Mesurer l’adaptation en milieu militaire ? Intérêts et limites de la psychométrie

Abstract

Context

Assessing the medical fitness of military personnel to serve in the armed forces is one of the principal responsibilities of the French Military Health Service. This fitness evaluation is a dynamic process, extending from enlistment to the end of the service member's career. It is reviewed every two years and at certain pivotal periods, such as specialization training or deployment. In certain difficult situations, where a soldier's ability to adapt to their environment is called into question, the general practitioner may ask the military psychiatrist to carry out a medical-psychological assessment in the form of an expert opinion. This assessment, which is a reasoned opinion, explores various aspects: the individual's medical and biographical background, professional motivation, lived experience, clinical examination, awareness of potential disorders and adherence to care, and social interactions, while considering the specificities of the military environment (hierarchical standards, operational missions, access to lethal means, etc.). To support this assessment, the psychiatrist may request a complementary assessment conducted by a psychologist using psychometric tools such as personality tests, diagnostic scales, projective tests and tests of cognitive function.

Objective/method

This work aims to explore the benefits and limitations of psychometric tools in assessing an individual's ability to adapt to their environment. Using a clinical example, we will discuss their usefulness by comparing them with other specialty areas, such as forensic psychiatric assessments, and questioning the predictive value of the psychiatric examination. The focus will be on understanding whether psychometric tools can provide additional insights and reduce uncertainty in clinical decision-making.

Results

Psychometric tools offer a range of benefits and limitations in the context of military fitness assessments. Personality tests, such as the Minnesota Multiphasic Personality Inventory (MMPI), can provide valuable insights into an individual's personality traits and potential psychopathologies. However, their limitations include the need for high language proficiency, sustained attention, and the potential for intentional response distortion. Diagnostic scales, like the Hospital Anxiety and Depression Scale (HADS), can help identify symptoms of psychiatric disorders but may be influenced by the subject's awareness of the test's purpose, thereby introducing bias. Projective tests, which assess associative processes and reactions to ambiguous stimuli, offer a deeper understanding of personality but are based on theories that may not be universally accepted and can be challenging to interpret. Cognitive function tests provide detailed assessments of cognitive abilities but may be affected by psychiatric conditions or stress, and they do not address social adaptation aspects crucial in a military context. Overall, while psychometric tools provide useful quantitative measures and can complement clinical evaluations, their effectiveness is limited by their specific constraints. Clinical examination remains indispensable for a comprehensive assessment. It can be conducted in a hospital setting or during repeated outpatient consultations. In the latter case, adapting the individual's work environment can allow for better clinical observation by the psychiatrist.

Conclusion

An approach combining clinical evaluation and psychometric tools renders a deeper understanding of an individual's vulnerabilities and capabilities. While psychometric tools offer useful quantitative measures for objectifying medical decisions, it is essential to be aware of their limitations and to ensure a balanced assessment, incorporating both clinical observations and psychometric data.