Effectiveness of Mental Health Screening and Coordination of In-Theater Care Prior to Deployment to Iraq: A Cohort Study

Walter Reed Army Institute of Research, Silver Spring, Maryland, United States
American Journal of Psychiatry (Impact Factor: 12.3). 04/2011; 168(4):378-85. DOI: 10.1176/appi.ajp.2010.10091303
Source: PubMed


The authors assessed the effectiveness of a systematic method of predeployment mental health screening to determine whether screening decreased negative outcomes during deployment in Iraq's combat setting.
Primary care providers performed directed mental health screenings during standard predeployment medical screening. If indicated, on-site mental health providers assessed occupational functioning with unit leaders and coordinated in-theater care for those cleared for deployment. Mental health-related clinical encounters and evacuations during the first 6 months of deployment in 2007 were compared for 10,678 soldiers from three screened combat brigades and 10,353 soldiers from three comparable unscreened combat brigades.
Of 10,678 soldiers screened, 819 (7.7%, 95% confidence interval [CI]=7.2-8.2) received further mental health evaluation; of these, 74 (9.0%, 95% CI=7.1-11.0) were not cleared to deploy and 96 (11.7%, 95% CI=9.5-13.9) were deployed with additional requirements. After 6 months, soldiers in screened brigades had significantly lower rates of clinical contacts than did those in unscreened brigades for suicidal ideation (0.4%, 95% CI=0.3-0.5, compared with 0.9%, 95% CI=0.7-1.1), for combat stress (15.7%, 95% CI=15.0-16.4, compared with 22.0%, 95% CI=21.2-22.8), and for psychiatric disorders (2.9%, 95% CI=2.6-3.2, compared with 13.2%, 95% CI=12.5-13.8), as well as lower rates of occupational impairment (0.6%, 95% CI=0.4-0.7, compared with 1.8%, 95% CI=1.5-2.1) and air evacuation for behavioral health reasons (0.1%, 95% CI=0.1-0.2, compared with 0.3%, 95% CI=0.2-0.4).
Predeployment mental health screening was associated with significant reductions in occupationally impairing mental health problems, medical evacuations from Iraq for mental health reasons, and suicidal ideation. This predeployment screening process provides a feasible system for screening soldiers and coordinating mental health support during deployment.

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    • "These findings underscore the importance of considering ACEs in pre-deployment and post-deployment intervention strategies for soldiers. Recent empirical work suggests that pre-deployment screening for mental health problems may reduce the risk of postdeployment mental health problems (Warner et al. 2011). However, this screening program did not include assessment of ACEs. "
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    ABSTRACT: BACKGROUND: Although it has been posited that exposure to adverse childhood experiences (ACEs) increases vulnerability to deployment stress, previous literature in this area has demonstrated conflicting results. Using a cross-sectional population-based sample of active military personnel, the present study examined the relationship between ACEs, deployment related stressors and mood and anxiety disorders.Method Data were analyzed from the 2002 Canadian Community Health Survey - Canadian Forces Supplement (CCHS-CFS; n=8340, age 18-54 years, response rate 81%). The following ACEs were self-reported retrospectively: childhood physical abuse, childhood sexual abuse, economic deprivation, exposure to domestic violence, parental divorce/separation, parental substance abuse problems, hospitalization as a child, and apprehension by a child protection service. DSM-IV mood and anxiety disorders [major depressive disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic attacks/disorder and social phobia] were assessed using the Composite International Diagnostic Interview (CIDI). RESULTS: Even after adjusting for the effects of deployment-related traumatic exposures (DRTEs), exposure to ACEs was significantly associated with past-year mood or anxiety disorder among men [adjusted odds ratio (aOR) 1.34, 99% confidence interval (CI) 1.03-1.73, p<0.01] and women [aOR 1.37, 99% CI 1.00-1.89, p=0.01]. Participants exposed to both ACEs and DRTEs had the highest prevalence of past-year mood or anxiety disorder in comparison to those who were exposed to either ACEs alone, DRTEs alone, or no exposure. CONCLUSIONS: ACEs are associated with several mood and anxiety disorders among active military personnel. Intervention strategies to prevent mental health problems should consider the utility of targeting soldiers with exposure to ACEs.
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    ABSTRACT: Veterans returning from Iraq and Afghanistan are diagnosed with Post-Traumatic Stress Disorder (PTSD) at an alarming rate. This significantly impacts the combat readiness of our formations and the well-being of our most valuable resource - our Soldiers. The Army has allocated tremendous resources to assist those diagnosed with PTSD - we are reactive in this regard. Commanders at all levels must become more knowledgeable and proactive in developing ways to prepare their formations to deal with adversity during combat operations. Although Commanders are conducting tough and realistic training prior to deployment, the high number of returnees diagnosed with PTSD indicates we are not doing enough. In training it is difficult to replicate the true nature of war; specifically graphic injuries to Soldiers or other traumatic events. The Army must assist commanders by conducting effective mental health screening on Soldiers prior to deploying, provide training that strengthens Soldiers through resilience and exposure, and provide forward mental health support. This paper addresses the issue of psychologically preparing our Soldiers for War; building psychological resilience. It will also address how the human dimension of leadership can assist in achieving this effect.
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