Characteristics of Deployed Operation Iraqi Freedom Military Personnel Who Seek Mental Health Care

Military Medicine, Feb 2008 by Felker, Bradford, Hawkins, Eric, Dobie, Dorcas, Gutierrez, Jorge, McFall, Miles

ABSTRACT Introduction: This study reports on the feasibility of using validated mental health screening instruments for deployed Operation Iraqi Freedom military personnel. Methods: For a 3-month period in 2005, all service members (N = 296) who initially presented to the U.S. Military Hospital Kuwait mental health clinic completed an intake questionnaire that gathered demographic information and contained validated instruments to screen for mental disorders and functional impairment. Results: A total of 19% of the sample subjects screened positive for post-traumatic stress disorder-related symptoms, 35% for a major depressive disorder, and 11% for severe misuse of alcohol. Significant levels of distress and functional impairment were reported by 58% of the sample. Women represented a disproportionately high percentage of those presenting for care (27%). Conclusions: Screening instruments were well accepted and useful in detecting psychopathological conditions and functional impairment. Female service members might represent a high-risk group. These results are useful for those caring for service members during or after deployment.

INTRODUCTION

Large, population-level, screening studies have reported on the mental health status of active duty service members following their return from deployment with Operation Iraqi Freedom (OIF).'2 More than 19% of active duty soldiers reported a mental health problem and 35% of OIF veterans accessed mental health services in the year after returning home.2 There have been few reports to date detailing mental health care in a deployed environment. One report described a functioning outpatient mental health clinic.3 That Air Force mental health clinic was part of a large expeditionary medical hospital stationed in southern Iraq. The authors described an approach to delivering mental health care that led to a 92% return-to-duty rate, with only seven soldiers requiring temporary restrictions.3 The authors also made many practical recommendations for deployed mental health teams.3

Well-validated screening instruments for common mental disorders are increasingly being used in clinical practice. However, there are no reports of these instruments being used in a deployed combat-zone environment. This report describes the feasibiUty of using common, weU-vaüdated, screening measures and describes the demographic and chnical characteristics of a sample of active duty, OIF, military personnel who sought mental health care while deployed.

METHODS

All service members voluntarily presenting for initial mental health care between May and July 2005 at the U.S. Military Hospital Kuwait mental health clinic, based at Camp Arifjan Kuwait, were eligible for participation in the study. Of those who presented for care, 98% (n = 296) consented to having their intake mental health screening and demographic information included in this research project. Institutional review board approval was granted by the U.S. Military Hospital Kuwait institutional review board.

The intake questionnaire was a 10-page, self-administered questionnaire that inquired about general demographic features and included several validated scales to screen for common mental disorders and functional impairment. The questionnaire was completed by the patient before evaluation by the mental health care provider. The four-item Primary Care Post-traumatic Stress Disorder (PTSD) Checklist (PCLPC)4 was administered to all participants. Those who scored ≥2 on the PCL-PC then completed the 17-item PTSD Checklist-Military Version (PCL-M).5 A PCL-M score of ≥50 was used to identify those at high risk for past-month PTSD. Depression was assessed by using the nine-item Patient Health Questionnaire (PHQ-9).6 A PHQ-9 score of ≥10 and

Treating clinicians (one psychologist and two psychiatrists) made their diagnoses after reviewing the intake questionnaire and interviewing the patient. Clinicians could thus agree or disagree with results of the screening instruments used in the intake. The clinical diagnoses were considered the standards. A chart review was subsequently conducted by research staff members, to record the primary clinical diagnoses assigned by the mental health care providers. The association between demographic characteristics (age category, gender, and race) and clinical screen outcomes (AUDrT-C, PHQ-9, PCL-M, and LSQ scores) were evaluated in a univariate model by using the χ^sup 2^ statistic.

RESULTS

Demographic and clinical characteristics based on the intake questionnaire are provided in Table I. The majority of the sample subjects (N = 296) were male (73%), Caucasian (66%), between the ages of 18 and 24 years (42%), enlisted (94%), and deployed for

For diagnostic purposes, the primary diagnosis recorded in the clinician interview was considered the standard. The most common clinician-made diagnoses are found in Table I and include adjustment disorders (34%), depressive disorders (32%), other anxiety disorders including acute stress disorder but not PTSD (13%), and PTSD (12%). In most cases, diese clinician-made diagnoses closely mirrored those detected with the screening instruments. However, this was not true for PTSD (PCL-PC positive, 51%; PCL-M positive, 19%; clinician-reported PTSD, 12%) and for past-year severe alcohol misuse (AUDIT-C positive, 11%; clinician-reported substance abuse/dependence, 1%).