PENTAGON—A newly published study shows that psychiatric and behavioral health disorders were reduced by 78% in Army brigades that underwent a pre-deployment health screening program that focused on screening and then linking soldiers to care in theater, if needed.

The study, which was conducted by Army personnel and involved the 3rd Infantry Division’s deployment to Iraq in 2007-2008, was published last month in the American Journal of Psychiatry.

“We are excited about what this study showed,” Army Deputy Surgeon General Maj Gen Patricia Horoho said. “As it is the first direct evidence that a program that combines pre-deployment support and care coordination in theater—involving primary care, unit surgeons, and behavioral health personnel—is effective in preventing adverse behavioral health outcomes during deployment.”

Study Uses Enhanced Screening

Three brigade combat teams (BCTs) of the 3rd Infantry Division underwent an enhanced pre-deployment behavioral health screening process. These teams were compared with three BCTs that did not undergo the same screening. The six BCTs were followed for the first six months of their deployment.

The servicemembers who underwent the screening process used in the study were asked about behavioral health treatment, medication changes within the previous 90 days, and suicidal thoughts prior to deploying. Servicemembers who screened positive were referred to a behavioral health professional, who saw them that day at the Soldier Readiness Processing site at Fort Stewart.

Behavioral health professionals then made a determination whether the soldiers were fit to deploy, fit to deploy with a waiver from the combatant command surgeon, or not fit to deploy. Unit surgeons were then responsible for tracking the soldiers who met requirements to deploy, but needed further behavioral healthcare in theater to proactively ensure that their care plan continued in theater.

The researchers followed 21,031 soldiers who either did or did not receive the pre-deployment mental health screening. They found that only 2.9% of the troops that underwent the screening program presented for psychiatric or behavioral health disorders in the first six months of deployment, compared to 13.2% of those servicemembers in the comparison group.

In addition, soldiers in the pre-deployment screening group also had lower rates of combat operational stress reactions than the comparison group (15.7% versus 22%). They also had lower rates of treatment for behavioral health diagnoses, suicidal ideation, and air evacuation from theater for behavioral health conditions than those who did not undergo the enhanced screening process.

Study Validates Prescreening and Care Coordination in Theater

Traditionally, behavioral health screenings focused on whether or not the servicemember met the deployment criteria. In this study the co-authors explained that the screening process was also used to proactively link those who were deemed fit to deploy, but needed continued help, with the continuity of care in theater that they needed.

The BCT surgeons and division psychiatrist were required to track and monitor all of the soldiers during their deployment and to coordinate in-theater care for those on medications and those who received waivers. “Instead of focusing on those who can’t deploy, what [the study] did is it really focused on ensuring that we had the right treatment plan and support plan in place for those who could deploy, and that we maintained and coordinated that from garrison into theater,” said Horoho.

Of the 10,678 soldiers who underwent the pre-deployment screening in the study, 48 were deemed unfit to deploy, 26 had their deployment delayed, and 96 were cleared for deployment with a waiver. The remaining 649 who screened positive were deemed fit to deploy without a waiver. Care was coordinated in-theater for all 771 soldiers who deployed after the behavioral health evaluation.

Horoho said that the study provides the first direct evidence to support the use of a service-wide program of pre-deployment behavioral health screening following the model used in the study.

The results of the study tie in with new requirements for enhanced pre- and post-deployment care coordination being implemented as part of the Comprehensive Behavioral Health System of Care Campaign Plan, which standardizes, synchronizes, and coordinates behavioral healthcare across the Army.

The primary co-authors of the study were Col George N Appenzeller, MD, then division surgeon of the 3rd Infantry Division and now commander of the Army hospital in Alaska, and Maj Christopher H Warner, MD, then the division’s staff psychiatrist and now a student in the Army Command and General Staff College.

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