Identifying Soldiers for behavioral health problems before they deploy, and then coordinating continuing care for them while they are overseas, can reduce suicidal thoughts, psychiatric disorders and other problems, according to a study published in the American Journal of Psychiatry.
The study was conducted with more than 20,000 Soldiers assigned to Multinational Division-Center in Iraq during 2007 and 2008. Three brigade combat teams of the 3rd Infantry Division were screened for behavioral health issues during the pre-deployment processing at Fort Stewart, Ga. Three brigade combat teams from other installations did not receive the same screening and provided a comparison group.
Only 2.9 percent of the screened troops presented psychiatric or behavioral health disorders in the first six months of deployment, compared to 13.2 percent of the comparison group. These Soldiers also had lower rates of combat operational stress reactions (15.7 percent versus 22 percent), expressing thoughts of suicide (0.4 percent versus 0.9 percent) and gestures toward suicide (0.1 percent versus 0.2 percent). Only 0.6 percent received duty restrictions for behavioral health reasons, and 0.1 percent were evacuated from the theater for those reasons, compared to 1.8 percent and 0.3 percent, respectively, in the comparison group.
Military behavioral health screening in past wars focused on identifying Soldiers who should not deploy. This process differed in that it also attempted to improve care for Soldiers during their deployments.
“… the purpose of this process was to ensure that we were not deploying unsafe Soldiers based on present conditions, and ensuring that we were linking those who were deploying with the in-theater assets so that they could stay in the fight,” said Maj. Christopher H. Warner, then the division’s staff psychiatrist and co-primary investigator for the study, along with Col. George N. Appenzeller, then division surgeon.
Soldiers in the 3rd Infantry Division who were preparing to deploy to Iraq were evaluated by primary-care health professionals and asked about behavioral health treatment, use of medications and suicidal or homicidal thoughts. Those who were identified as needing more screening were interviewed by a psychiatrist, psychologist or licensed clinical social worker. They were evaluated using Department of Defense guidelines established in 2006 to ensure that Soldiers under treatment for behavioral health conditions were stable for deployment, and to facilitate ongoing care for those who required further treatment in the deployed environment. All care was coordinated through the unit health care providers.
“A unique aspect to this study was the requirement for BCT surgeons and the division psychiatrist to track and monitor all of these Soldiers during their deployment and coordinate in-theater care for those on medications and those who received waivers,” Appenzeller said.
Of the 10,678 Soldiers who underwent the pre-deployment screening process, 819 were identified as requiring an evaluation with a behavioral health professional. After evaluation, only 48 were unable to deploy because of a serious behavioral health problem, 26 had their deployment delayed one to two months for behavioral health treatment, and all of the remaining Soldiers with behavioral-health concerns deployed with ongoing support in theater. Soldiers who needed ongoing care were seen regularly by unit medical providers. The program assisted Soldiers to complete the deployment successfully.