the p < .007 or better level. These

results are shown in Table 2.

Post hoc Newman Keuls tests showed that for

most subscales the group that was referred
and dropped differed from both other groups

that were not referred. The single exception

was the self criticism (SCR) subscale. The

group that was referred and dropped did not

differ from the group that was referred but not

dropped, on most of the Socialization

subscales and on the dependency subscale of

the Additional Scale. This is not surprising

because these subscales are used as the basis

of the referral decision. The two referred

groups did differ on the all other subscales.

Table 3 shows the results of all scales and

subscales. Table 4 shows the results for the

six factors. As noted above, Appendix A contains descriptions of each of the subscales. In

each table, data are shown for the group that

was referred by Subscreen and dropped for

psychiatric reasons (yes/yes), the group that

was not referred and was dropped for psychiatric reasons (no/yes), the group that was referred and not dropped (yes/no), and a group

that was not referred and not dropped. A single asterisk is used to denote a group that differed significantly from all three other groups.

A double asterisk is used to denote referred

groups that differed only from the two groups

that were not referred. For most subscales

there appears to a hierarchy of scores. The

group that was referred and dropped shows

the largest Z scores (that is, they are the "most

abnormal"); the group that was referred but

not dropped shows intermediate Z scores. The

groups that were not referred show the smallest Z scores and do not differ from each other.

The results of the analysis of variance reported above suggest that a set of discriminating variables could be developed that would

more accurately determine which individuals

should be referred to the Psychiatric Clinic for

evaluation. A discriminant analysis (WILKS

method) was performed to determine if there

was a linear combination of subscale, demographic and factor scores that could discriminate between individuals who were referred

and dropped and those who were referred and

Table 4

Factor and other scoresfor SUBSCREEN

SUBSCREEN

FACTORS

Subscreen Yes No Yes No

Psych Drop Yes Yes No No

Vulnerability 1.54* -.14 .94* -.37

Motivation 2.70* .26 .72* -.22

Depression/Suicide 2.01* .26 .77* -.11

Competency -1.08** .02 -.32 .00

Manipulative 1.17** -.17 .89** -.24

Isolation vs Support 1.43** .03

OTHER SCORES

1.14** -.06

Problem 2.49* .26 1.52** -.19

Motivation 3.72* .26 .66** -.15

Affective 4.89* -.13 1.86** -.24

* Group differs from all others at p < .05

** Group differs from No/Yes and No/No at p < .05
not dropped. Table 5 shows the classification

ofindividuals as a result of the discriminant

function coefficients developed in this analysis. This table shows how well the discriminant function performs in discriminating

drops from non-drops in this sample. Only

students for whom a score was available on

all subscales are included. Figures are included for the percentages of each group predicted to fall in each category by the function.

Discriminating variables included Good Impression, Mistake Joining Subs, Problems in

Subschool, Physical Wellbeing, Low Situational Control, Nervous (Anxiety), Problems

at Home or School, Suicide, Self-criticism

and Vulnerability. These variables showed

excellent discrimination ofthe two groups.

Sensitivity ofthis function is 82.5%, specificity is 91.7%. Positive predictive value is

70.2% and negative predictive value is 90.6%.

88% ofthe total group were correctly classified. A second discriminant function analysis

was performed to see how well a function

could discriminate among those referred and

dropped, those referred and not dropped, and

those not referred and not dropped. This function correctly classified 83% of the students.

One interesting result ofthis analysis was that

the Submarine Specific Motivational

subscales showed better discrimination of

drops versus non-drops than either the Affective or Socialization subscales (see Table 3).

Students who were referred and dropped

show a mean Z score of 2.0 or greater for 5 of

the 6 Motivation subscales while the largest Z

score for any of the Motivation subscales in

the group that was referred and not dropped is

less than 1.0, and in the not referred and not

dropped group, the largest Z score is .30.

This occurs despite the fact that these

subscales were not used as a basis for initial

referral. This strongly suggests that revision

of the process used to refer students to include

these subscales could improve the screening

process by referring fewer students while

keeping a similar number of drops.

