January 25, 2011

Army Study Pushes Better Mental Health Screening For Troops

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Thorough pre-deployment mental health screenings of soldiers help to reduce combat stress, psychiatric problems and suicidal thoughts among troops, says a new Army study.

The study—commenced in the wake of media reports and veterans’ concerns that the Army was deploying troops to Iraq and Afghanistan without adequate mental health evaluations—found that troops who received a detailed screening and follow-up for mental health issues were less likely to report psychiatric and behavioral health disorders than those who were not screened.

Less than 3 percent of troops who were screened and tracked during deployments reported psychiatric disorders, compared to 13.2 percent of those who were not screened. Soldiers who participated in the screening also were less likely to report combat-stress disorders in their first six months of deployment – 15.7 percent, compared to 22 percent.

“The pre-deployment time frame can be stressful for both soldiers and commanders,” says the study, reported in the American Journal of Psychiatry.

“By creating a systematic process involving primary care staff, mental health care staff, and unit leaders, soldiers were provided with the care they needed . . .

“These results show that an aggressive program of mental health screening, tracking, and coordination of care may enhance a unit’s functioning, while decreasing negative soldier outcomes.”

The conclusion that pre-deployment screening can be effective in reducing soldiers’ psychological problems comes 14 years into a running debate over whether the Department of Defense [DoD]  has abided by a 1997 Congressional mandate designed to ensure that troops are given a baseline medical evaluation before being sent to war.  The mandate calls for all deploying troops to receive an “assessment” of their mental health.

In practice, troops have been given a questionnaire that includes just one mental-health question, about whether they have received mental health care in the past year. DoD officials maintain that they take other steps to safeguard mental health.

The new study cites a series of articles in The Hartford Courant in 2006 that highlighted gaps in the screening and treatment of soldiers with mental health problems – gaps that in some cases led to suicides. After those stories, Congress directed the military to tighten screening, and new pre-deployment guidelines were put in place, including one directing that soldiers with mental health disorders demonstrate a “pattern of stability” for at least three months prior to deployment.

However, the authors of the new study noted, “There are virtually no scientific studies to help guide the military in how to do this most effectively.”

In the study, the researchers screened a large group of soldiers using a 15-question form that sought information about antidepressant and other medication use, hospitalization for mental health problems, and other issues. Soldiers with any significant issues were referred for an on-site mental health evaluations. Of the 10,678 soldiers in the screened group, 819 required further mental health evaluations before deployments; 347 reported taking psychotropic medications.

Some of the soldiers screened were barred or delayed from deploying. Others who were receiving mental health treatment but deemed deployable had treatment plans developed before they went to war and were tracked by mental health clinicians.

“Although not a randomized study, this systematic program evaluation provides the first direct evidence to support the use of a service-wide program of pre-deployment mental health screening following this model,” the authors said.

“Soldiers in screened brigades had significantly lower rates . . . for clinical contacts for suicidal ideation, combat stress, and psychiatric disorders, as well as lower rates of occupational impairment and air evacuation for behavioral health reasons.”

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