Convergent and discriminant validity of the blast exposure threshold survey in U.S military service members and Veterans

Abstract: The Blast Exposure Threshold Survey (BETS) is a recently developed and promising new self-report measure of lifetime blast exposure (LBE). However, there are no studies that have examined the psychometric properties of the BETS which currently limits its clinical utility. The purpose of this study was to examine the convergent and discriminant validity of the BETS by comparing the BETS Generalized Blast Exposure Value (GBEV) to six variables hypothesized to be associated with LBE (i.e., single-item LBE, combat exposure, years in the military, number of combat deployments, military occupation specialty [MOS]) and three variables hypothesized not to be associated with LBE (i.e., age at the time of injury, estimated premorbid FSIQ, and resilience). Participants were 211 US service members and veterans prospectively enrolled from three military medical treatment facilities (68.7%) and community recruitment initiatives (31.3%), classified into three broad groups: traumatic brain injury (TBI; n=116), injured controls (IC, n=68), and non-injured controls (NIC, n=27). Participants completed the BETS, Combat Exposure Scale (CES), Deployment Risk and Resiliency Inventory-2 Combat Experiences (DRRI-2 CE), Traumatic Brain Injury-Quality of Life Resilience scale, and a brief structured interview. For some analyses, participants were classified into two Blast Risk MOS groups: High (n=93) and Low (n=98). The BETS GBEV was not significantly correlated with all three non-blast related variables (rs=.01 to rs=.11). In contrast, GBEV was significantly (p<.001) associated with all blast-related variables; single-item LBE (rs=.76), CES (rs=.59), number of combat deployments (rs=.53), DRRI-2 CE (rs=.47), and High Blast Risk MOS (r=.36, medium effect size). However, a stronger relationship was found between the blast-related variables and three modified GBEV scores when excluding some small weapons categories. This is the first study to examine the psychometric properties of the BETS. Overall, the convergent and discriminant validity of the BETS was considered to be excellent. In order to ensure that the BETS can be confidently used as a valid and reliable measure of LBE, more research is needed to further examine the psychometric properties of the test, particularly with regard to the establishment of test-retest reliability.

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