One problem with discriminant function analysis is that it maximizes the sources of variance

between groups and may include or capitalize

on sources of variance unique to the particular

data set. This unique variance is unrelated to

the variables of interest and does not generalize to a different data set. A discriminant

function obtained on one data set must therefore be tested on a different data set to assure

that the function is valid. Another test procedure derives the function on half of the available data and tests the function on the other

half (jack-knife procedure). Although the

Table 5. , ,. .

Predictive results ofdiscriminant analysis to discriminate psychiatric

dropsfrom BESS referred by Subscreen with individuals referred but

not droppedfor psychiatric reasons

Actual Group #Cases

Dropped

Not Dropped

40

85

Predicted Group

Dropped Not Dropped

33

(82.5%)

7

(17.5%)

8

(9.4%)

77

(90.6%)

10
data included above show considerable promise in being able to refine Subscreen scoring

protocols to better predict those individuals

who would be Psychiatric drops, further research with a larger data set would be required to accurately determine the best set of

discriminant function coefficients. It would

also be desirable to perform this analysis on a

group ofsubmarine school candidates for

which the clinical evaluations were made

without access to the Subscreen results. These

functions could be incorporated into the scoring program. New norms to calculate the Z

scores also need to be computed and added periodically to the scoring routines as the population characteristics change.

Subscreen used to predict

passing or failing BESS

Although Subscreen was developed to assess

psychological functioning, the possibility that

it could be useful in predicting attrition from

BESS for all causes has also been studied.

Bryant (unpublished, 1987) performed a discriminant function analysis of Subscreen to

determine whether it could be used to predict

loss from all causes from BESS. Bryant analyzed Subscreen scores from 778 enlisted personnel in BESS. Eleven percent (n=83) of

these did not graduate. This analysis included

all students who did not complete BESS. Psychological drops were included in this group

but were not studied separately. Bryant reported a general discriminant function that

had a total canonical r

2

= .38 (p < .001,

df=l 1). This figure specifies the proportion

of variance in either variable which is linearly

accounted for by the other. Note that this accounts for approximately 14% of the variance.

Most ofthe variance is, therefore, not accounted for by these variables.

Eleven ofthe 28 subscales contributed to the

general prediction equation. Separate functions for the Affective, Socialization and Motivation scales were also developed. The general predictive equation correctly classified

79% of the group. As Bryant notes, assigning

all of the students to the pass group would

have yielded a correct classification of 89% of

the group. For attrites, 60.2% (n=50) were

correctly identified and 19% (n=132) of the

non-attrites were incorrectly identified as potential attrites. These data show a sensitivity

of 60% and a selectivity of 86%. Positive predictive value, the probability that someone

with a loss prediction was actually lost, is

27%.

Bryant concludes that Subscreen "does

identify individuals who become attrites". He

also concludes that to improve prediction

accuracy, further research is needed to develop the most appropriate cutoff scores for

the discriminant function. There are several

reasons why individuals may not complete

BESS. These include not only psychiatric

problems but also motivational, academic and

personal reasons. It would be naive to expect

that a single discriminant function would discriminate among all attrites and non-attrites.

Conceivably functions to predict each type of

drop from BESS could be developed, but the

use of a test designed principally to screen for

psychiatric problems would seem inappropriate, and in this attempt, at least, was unsuccessful.

Subscreen used to predict

less than honorable discharge

In fact, the possible use of Subscreen forjust

such a broader screening has been studied. In

1991, Katz (unpublished) examined data from

4695 enlisted men who took the Subscreen inventory in 1986 and summarized performance

(attrition, pay grade) data obtained from Naval Personnel Research and Development

Command (NPRDC) and Subscreen results using only the multiple regression results determined previously in Katz and Rexer (1990)

11
for the three scales that best predicted psych

drops. He did not perform a multiple regression analysis ofthe raw item scores or all of

the scale or factor scores.

Complete data were available for only 4675

of the people. Sixty-four percent were still on

active duty in 1990. Thirty-two percent failed

to complete their enlistment; 17.7% left with

less than an honorable discharge.

