' More than half of deployed soldiers diagnosed with mental disorders concealed their illnesses when completing a pre-deployment health assessment intended to screen out unfit warriors, according to a newly released military study.
The report, by a career Army epidemiologist, is the first scientific study of how well the pre-deployment form identifies service members with mental health problems. Its findings confirm what military leaders have heard for years: The form alone is of questionable value as a screening tool.
"The results of this study provide strong evidence that relying on self-report alone may be insufficient policy for screening for disqualifying or significant mental health conditions," wrote Army Maj. Remington L. Nevin, the study's author.
But the report found that military health officials relied heavily on those self-reported answers, with soldiers rarely referred for a professional evaluation if they failed to acknowledge seeking mental health care.
At least 230 service members have committed suicide in Iraq and Afghanistan since the U.S. launched the first offensive eight years ago this month. As the wars continue, the study said, valid information on mental health is particularly important as the military faces challenges maintaining troop strength.
"Lowered standards for acceptance of recruits into the military and repeated deployments have combined to significantly increase the prevalence of mental health disorders among U.S. military personnel," Nevin wrote. "As a result, the risk is increased that service members with disqualifying mental health disorders will be inappropriately deployed."
The study, in fact, found that 19 soldiers were sent to Afghanistan despite diagnoses of psychotic or bipolar disorders, which specifically disqualify service members for deployment under Pentagon rules. Nevin said it could not be determined if those soldiers were deployed properly.
Nevin, who served in Afghanistan as a U.S. Army Preventive Medicine physician from January through October 2007, said the military should consider adding a better mental health screening tool at the pre-deployment phase. When soldiers return from deployment, for example, they are asked a series of diagnostic question to help measure their mental health.
The study also called for developing a system to automatically screen medical records for deploying service members to check for mental health issues.
Military officials have acknowledged that the lengthy wars and repeated deployments have strained soldiers' mental well-being. But they say the pre-deployment questionnaire is only one element of a broader effort to identify and help potentially troubled troops.
The Defense Department "seeks to deploy only healthy and fit individuals," said Air Force Col. Michael G. Butel, director of global health surveillance within the office of the assistant secretary of defense for health affairs. "In addition to completion and review of the pre-deployment form, a medical chart review is required and deployment roster names are screened for … current mental health care."
The Pentagon has also launched numerous programs to build mental "resiliency" among troops, combat the stigma associated with mental health care and increase access to care.
The Pentagon maintains detailed electronic health information on all service members. The study released last week marked the first time military officials matched the answers on the pre-deployment form to actual medical records.
The study looked at a sample of more than 11,000 troops deployed to Afghanistan in 2007 and found that 4.2 percent had been formally diagnosed in the previous year with a serious mental health disorder. But of those, only 48 percent answered "yes" to the question: "During the past year, have you sought care or counseling for your mental health?"
That answer was a key factor in determining whether service members were seen by a mental health professional before being deemed deployable, with those answering "yes" more than 30 times more likely to receive a referral than those who answered "no."
But in either case, referrals are extremely rare. The study found that of all deployed troops, only 0.3 percent had been referred for a mental health evaluation. Even among troops known to have been diagnosed with a mental disorder and who acknowledged seeking mental health care, 87 percent were deployed without a referral to a mental health professional. Among those who concealed their treatment, 97 percent were cleared without a mental health evaluation.
The reluctance of service members to acknowledge mental health care matches what military investigators have found in surveys of troops. The Department of Defense Task Force on Mental Health, created by order of Congress, noted in its final June 2007 report that its members "were told on multiple site visits that the validity of the Pre-Deployment Health Assessment suffers because service members underreport their mental health concerns if they are eager to deploy."
The pre-deployment form also asks only if service members have sought treatment, and the study notes a lingering stigma in the military against seeking help. The study cites a 2005 study by military scientists that found that among service members preparing for deployment who screened positive for major depression, generalized anxiety or post-traumatic stress disorder, 86 percent acknowledged to investigators that they had a problem, but only 40 percent expressed interest in getting help.
Congress had ordered the Pentagon to tighten mental health screening after a 2006 series in The Courant reported that the military had deployed and retained mentally ill service members. New policies required that troops with mental health disorders demonstrate a "pattern of stability, without significant symptoms," for at least three months prior to deployment. But there were no significant changes in pre-deployment screening, and the inquiry into whether service members had sought mental health care remains the only mental health question on the pre-deployment form.
When that form was introduced in 1998, a Pentagon official wrote in a memorandum that questions would be tested and validated as the form evolved. He added that "deployment-related mental health screening will be addressed in a separate policy memorandum."
But it never happened, according to Nevin.
"Since this original announcement released over 10 years ago," Nevin wrote in the study, "no such policy memorandum has been issued, and no formal validation of the [pre-deployment form] has been published or undertaken."
STUDY ON SCREENING
Online Therapy Treatment