Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia.
Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
BMC Psychiatry. 2020 Nov 10;20(1):531. doi: 10.1186/s12888-020-02936-y.
The transition out of military service and subsequent reintegration to civilian life has been established as a period associated with an increased risk of psychological adjustment difficulties, psychiatric disorders and suicide risk, yet no tool exists to measure cultural and psychological adjustment following permanent separation from the military. This study describes the two-phase mixed-methods development and validation of the self-report Military-Civilian Adjustment and Reintegration Measure (M-CARM).
In Phase I, four focus groups (n = 20) and semi-structured one-on-one interviews (n = 80) enabled thematic analysis and generation of 53 initial items that were reviewed by an expert multidisciplinary panel (n = 12) and piloted for clarity and relevance in an Australian service-veteran sample (n = 11). In Phase II, psychometric properties of the 47 items resulting from Phase I were evaluated with online assessment of a convenience sample of transitioned Australian Defence Force veterans (n = 725). Analyses included exploratory and confirmatory factor analyses, as well as evaluation of test-retest reliability, internal consistency, and convergent, divergent and discriminant validity.
Exploratory factor analysis on a randomized split-half sample (n = 357), resulted in a 21-item, five-factor solution of Purpose and Connection, Help seeking, Beliefs about civilians, Resentment and regret, and Regimentation, explaining 53.22% of the variance. Confirmatory factor analysis (n = 368) verified this factor structure without modification (χ2 = 304.96, df = 160; CFI = .96, TLI = .94, NFI = .91, RMSEA = .05). Strong convergent, divergent and discriminant validity was demonstrated as M-CARM scores significantly correlated with related constructs assessed by standardised clinical measures as well as differentiated groups based on three binary reintegration items, with large effect sizes (d = > 1). Strong test-retest reliability for the total score (n = 186, r = .93) and excellent internal consistency (n = 725, a = .90) were also found.
Results provide promising evidence the M-CARM is a valid, reliable measure of psychological and cultural reintegration to civilian life, with potential for considerable clinical and research application.
从军队退役并重新融入平民生活已被确定为一个与心理适应困难、精神障碍和自杀风险增加相关的时期，但目前还没有工具可以衡量永久性离开军队后的文化和心理适应。本研究描述了自我报告的军人-平民调整和再融入测量工具（M-CARM）的两阶段混合方法开发和验证过程。
在第一阶段，通过四个焦点小组（n=20）和半结构化的一对一访谈（n=80）进行主题分析，并生成了 53 个初始项目，这些项目由一个多学科专家小组（n=12）进行审查，并在澳大利亚服务退伍军人样本（n=11）中进行试点以提高清晰度和相关性。在第二阶段，通过在线评估过渡时期的澳大利亚国防军退伍军人的方便样本（n=725），评估了来自第一阶段的 47 个项目的心理测量特性。分析包括探索性和验证性因素分析，以及评估重测信度、内部一致性以及收敛、发散和判别效度。
对随机分组样本（n=357）进行的探索性因素分析得出了一个 21 项、五因素的解决方案，包括目的和联系、寻求帮助、对平民的信念、怨恨和遗憾以及纪律，解释了 53.22%的方差。验证性因素分析（n=368）无需修改即可验证该结构（χ2=304.96，df=160；CFI=0.96，TLI=0.94，NFI=0.91，RMSEA=0.05）。M-CARM 分数与标准临床测量评估的相关结构显著相关，与基于三个二元再融入项目的群体明显不同，具有较大的效应量（d>1），这表明了较强的收敛、发散和判别效度。还发现总分的重测信度（n=186，r=0.93）很强，内部一致性也很好（n=725，a=0.90）。
结果提供了有希望的证据，表明 M-CARM 是一种衡量心理和文化重新融入平民生活的有效、可靠的工具，具有广泛的临床和研究应用潜力。