This report looked only at the following Subscreen scores as predictors of attrition:

1. Affective Factor

2. Socialization Factor

3. Motivation Factor

4. Low Frequency (endorses items rarely

endorsed by the main population).

The same regression coefficients determined

in Katz and Rexer (1990) were used to evaluate discharge type. These were previously

shown in Figure 1. The Socialization and

Low Frequency scores were the most useful

for predicting type of discharge. For the Socialization score the difference between the

groups was statistically significant, but

amounted to only 15% of one standard deviation (SD). The men in the attrition group also

endorsed unusual items slightly more frequently. This result is less predictive than

that obtained by Bryant for general Submarine

School attrition or by Katz and Rexer (1990)

for attrition from Submarine School. Very little of the variance between the groups is

accounted for by these two scores, approximately 2%. That means that 98% of the difference between the two groups is not

accounted for by Subscreen test scores. The

Motivation and Affective scores did not distinguish between the groups for discharge type.

Katz recommends using a Socialization Z

score of 1.5 or greater as an "at risk" criterion

score for less than honorable discharge. He

makes this recommendation because the percent of the individuals obtaining scores

greater than this is higher in the Less than

Honorable discharge groups (mean 15.8%)

than in those still on active duty (1.9%) and

those receiving an Honorable discharge

(5.7%). The sensitivity (probability of a Z

score greater than or equal to 1.5 given that a

less than honorable discharge occurred) and

the specificity (the probability ofZ score less

than 1.5 score when a honorable discharge or

continuance of active duty occurred) of this

recommended cutoff were examined. The sensitivity is very low, 7.6%. The specificity is

fairly high, 97%. Specificity is high, of

course, because of the large proportion of true

negatives. If all the personnel still on active

duty who received a score above 1.5 (and,

therefore, were classified in the above figures

as false positive) did, in fact, later receive less

than honorable discharges) the sensitivity

only goes up to 23%. In actual figures using

this criteria would have correctly recommended that 47 men were at risk of less than

honorable discharge; 94 men would have

been recommended who did not actually receive a less than honorable discharge, and 564

men who would not have been recommended

did, in fact, receive a less than honorable discharge. The remaining 3431 men would not

have been recommended for discharge and, in

fact, were not discharged. The positive predictive value of this test, the probability that

someone with a positive test (Z score > 1.5)

was actually discharged less than honorably,

is 33%.

These men had already been through several

selection procedures including basic recruit

training, Subscreen, passing Subschool, etc.

As Katz noted, the predictive value of Subscreen is, therefore, less in this group than

would be expected ifit had not been one of

12
the earlier selection tools employed. The prediction value also would probably be much

higher ifseparate multiple regressions using

all of the data, including demographic information, were calculated for the drop categories of interest.

To date the question of whether Subscreen is

able to predict which individuals will become

psychiatric disquals during active submarine

duty has not been investigated. We are currently performing this research.

Summary and Conclusions

The use of Subscreen during Basic Recruit

Training for individuals designated to continue on to BESS would be appropriate. In

this context it would be used to screen individuals for referral to a professional psychologist, psychiatrist, or psychiatric social worker

for clinical evaluation. Because it has submarine specific motivation subscales that should

be used in the referral process, it would only

be appropriate for individuals scheduled to attend BESS. Early identification of individuals who are psychiatrically and/or

motivationally unsuited for submarine service

would save additional training and travel dollars.

For FY91 and FY92,124 BESS students were

dropped for psychiatric reasons. Ninety-three

of these were identified by Subscreen. BESS

is a 6 week course with an approximate cost

of $3724.00 per student (figures on training

costs were obtained from Resource/Manpower Analysis Course Costing Branch,

NETEMPSA, Pensacola, Florida). Identifying these individuals as unsuitable for submarine service resulted in a cost avoidance of

$346,332.00 at BESS alone.

