Mental Health Requirement Of Soldiers Grows Long After Returning From Iraq

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Main Category: Anxiety / Stress
Also Included In: Psychology / Psychiatry;  Mental Health
Article Date: 13 Nov 2007 - 13:00 PDT

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The mental health needs of American soldiers returning from Iraq are greater a few months after their initial screening, according to an article in the Journal of the American Medical Association (JAMA), November 14th issue. Such problems as PTSD (post-traumatic stress disorder) and depression are the most common.

The researchers explain "Our previous article described the Department of Defense's (DoD) screening efforts to identify mental health concerns among soldiers and Marines as they return from Iraq and Afghanistan using the Post-Deployment Health Assessment (PDHA). However, the article also raised concerns that mental health problems might be missed because of the early timing of this screening. It cited preliminary data showing that soldiers were more likely to indicate mental health distress several months after return than upon their immediate return. Based on these preliminary data, the DoD initiated a second screening similar to the first, to occur 3 to 6 months after return from deployment."

Charles S. Milliken, M.D., Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command, Silver Spring, Md., and team looked at the mental health responses of the initial cohort of soldiers, 88,235 in total, who had completed initial screening and then a new later screening. There was a median (midpoint) of 6 months between the first and second screenings. Both assessments consisted of a short interview with a clinician as well as a self-report questionnaire.

More reports of PTSD, major depression and/or alcohol misuse were reported after then second screening, say the researchers.

4.4% (3,925) of the soldiers were referred for mental health care as a result of the first screening, while another 11.7% (10,288) were referred after the second screening. After analyzing combined data (from the two screenings), 20.3% of active and 42.4% of reserve soldiers were identified as needing referral or already being treated for mental health problems.

As far as the active soldiers were concerned, the use of mental health services grew significantly after the second screening, especially within a month of the assessment. 74% of soldiers who accessed mental health care had not been identified as needing referral.

Interpersonal conflict concerns quadrupled between the two screenings. Alcohol problems were commonly reported, yet a very small number were ever referred to alcohol treatment.

Despite the fact that many more soldiers were likely to report PTSD symptoms on the second screening, 49%-59% of those who had PTSD symptoms identified during the first screening got better by the time the second screening took place. This, say the researchers, suggests that the increase was mainly due to new symptoms being reported.

The researchers explain "The study shows that the rates that we previously reported based on surveys taken immediately on return from deployment substantially underestimate the mental health burden. This emphasizes the enormous opportunity for a better-resourced DoD mental health system to intervene early before soldiers leave active duty."

"Increased relationship problems underscore shortcomings in services for family members. Reserve component soldiers who had returned to civilian status were referred at higher rates on the (later screening), which could reflect their concerns about their ongoing health coverage. Lack of confidentiality may deter soldiers with alcohol problems from accessing treatment. In the context of an overburdened system of care, the effectiveness of population mental health screening was difficult to ascertain."

JAMA. 2007;298(18):2141-2148
http://jama.ama-assn.org

Written by - Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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