Does anonymity increase the reporting of mental health symptoms?

BMC Public Health (Impact Factor: 2.26). 09/2012; 12(1):797. DOI: 10.1186/1471-2458-12-797
Source: PubMed


There is no doubt that the perceived stigma of having a mental disorder acts as a barrier to help seeking. It is possible that personnel may be reluctant to admit to symptoms suggestive of poor mental health when such data can be linked to them, even if their personal details are only used to help them access further care. This may be particularly relevant because individuals who have a mental health problem are more likely to experience barriers to care and hold stigmatizing beliefs. If that is the case, then mental health screening programmers may not be effective in detecting those most in need of care. We aimed to compare mental health symptom reporting when using an anonymous versus identifiable questionnaire among UK military personnel on deployment in Iraq.

Survey among UK military personnel using two questionnaires, one was anonymous (n = 315) and one collected contact details (i.e. identifiable, n = 296). Distribution was by alternate allocation. Data were collected in Iraq during January-February 2009.

No significant difference in the reporting of symptoms of common mental disorders was found (18.1% of identifiable vs. 22.9% of anonymous participants). UK military personnel were more likely to report sub-threshold and probable PTSD when completing questionnaires anonymously (sub-threshold PTSD: 2.4% of identifiable vs. 5.8% of anonymous participants; probable PTSD: 1.7% of identifiable vs. 4.8% of anonymous participants). Of the 11 barriers to care and perceived social stigma statements considered, those completing the anonymous questionnaire compared to those completing the identifiable questionnaire were more likely to endorse three statements: “leaders discourage the use of mental health services” (9.3% vs. 4.6%), “it would be too embarrassing” (41.6% vs. 32.5%) and “I would be seen as weak” (46.6% vs. 34.2%).

We found a significant effect on the reporting of sub-threshold and probable PTSD and certain stigmatizing beliefs (but not common mental disorders) when using an anonymous compared to identifiable questionnaire, with the anonymous questionnaire resulting in a higher prevalence of PTSD and increased reporting of three stigmatizing beliefs. This has implications for the conduct of mental health screening and research in the US and UK military.

Download full-text


Available from: Norman Jones
  • Source
    • "This showed that anonymous surveys of line infantry units reported higher levels of PTSD compared to studies that are not anonymous. KCMHR therefore performed a randomised controlled trial to investigate this further, which showed there was a statistically significant effect on the reporting of sub-threshold and probable PTSD (adjusted odds ratio [AOR] 3.18) when using an anonymous compared to identifiable questionnaire (Fear et al., 2012). The researchers believed that this was most likely to be due to an underreporting of symptoms in those who were concerned about the consequences of disclosure. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals.
    Full-text · Article · Aug 2014 · European Journal of Psychotraumatology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: UK Armed Forces (AF) personnel deployed to Afghanistan are frequently exposed to intense combat and yet little is known about the short-term mental health consequences of this exposure and the potential mitigating effects of military factors such as cohesion, morale, and leadership. To assess the possible modulating influence of cohesion, morale, and leadership on post-traumatic stress disorder (PTSD) symptoms and common mental disorders resulting from combat exposure among UK AF personnel deployed to Afghanistan, UK AF personnel, during their deployment to Afghanistan in 2010, completed a self-report survey about aspects of their current deployment, including perceived levels of cohesion, morale, leadership, combat exposure, and their mental health status. Outcomes were symptoms of common mental disorder and symptoms of PTSD. Combat exposure was associated with both PTSD symptoms and symptoms of common mental disorder. Of the 1,431 participants, 17.1% reported caseness levels of common mental disorder, and 2.7% were classified as probable PTSD cases. Greater self-reported levels of unit cohesion, morale, and perceived good leadership were all associated with lower levels of common mental disorder and PTSD. Greater levels of unit cohesion, morale, and good leadership may help to modulate the effects of combat exposure and the subsequent development of mental health problems among UK Armed Forces personnel deployed to Afghanistan.
    Full-text · Article · Mar 2012 · Psychiatry Interpersonal & Biological Processes
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Rest and Recuperation (R & R) is a period of home leave taken during an operational deployment; we sought to examine the relationship between taking R & R and mental health.DesignA survey-based post-intervention evaluation.SettingUKParticipants232 members of the UK Armed Forces; 42 of which completed pre and post R & R surveys.Main Outcome MeasuresAlcohol use, Post Traumatic Stress Disorder, Common Mental Disorder Symptoms and R & R experiences.Results12.1% of respondents (n=27) reported symptoms of common mental disorder and 3.7% (n=8) reported probable PTSD. 50% (n=110) reported hazardous use of alcohol during R & R. In the pre- and post-assessed sample, mental health status and alcohol use levels were similar at both survey points. Using principal component analysis, five components of R & R were identified; mentally switching off from deployment, travel experience, physical recovery, relaxation, rest and social support. R & R was extremely popular and although it did not improve mental health overall, the ability to engage with or derive satisfaction from aspects of the five components was significantly associated with better mental health and less alcohol use at the end of R & R.Conclusion Operational commanders should advise personnel about the best way to actively engage with R & R before they leave theatre and be aware of the significant detrimental impact of disrupted travel arrangements upon the ability to benefit from R & R.
    Preview · Article · Jul 2013 · Journal of the Royal Society of Medicine
Show more