Fifteen BESS students who were already identified as candidates for advanced schools were

dropped in FY91 as a result of Subscreen testing. The cost for these 15 students at Basic

Electronic Rate Training (BERT), a 14 week

course, would have been $12,511 per student,

a savings of $187,665.00. For training beyond BERT, such as the Radioman pipeline,

the savings per student would equal over

$53,400.00; a total of $801,180. This latter

example is illustrative. While all 15 men

were scheduled for advanced training, not all

were in the radioman training group. An additional four of the psychiatric drops were

scheduled for guided missile school, and one

of the drops was a corpsman scheduled to go

to additional training at the Naval Undersea

Medical Institute (NUMI). It is likely that at

least 14 of the other psych drops would also

have gone on to advanced schools at a conservative total cost of over 1 million dollars.

The majority of BESS graduates go on to receive additional training prior to submarine

duty. For FY91 46% of BESS graduates reported to Advanced Submarine School for Basic Electronics Rate Training (BERT), 13%

reported to an advanced school for guided

missile training, 2% reported to the Naval Undersea Medical Institute, and 27% received orders directly to a submarine.

Since motivational factors are not part of the

criteria for allowing a psychiatric drop by the

Medical Department, many of those interviewed are passed psychologically but are

dropped for other reasons. Perhaps an "Assessment Center" approach using information

from instructors, administrators and medical

(psychiatric) personnel would be useful.

Often information about an individual is not

known by all concerned in the evaluation

process. For example, the clinician may have

Subscreen results indicating low motivation,

but may not be aware of disciplinary problems which could affect recommendation for

drop. This type of approach is feasible for a

relatively small command such as BESS, but

is less practical for larger groups.

13
At the present, time Subscreen is not a useful

measure for predicting attrition from BESS

for other than what are considered to be psychiatric or motivational reasons. Subscreen is

also not useful for predicting less than honorable discharges from the US Navy. A combination of Subscreen factors and other

information such as AFQT, reading scores,

high school class standing, etc. might yield a

better prediction of non-psychiatric attrition.

There is a long history of Navy research using

demographic variables to predict performance

and attrition. Numerous Navy and Air Force

studies (Jensen, 1961; Noddin, 1969; Lachar,

Sparks and Larsen, 1974; Weybrew and Noddin, 1974; McGraw and Bearden, 1988; Crawford and Fiedler, 1991) have identified

motivation as a prime cause for unsuitable performance. Analysis of all of the FY91 BESS

attrition data showed an additional 16 men

were dropped from BESS for motivational reasons. Subscreen may have identified these

men, but motivation information is not currently used as a basis for referral so this information was never available to the BESS staff.

Individuals who desire to leave the service express this interest early and often. Clearly a

good test of motivation would have great utility.

The Navy-AFMET test is currently being

given by the Navy as a general screening test.

The first phase of Navy-AFMET assesses family, school, legal, alcohol and anti-social problems. It includes demographic information,

history of depressive problems and mental

health treatment history. In the second screening phase, the NEO Personality Inventory FFI

(Costa and McCrae, 1985) is given. This

phase addresses issues of neuroticism, responsibility, suicidal ideation, unmodulated anger,

perseverance, emotional stability, and selfconfidence. At the third phase, an MMPI-2

and clinical interview are given. For the basic

Navy population this appears to be a thorough

and responsible approach to general screening. Since it has only recently been instituted

(October, 1991) at US Navy Recruit Training

Centers its specificity, sensitivity, positive predictive value, etc. in this population are unknown. Sensitivity of the Air Force version of

the test, AFMET, is low, however (Crawford

and Fiedler, 1991).

The submarine environment necessitates additional or revised testing that increases the importance of claustrophobia, sleepwalking,

attitudes toward nuclear weapons, and feelings about submerging for extended periods.

Claustrophobia (situation reaction) alone accounted for 29 percent of the Submarine

School psychiatric attrition for FY91. Sleepwalking accounted for another 2 percent.

These items are not adequately covered in a

general screening program and must be included in any submarine specific screening

program. There is clearly a need to continue

to administer Subscreen and/or perform other

submarine specific testing. Additional research designed to improve the sensitivity and

specificity of Subscreen and to include motivational issues could save the Navy hundreds

of thousands of training and travel dollars.

