Mental Health Pre-Screening Shows No Benefit for Soldiers Post-Deployment

Depression 'more common in military'
Depression ‘more common in military’
Pre-screening military personnel after deployment did not affect the presence of mental illness.

Pre-screening military personnel after their deployment did not affect the prevalence of mental health conditions in personnel who did and did not receive the screenings, according to a recent study. It also did not have an impact on the percentage of personnel who chose to seek support for mental health, the researchers found.

“We found no evidence to support the idea that informing someone that they were experiencing mental health disorder symptoms encouraged them to seek help from mental health-care providers,” reported Roberto Rona, PhD, of King’s Centre for Military Health Research in London, United Kingdom, and his colleagues. “We have previously shown that pre-deployment screening in UK service personnel did not lead to an increase in seeking health care and that the prediction of subsequent psychiatric morbidity including PTSD [post-traumatic stress disorder] was modest,” they added.

The researchers randomly assigned 434 platoons, including 10,190 service personnel, to either receive or not receive screening for several mental health conditions after returning from deployment to Afghanistan. The study ran from October 2011 to October 2014, with 274 platoons (6350 personnel) assigned to receive screening and 160 platoons (3840 personnel) not assigned to receive screening.

In soldiers assigned to screening, 5577 (88%) actually received the screening, and 3996 (63%) completed the follow-up. In soldiers not assigned to screening, 3149 (82%) completed the control group questionnaire and 2369 (62%) completed the follow-up.

Personnel screened were first assessed for PTSD, depression, anxiety, or alcohol misuse at 6 to 12 weeks after their deployment, followed by a second assessment 10 to 24 months later, using the PTSD Checklist–Civilian Version, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 scale, and Alcohol Use Disorder Identification Test. The researchers also asked whether soldiers had sought help on their own. 

“A key secondary outcome was assessment of whether post-deployment screening followed by tailored advice would modify help-seeking behavior,” the investigators explained.

Just over a third (35%) of personnel in the screening group chose not to heed tailored advice based on their results, a finding that surprised the researchers.

“This finding was more common in younger groups and among lower ranks, both of which are risk factors for mental disorders,” they wrote. “The unwillingness to view the tailored advice might be because of low interest, mistrust in health services, fear of receiving bad news, or a belief that mental health issues are not personally relevant.”

Of personnel who chose not to heed the tailored advice, however, only 15% had a score suggesting PTSD, anxiety, or depression, and a quarter had a score suggesting alcohol use disorder.

Meanwhile, 83% of the soldiers with PTSD and 84% of soldiers with depression did choose to receive the tailored advice, compared with 64% of soldiers with none of the screened conditions. 

At follow-up, the rates of PTSD, depression, anxiety, or alcohol misuse did not significantly differ in the two groups, nor did the percentage of personnel seeking help for mental health conditions.

“Possible explanations for the ineffectiveness of post-deployment screening include the heterogeneity of evolution of mental disorders over time, possible absence of interest in engaging with services in some cases and potential unwillingness to continue treatment among those who engage with services,” the researchers wrote. “The findings from this study do not support the introduction of this type of post-deployment screening for mental disorders in the UK Armed Forces.”

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Rona R, Burdett H, Khondoker M, et al. Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial [published online February 16, 2017]. The Lancet. doi:10.1016/ S0140-6736(16)32398-4