Screening for physical and psychological illness in the British Armed Forces: I: The acceptability of the programme

Abstract

Objectives:To assess the response to a self-administered questionnaire and attendance of a medical centre for physical and psychological health screening.Methods: 4500 men and women from the three services were randomly selected to receive either a full or abridged screening questionnaire. The full questionnaire included the General Health Questionnaire-12 (GHQ-12) and Post-traumatic Stress Disorder (PTSD) checklist, 15 symptoms, a selfassessed health status question and three questions on alcohol behaviour (WHO Audit). The abridged questionnaire included GHQ-4, a slightly shortened PTSD checklist and five symptoms, but excluded questions on alcohol behaviour. All 'screen-positive' and a random 'screen-negative' sample were invited to attend a medical centre.Results: 67.1% of the servicemen completed a questionnaire; slightly but significantly more the abridged than the full questionnaire (4.9%, 95% confidence interval 2.3-7.4%). Of those receiving a full or abridged questionnaire, 32% and 22.5% respectively were 'screen-positives', most of the difference (7.5%) attributable to alcohol behaviour. Less than 30% of the servicemen invited to attend a medical centre accepted the invitation, even fewer during the preparation for deployment to Iraq. Those who fulfilled the criteria for PTSD, alcohol behaviour or multi-criteria 'screen-positive' were more reluctant than controls to attend. Conclusions:Screening for psychological illness has little support among servicemen, perhaps because they may not wish to share concerns with a military doctor. Avoidance behaviour among those with a psychological condition may also selectively reduce willingness to attend a medical centre. Screening during pre-deployment periods has even less support than at other times.

Screening for physical and psychological illness in the British Armed Forces: III: The value of a questionnaire to assist a Medical Officer to decide who needs help

“…11 All 'screen-positives' and a random sample of 'screen-negatives' were invited to attend their medical centre. The ratio of the two groups was one to one.…”

Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial

“…We have previously demonstrated that predeployment screening in UK service personnel did not lead to an increase in seeking health care and that the prediction of subsequent psychiatric morbidity including PTSD was modest. 28,29 A US study indirectly suggested that screening did not promote help-seeking behaviour among personnel with mental disorders. 30 On the other hand a further US study has shown that pre-deployment review of those who are already being treated for a mental disorder may have an impact on the prevalence of PTSD in deployed US military personnel by either debarring them from deployment or by providing ongoing monitoring for those already receiving health-care.…”

Exploring Patterns in Referrals to Combat Stress for Uk Veterans with Mental Health Difficulties between 1994 and 2014

“…The relationship of stigma in the Armed Forces is complicated by the military culture that places an emphasis on psychological resilience (Rona et al, 2004;Vogt, 2011). For example, it has been observed that soldiers are more likely to attend appointments for physical health problems than appointments for mental health difficulties (French, 2005).…”