Acknowledgements

The author would like to thank Dr. L. Katz,

Mr. E. Noddin, and CAPT P. K. Weathersby

for their substantial help during the preparation of this review. Thanks are also due to E.

Perkins for clerical support.

References

Bloom, W. (1983). Changes made, lessons

learned after mental health screening.

Military Medicine, 148, 889-890.

Bryant, K.J. (1986). Longitudinal analysis

ofinvoluntary turnover characteristics

within the submarine service: Non-nuclear trained enlistedpersonnel (NSMRL

14
Report Number 1077). Groton, CT:

Naval Submarine Medical Research

Laboratory.

Bryant, K. (1987). Discriminantfunction

analysis ofSubscreenfor basic enlisted

Submarine School: Preliminary Report.

Unpublished manuscript.

Costa, P. T. & McCrae, R. R. (1985). The

NEO Personality Inventory. Odessa, FL:

Psychological Assessment Resources.

Crawford, S. L. & Fiedler, E. R. (1991). Development and current status of USAF

Mental Health Screening. Military Medicine, 156, 596.

Cronbach, L. J. (1951). Coefficient alpha

and the internal structure of tests. Psychometrika, 16,297-334.

Heaton, W. J. (1991). An expert system to

evaluate Ernie Noddin's evaluation of

Subscreen test results. Unpublished

manuscript. Groton, CT: Naval Submarine Medical Research Laboratory.

Jensen, M. B. (1961). Adjustive and non-adjustive reactions to basic training in the

Air Force. Journal ofSocial Psychology,

55, 33-41.

Lachar, J. A., Sparks, J. C, & Larsen, R. M.

(1974). Psychometric prediction of behavioral criteria of adaptation for USAF basic

trainees. Journal of Community Psychology, 2,268-277.

McGraw, R. K., & Bearden, D. L. (1988).

Motivational and demographic factors in

failure to adapt to the military. Military

Medicine, 153, 325-328.

Noddin, E .M. (1969). The relationship of

background variables to attrition in Basic

Enlisted Submarine School (NSMRL Report 597). Groton, CT: Naval Submarine

Medical Research Laboratory.

NDRC Project 44, Div 7. (1943). A report of

research on selection tests at the U.S. Naval Submarine Base, New London

(O.S.R.D. Report No. 1770). Providence:

Brown University.

Okros, A. C. (1989). A proposal for the

screening and monitoring of psychological fitness for submarines (Working Paper

89-1). Canadian Forces Personnel Applied Research Unit.

Taylor, J. (1953). A personality scale of

manifest anxiety. Journal ofAbnormal

Social Psychology, 48,285-290.

Katz, L. (1991). Subscreen as it relates tofol-

• low-up datafrom NPRDC an informal

pre-discussion report. Unpublished report. Groton, CT: Naval Submrine Medical Research Laboratory.

Katz, L. & Rexer, K. (1990). Geo-Centers

Report on Subscreen Inventoryfor Naval

Submarine Medical Research Laboratory.

Unpublished report. City, ST: Geo-Centers.

Weybrew.B. B. (1959). The Personality Inventory Barometer (PIB): II. Obversefactor analysis with PIB items as validation

technique with Submarine School Criteria

(NMRL Report No. 309). Groton, CT:

Naval Medical Research Laboratory.

Weybrew, B. B. & Noddin, E. (1969). Factors related to thefailure ofenlisted

Submarine School graduates to qualify

(NSMRL Report No. 586). Groton, CT:

Naval Submarine Medical Research

Laboratory.

15
Weybrew, B. B. & Noddin, E. M. (1974). A

simplifiedprocedurefor identification of

optimal test score cut-offpointsfor nonrated submariner candidates (NSMRL

Report No. 797). Groton, CT: Naval

Submarine Medical Research Laboratory.

Weybrew, B. B. & Noddin, E. M. (1979).

