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Values

Percent

Values

Percent

Traumatic Stress

15 / 488

2.98%

42 / 457

8.42%

Depression (PHQ)

5 / 502

0.99%

26 / 478

5.16%

General Distress (K6)

4 / 503

0.79%

24 / 479

4.77%

Anger Scale

44 / 456

8.64%

97 / 402

19.44%

Any of the above

53 / 448

10.58%

110 / 379

22.49%

While the 120-day rates in the matched sample of 509 are lower than rates reported in other comparative samples at the same time point [14], the results nonetheless show that psychological symptoms increase during the time from immediate reintegration to 120 days post-reintegration. This, in turn, suggests psychological screening may be particularly useful at 90 to 120 days post-reintegration relative to being conducted immediately at reintegration. Based on these results, the Commanding General of the US Army, Europe (USAREUR) tasked the Europe Regional Medical Command (ERMC) to develop a plan to screen all USAREUR Soldiers at 90 to 120 days after returning from a combat deployment.

6. Program Implementation

The first Army unit to be affected by this plan, the 1st Armored Division (1AD), adopted the USAMRU-E's newly developed short screen for their 120 day post-deployment screening program. The 1AD was able to implement the plan using primarily Division medical resources. Execution was delegated to Brigade Surgeons and in a little over two weeks nearly 6,000 Soldiers were screened. Estimates from this screening experience can be made to predict the impact of screening combat Soldiers at post-deployment on mental health resources.

Specifically, from this experience, it is estimated that 27.5% of every 1000 combat Soldiers screened at post-deployment will score above cut-off criteria. Furthermore, we can estimate that for every 1,000 Soldiers, 28 Soldiers will require immediate referral to assess for harm to self or others; 8 Soldiers will be referred for alcohol problems; 17 Soldiers will be referred for family/relationship problems; 69 will require a standard mental health care appointment; and 153 will not require any referral, will refuse care, or will be lost to follow-up.

Subsequent to the 1AD implementation of the screening program, the US Army, Europe screening program was noted by the Office of the Secretary of Defense for Health Affairs and a 26 January 2005 press release announced the wide-scale implementation of the screening program. On 10 March 2005, an official policy letter was signed, mandating 120-day post-deployment screening across the entire military [15]. The actual screening tool to conduct this screening is currently under consideration. USAMRU-E meanwhile is still engaged in further refining measures and optimal cut-off scores.

7. Future Directions

USAMRU-E is engaged in re-validating the short screen and improving the measurement of alcohol problems and relationship problems. In addition, USAMRU-E is assessing a short, valid screen for sleep problems because research with the 1AD showed there were high prevalence rates of sleep problems particularly among those Soldiers with high combat exposure. Finally, USAMRU-E has just conducted the first program evaluation of the screening program. This program evaluation is one part of an additional goal to determine the impact screening has on the stigma associated with mental health problems and on perceptions of barriers to care. Through the development of an efficient one-page screening tool, recommendations for a brief structured clinical interview, and procedures that may help reduce stigma and other barriers to care, the USAMRU-E psychological screening program of research is geared to meet the needs of service members across the deployment cycle.

References

[1] Wright, K.M., Huffman, A. H., Adler, A. B., & Castro, C. A. (2002, October). Psychological screening program overview. Military Medicine, 167, 853-861.

[2] Adler, A.B., Huffman, A.H., Bliese, P.D., Castro, C.A. (2005). The impact of deployment length and experience on the well-being of male and female soldiers. Journal of Occupational Health Psychology, 10(2), 121-137.

[3] Adler, A.B., Wright, K.M., Huffman, A.H., Thomas, J.L. & Castro, C.A. (2002). Deployment cycle effects on the psychological screening of soldiers. U.S. Army Medical Department Journal, 4/5/6, pp. 31-37.

[4] Wright, K.M., Thomas, J.L., Adler, A.B., Ness, J.W., Hoge, C.W., & Castro, C.A. (2005). Psychological screening procedures for deploying U.S. Forces. Military Medicine 170.

[5] Martinez, J.A., Huffman, A.H., Adler, A.B., & Castro, C.A. (2000). Assessing psychological readiness in U.S. soldiers following NATO operations. International Review of the Armed Forces Medical Services, 73, 139-142.

[6] American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.

[7] Bliese, P.D., Wright, K.M., Adler, A.B., Thomas, J.L. (2004). Validation of the 90 to 120 day post-deployment psychological short screen (U.S. Army Medical Research Unit-Europe Research Report 2004002). Heidelberg, Germany: USAMRU-E.

[8] Bliese, P.D., Wright, K.M., Adler, A.B., Thomas, J.L., & Hoge, C.W. (2004). Screening for traumatic stress among re-deploying soldiers (U.S. Army Medical Research Unit-Europe Research Report 2004-001). Heidelberg, Germany: USAMRU-E.

[9] Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The MiniInternational Neuropsychiatry Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22-33.

[10] Weathers, F.W., Litz, B.T., Herman, D.S., Huska, J.A, Keane, T.M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, San Antonio.

[11] Prins, A., Ouimette, P. Kimerling, R., Cameron, R.P., Hugleshofer, D.S., Shaw-Hegwer, et al. (2004). The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Primary Care Psychiatry, 9 (1), 9-14.

[12] Spitzer, R.L., Kroenke, K., & Williams, J.BW., and the Patient Health Questionnaire Primary Care Study Group. (1999, November). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Journal of American Medical Association, 252(18), 1737-1744.

[13] Zung, W. W. K. (1965). A Self-Rating Depression Scale. Archives of General Psychiatry, 12, 63-70.

[14] Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I., & Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13-22.

[15] Assistant Secretary of Defense for Health Affairs Memorandum, Policy for Department of Defense Post-deployment Health Assessment, March 10, 2005.

Acknowledgments

We thank Ms. Rachel Prayner, Ms. Angela Salvi, Ms. Andrea Bellis, Ms. Kelley Rice, SGT Deena Carr, and SPC Nicol Sinclair for their technical support and gratefully acknowledge the support of the Europe Regional Medical Command (ERMC); the Southern European Task Force (SETAF); COL Richard Trotta, Commander, Vicenza Health Clinic and CPT Robert Johnson, Division Psychologist, 1st Infantry Division.

Novel Approaches to the Diagnosis and Treatment of Posttraumatic Stress Disorder 87

© 2006 IOS Press. All rights reserved.

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