Does screening shorten delays to care for post-deployment mental disorders in military personnel? A longitudinal retrospective cohort study

Boulos, David; Garber, Bryan G.

doi:10.1136/bmjopen-2020-037853

Cited by 5 publications

(3 citation statements)

References 33 publications

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“… 1 2 6–9 Moreover, recent research has observed that postdeployment screening in the CAF resulted in a shorter delay to care among those who, subsequent to their deployment return, had been diagnosed with a mental disorder that was assessed to be deployment related. 14 …”

Section: Introductionmentioning

confidence: 99%

“…The goal of this screening is to facilitate early detection and care-seeking for service members with a potential need for services following their deployment 1 2 6–9. Moreover, recent research has observed that postdeployment screening in the CAF resulted in a shorter delay to care among those who, subsequent to their deployment return, had been diagnosed with a mental disorder that was assessed to be deployment related 14…”

Section: Introductionmentioning

confidence: 99%

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Does recommended mental health follow-up care occur after postdeployment screening in the Canadian Armed Forces? A retrospective cohort study

Boulos

Garber

2023

BMJ Open

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ObjectiveTo determine Canadian service members’ level of adherence to a recommendation for mental health services follow-up that was assigned by clinicians during postdeployment screening.DesignRetrospective cohort study.SettingCanadian military population.ParticipantsThe cohort consisted of personnel (n=28 460) with a deployment within the 2009–2014 time frame. A stratified random sample (n=3004) was selected for medical chart review. However, we restricted our analysis to individuals whose completed screening resulted in a recommendation for mental health services follow-up (sample n=316 (weighted n=2034) or 11.2% of screenings.InterventionsPostdeployment health screening.Primary outcome measureThe outcome was adherence to a screening-indicated mental health services follow-up recommendation, assessed within 90 days, a preferred delay, and within 365 days, a delay considered partially associated with the screening recommendation.ResultsAdherence within 90 days of screening was 71.1% (95% CI 59.7% to 82.5%) for individuals with ‘major’ mental health concerns, 36.1% (95% CI 23.9% to 48.4%) for those with ‘minor’ mental health concerns, and 46.8% (95% CI 18.6% to 75.0%), for those with psychosocial mental health concerns; the respective 365-day adherence fractions were 85.3% (95% CI 76.1% to 94.5%), 55.7% (95% CI 42.0% to 69.4%) and 48.6% (95% CI 20.4% to 76.9%). Logistic regression indicated that a 90-day adherence among those with a ‘major’ mental health concern was higher among those screening after 2012 (adjusted OR (AOR) 5.45 (95% CI 1.08 to 27.45)) and lower, with marginal significance, among those with deployment durations greater than 180 days (AOR 0.35 (95% CI 0.11 to 1.06)).ConclusionsOn an individual level, screening has the potential to identify when a care need is present and a follow-up assessment can be recommended; however, we found that adherence to this recommendation is not absolute, suggesting that administrative checks and possibly, process refinements would be beneficial to ensure that care-seeking barriers are minimised.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does recommended mental health follow-up care occur after postdeployment screening in the Canadian Armed Forces? A retrospective cohort study

Boulos

Garber

2023

BMJ Open

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“…It consists of a questionnaire to screen for health issues, followed by a semi-structured interview with a mental healthcare provider during which the results of the questionnaire are reviewed and recommendations for follow-up care are made, as required. A recent study found that among CAF members with a diagnosed mental health problem, those who had completed post-deployment screening had a shorter delay to care compared with those who had not; moreover, within those screened, receiving a recommendation for mental healthcare follow-up in the post-deployment screening interview was associated with reduced delays to care compared with not having a recommendation 8. Such findings indicate that post-deployment screening is meeting its goals of facilitating early access to care in those with mental health issues—that is, screening itself reduces the delay to care, and the actual outcome of screening (ie, a recommendation for follow-up care) drives this association.…”

Section: Introductionmentioning

confidence: 99%

Recommendations for follow-up care during post-deployment screening of Canadian Armed Forces personnel: how well does self-reported mental health predict referral decisions?

2023

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ObjectiveCanadian Armed Forces (CAF) post-deployment screening aims to facilitate early care for members with mental health issues. The process consists of a questionnaire to screen for mental health problems, followed by an interview with a healthcare provider during which recommendations for follow-up care are provided if needed. In this study, we examined the association of self-reported mental health from the screening questionnaire with recommendation for follow-up care during the interview.DesignUsing screening data collected from CAF members who deployed from 2009 to 2012 (n=14 957), logistic regression analysis was conducted to examine the association of self-reported mental health from the screening questionnaire with clinicians’ recommendation for follow-up care.ResultsIn total, 19.7% of screened individuals were recommended for follow-up care. In the adjusted logistic regression model, some demographic characteristics, as well current and prior mental healthcare and self-reported mental health problems, had a substantial association with recommendation for follow-up. Compared with each mental health problem’s lowest severity category, recommendation for follow-up care was higher by approximately 12%–17% for those with mild to severe depression, 7% for those with panic disorder, 8%–10% for those with mild to severe anxiety, 8% for those experiencing high levels of stressors, 4%–10% for those at risk of alcohol use disorder and 7%–12% for those at risk of post-traumatic stress disorder.ConclusionsAlthough the presence of mental health problems was significantly associated with receiving a follow-up recommendation, the relationships between self-reported mental health and subsequent recommendations for care were not as high as expected. Although this may partly reflect time delays between the questionnaire and interview, further research is needed on the extent to which other factors contributed to referral decisions.

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Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective

Fikretoglu

Sharp

Adler

et al. 2022

Clinical Psychology Review

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Does screening shorten delays to care for post-deployment mental disorders in military personnel? A longitudinal retrospective cohort study

Cited by 5 publications

References 33 publications

Does recommended mental health follow-up care occur after postdeployment screening in the Canadian Armed Forces? A retrospective cohort study

Does recommended mental health follow-up care occur after postdeployment screening in the Canadian Armed Forces? A retrospective cohort study

Recommendations for follow-up care during post-deployment screening of Canadian Armed Forces personnel: how well does self-reported mental health predict referral decisions?

Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective

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