Psychiatric aspects of adaptation to long

submarine missions. Aviation, Space and

Environmental Medicine, 50, 5757-580.

Weybrew, B. B. & Youniss, R. P. (1959).

The Personality Inventory Barometer

(PIB): I. Development ofthe questionnaire (NMRL Report No. 290). Groton,

CT: Naval Medical Research Laboratory.

Woolsen,R. F. (1987). Statistical methods

for the analysis ofbiomedical data. New

York: Wiley & Sons.

16
APPENDIX A

SUBSCREEN

GDS Classification

EXS Extreme Scores

DIS Distortion

GIM Good Impression

Procedural Subscales

A derived score that includes the following subscales

(described below) - GIM, EXS, DIS, UCS, PSS, LOC,

DEP, SOI, SUI, CLA Different weights are attached

to the subscales in computing this score.

Score based on the number of agree strongly and

disagree strongly responses.

Eight items related to traits which are desirable to

have but which are almost statistically impossible to be

found in one individual, e.g., "I am always honest"; "I

never take advantage of anyone."

Twelve items which are socially acceptable and likely

to be endorsed by someone trying to impress people,

e.g., "I like to look at the positive side of life." "I'm

very careful in my work."

MJS Mistake Joining

Subs

UNS Uncertain About

Subs

Submarine Specific Motivation Subscales

Eight items expressing dissatisfaction with the

submarine force and/or the Navy, e.g., "It would take

very little change in my life to cause me to leave the

submarine service;" "Joining the Navy was a definite

mistake on my part."

Six items which reflect ambiguous attitudes toward

submarines, e.g., "At times I'm not sure I should have

volunteered for submarines"; "I really don't know why

I'm interested in submarines."

A-l
COS Conditional

Acceptance of

Submarines

UCS Unconditional

Acceptance of

Submarines

Five items expressing acceptance of submarines if

certain conditions are met, e.g., "If my submarine were

to be stationed outside the U.S. for long periods of

time, I'd feel like quitting;" "If I didn't get my choice

of a home port, I'd feel like getting out."

Eight items expressing the acceptance of submarines

even under negative conditions, e.g., "I believe that

even if submariners did not get extra pay, I would still

have volunteered;" "I would accept almost any kind of

job assignment in order to stay in the submarine

service."

PSM Problems Submerging

PSS Problems Submarine

School

PWL Physical Well Being

LOC Low Situational

Control

ANX Nervous or Worrying'

DEP Depressed Mood

Four items related to working/living under submerged

conditions on a submarine, e.g., "Working with the

same people under the same conditions during long

submerged cruises does not appeal to me."

Six items that address learning skills and selfperception of capacity to do well at submarine school,

e.g., "I believe Submarine School will be easy for me."

Affective Subscales

Nine items related to the individual's perceptions of

his health or stamina, e.g., "My health is excellent"

(scored negatively) or "I tire very easily."

A group of ten items expressing elements of worry and

the feeling that they have little control over the

situation they are in, e.g., "I worry too much about

things I cannot change;" "Sometimes planning ahead

seems impossible."

Eleven items related to anxiety and nervousness, e.g.,

"I am a very nervous person;" "Often I become so

upset I find it hard to get to sleep."

Eight items which are normally associated with

depression, e.g., "I feel moody and depressed most of

the time; Sometimes I get just plain sick and tired of

living."

A-2
Socialization Subscales

COE Coercive Attitudes

AGG Aggressive/Destructive

PHS Problems Home/School

SOI Social Isolate

IMP Impulsive

SSP Social Support

Fourteen items related to behavior which is not

normally accepted by most people and often found in

personality disorders, e.g., "I know how to make

people feel uneasy when I want to; I can get away with

just about anything I want to."

Eight items related to argumentative behavior,

fighting, and anger, e.g., "I like to see how far I can

push people before they fight back; I have never

backed down from a fight."

Eleven items related to negative behaviors or

situations in the past, e.g., "I went into the military

because I didn't like my home life; When I was going

to school, I played hooky quite often."

Ten items indicating problems associating with others,

e.g., "I have very few ties to other people or places; I

don't have many close friends."

