MHS Implements Multiple Programs to Improve PTSD and Depression Care

By Annette M. Boyle

Kimberly A. Hepner, PhD, senior behavioral scientist at RAND

SANTA MONICA, CA — In the year since the release of a RAND report critical of follow-up within the Military Health System (MHS) for patients with post-traumatic stress disorder (PTSD) and depression, the DoD has released results of several new programs to improve screening, increase the number of therapeutic visits and track mental health measures.1

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury estimate that up to 20% of the 2.6 million servicemembers who served in the Iraq and Afghanistan conflicts have or will develop PTSD.

At the end of 2014, 2.5% of all active duty servicemembers and 4.3% of those still on active duty who had ever deployed had received a diagnosis of PTSD at some point, but the center noted that many cases of PTSD in the military go undiagnosed and untreated. Studies place the prevalence of major depressive disorder among currently deployed servicemembers at 12% and at 13% among those previously deployed.2

MHS research into improved treatment for PTSD and depression stands to not only improve care for military patients, but to change how civilians receive care as well. “There’s very little in the civilian healthcare world that looks at how patients with PTSD and depression who receive behavioral health services do over time,” explained Kimberly A. Hepner, PhD, senior behavioral scientist at RAND and lead author of the 2016 report.

Posttraumatic Stress Disorder (PTSD)- and Depression-Related Outcomes Among Study Participants

 

 

Screening

The first step in improving treatment and outcomes is identifying patients who need help. The four-question Primary Care PTSD Screen (PC-PTSD) followed by a more in-depth assessment for those who screen positive has been the “gold standard” for PTSD screening. An update to a single question tool (SIPS A and SIPS B) might challenge that position, as both versions of the ultra-brief screen had greater sensitivity and comparable specificity to the PC-PTSD. SIPS A and B and PC-PTSD had similar positive and negative predictive value and diagnostic efficiency, according to a presentation made at the Annual Meeting of the International Society for Traumatic Stress Studies in November.3

“These findings suggest that the SIPS A and SIPS B are promising ultra-brief screening instruments for military primary care,” the authors said. The shorter form provides particular value for high-volume medical facilities treating a patient group with elevated risk. “Population-level screening necessitates a validated PTSD screening tool that minimizes patient and provider burden in busy primary care clinics,” said the presenters.

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