Eleven items related to impulsive behavior, e.g., "I

often do things on the spur of the moment without

stopping to think; I would do almost anything on a

dare."

Ten items indicating emotional support by family or

friends, e.g., "My home life was very happy; Many

people care about me."

A-3
BTH Unusual Thoughts

BPC Unusual Physical

Complaints

SUI Suicidal Thoughts

CLA Claustrophobic Feelings

NUC Problems Nuclear

DEPND Dependency

SCR Self-Criticism

COM Competency

Additional Subscales

Seven items - thoughts which most people do not

adhere to, e.g., "I think that people often talk about

me behind my back; I am afraid of the dark."

Six items which are infrequently endorsed by most

people, e.g., "I am almost always too hot or too cold; I

often walk in my sleep."

Seven items related to death or suicidal thoughts, e.g.,

"I have sometimes thought of taking my own life; I feel

the world is not worth continuing to live in."

Six items related to discomfort in enclosed spaces or

crowds, e.g., "I often feel uneasy in a crowd; I often

feel cramped and hemmed in when I am in a small

room."

Six items related to fear or dislike of nuclear weapons

or radiation, e.g., "I am concerned about the possibility

of being exposed to radiation while aboard a

submarine; Considering the feelings I have, I might

disobey an order to fire a nuclear weapon."

Eleven items indicating need for social support, e.g., "I

become frightened when I feel alone; I am very

sensitive to others for signs of rejection."

Nine items that address feelings of self-worth, e.g., "I

feel good about myself whether I succeed or fail."

Seven items related to responsibility, goal setting, and

self-image, e.g., "I set my personal goals and standards

as high as possible." (Not currently included in

printout but discussed in text.)

A-4
VUL Vulnerability

MOT Negative Motivation

DPS Depression/Suicide

SCN Competence

MAN Manipulation

FACTORS

Thirty-three items which reflect locus of control,

nervous anxiety, depression, and suicide.

Nineteen items that address attitudes toward the

military and submarine service.

Twenty-four items that reflect self-reported depression

and suicide ideation and attitude.

Twenty items that measure general competence and

efficacy.

Eighteen items that reflect manipulativeness.

ISO Isolation/Social Support Nineteen items which measure social isolation and

support.

Other Scores

Problem: Weighted score computed as follows:

PROBLEM = ((-2.25 X ZPHS) + (2.19 X ZPHS2)) - 8.27

Motivation: Weighted score computed as follows:

MOTIVATION = ((-.31 x ZMJS) +

(-1.18 x ZPSM) +

(.26 x ZNUC) +

(-.49 x ZUCS) +

(.31 x ZPSS) +

(-1.60 x ZCLA) +

(2.01 x (PXM + CLA))

-2.88

Affective: Weighted score computed as follows:

AFFECTIVE = ((-1.75 x ZDEP) +

(-2.43 x ZSUI) +

(3.40 x (DEP x SUI) +

(.30 x (ANX x LOC))

-11.45

A-5
Appendix B

Evaluation of Screening Tests

Both a screening test and an actual diagnosis can give either a positive or a negative

* answer. The screening test may or may not accurately predict the true condition of the

j, individual. The following table shows these possibilities:

Diagnosis

Condition Present No Condition

Positive a b

Test

Procedure

Negative c d

Total a+c b+d

The grand total (n) = a+b + c+d

Estimating the Usefulness of a Test

1. The sensitivity of a test is an estimate of the probability of a positive test result given

that a psychiatric condition exists.

Sensitivity = a/a+c

2. The specificity of a test is the probability of a negative test result given that no

psychiatric condition exists.

Specificity = d/b+d

3. The positive predictive value of a test is the probability that a person with a positive

test actually has the condition in question.

Positive Predictive Value = a/a+b

4. The negative predictive value is the probability that a person with a negative test does

A- not have the condition.

t Negative Predictive Value = d/c+d

B-l
In order to determine a cutting score for any test, one must also know the seriousness for

the selection process of the two types of incorrect decisions, false positives, in this case

persons recommended for psychiatric evaluation who will not be dropped, and false

negatives, people who should have been recommended for evaluation and dropped but

were not.

5. The percentage of correct decisions is the number of the cases in which both the test

result and the diagnosis agree.

Percent Correct Decisions = (a+d/n) x 100.

6. The Coefficient of practical validity is the difference between number of correct and

incorrect decisions.

Coefficient of Practical Validity = (a+d)-(b + c)/n

A high positive COPY correlates with overall efficiency in the selection tool.

A

*

»

B-2
UNCLASSIFIED

SECURITY CLASSIFICATION OF I HIS PAUfc

REPORT DOCUMENTATION PAGE

1a. REPORT SECURITY CLASSIFICATION

TTNTTASSIFITO

2a. SECURITY CLASSIFICATION AUTHORITY

2b. DECLASSIFICATION/DOWNGRADING SCHEDULE

4. PERFORMING ORGANIZATION RE PORT NUMBER(S)

NSMRLREPORT1193

6a. NAME OF PERFORMING ORGANIZATION

Naval Submarine Medical

RfrfOffiMrafriratflry

6b. OFFICE SYMBOL

(IfApplicable)

6c. ADDRESS (City, State, Zp Code)

Box 900, Naval Submarine Base NLON

Groton,CT 06349-5900

8a. NAME OF FUNDING/SPONSORING

ORGANIZATION

Naval Sea Systems Command

8b. OFFICE SYMBOL

(IfApplicable)

8c. ADDRESS (City, State, Zp Code)

CommandavNaval Sea Systems Command Headquarters

WashingtonDC 20362-5101

Form Approved

OMB No. 074-0168

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ä. DISTRIBUTION/AVAILABILITY OF THE REPORT

Approved for public release;

distribution unlimited

5. MONITORING ORGANIZATION REPORT NUMBER(S)

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7a. NAME OF MONITORING ORGANIZATION

Naval Medical Rsearch and Development Command

7b. ADDRESS (City, State, Zp Code)

National Naval Medical Center, Bid 1, Tower 12,

Bethesda, MD 20889-5044

9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER

10. SOURCE OF FUNDING NUMBERS

PROGRAM

ELEMENT NO.

PROJECT NO. TASK NO. WORK UNIT

ACCESSION NO.

11. TITLE (Include Security Classification)

Psychiatric saeeningibriresubnMri^

12. PERSONAL AUTHOR(S)

Christine L. Schlichting

13a. TYPE OF REPORT

Interim

13b. TIME COVERED

FROM TO.

14. DATE OF REPORT (Year, Mann Day)

IQCttfVtnlYTl*

15. PAGE COUNT

_2S_

16. SUPPLEMENTARY NOTATION

17. COSATI CODES

FIELD GROUP SUB-GROUP

18. SUBJECT TERMS (Continue on reverse ifnecessary and identify by block number)

Psychiatric screening

19. ABSTRACT (Continue on reverse ifnecessary and identify by block number)

A brief overview of 25 years of psychiatric screening of enlisted personnel for submarine service in the

United States Navy is presented. Current screening consists of administration of a submarine specific test,

Subscreen, to all prospective Basic Enlisted Submarine School (BESS) candidates. Figures from 1991 and

1992 show that approximately 9.7% of these candidates are referred for more extensive testing at the

Psychiatry Department of the Naval Hospital Groton. Less that two percent of all candidates are

subsequently dropped from Bess. Two measures oftest performance, sensitivity (the ability of a test to

yield a positive finding when the individual tested actually has the condition being tested for) and

specificity (the ability of a test to yield a negative finding when the individual tested does not have the

condition) were studied. Both sensitivity (75%) and specificity (92%) were very good for Subscreen,

especially compared to a test the USAF administers for similar purposes. Although some small changes

will improve test performance, in general, Subscreen remains an effective tool for screening for Submarine

Service.

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Susan Monty, Publications Office

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(203)449-3967

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DD Form 1473, JUN 86 Previous editions ate obsolete.

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