By Annette M. Boyle

Spc. Jack Buckwalter, a mental health specialist with HHC, 1st ACB, 1st Cav. Div., provided triage to a soldier during a behavioral health assessment at Troop Medical Clinic 12 at Hood Army Airfield, TX. Photo by Sgt. Christopher Calvert

Spc. Jack Buckwalter, a mental health specialist with HHC, 1st ACB, 1st Cav. Div., provided triage to a soldier during a behavioral health assessment at Troop Medical Clinic 12 at Hood Army Airfield, TX. Photo by Sgt. Christopher Calvert

BETHESDA, MD — In the wake of record-high suicide rates, the Army instituted a number of programs to identify and treat mental illness among soldiers.

New research indicates that DoD might be on the right track. Recent findings suggested that almost 80% of soldiers with mental disorders are not receiving any treatment whatsoever.

Rates of current treatment were lowest among soldiers with major depressive disorder at 26.6% and those with externalizing disorders, at an average of 20.6%. In contrast, at least 40% of soldiers with bipolar disorder and panic disorder were receiving treatment.

Overall, only 21.3% of soldiers with any mental illness were receiving any current treatment, according to a study published in the October issue of Military Medicine.1

The new data comes from a de-identified survey component of the Army Study to Assess Risk and Resilience in Service members (Army STARRS), a large, multicomponent epidemiological-neurobiological study of risk and resilience factors for suicide. The self-administered questionnaire went to a representative sample of nondeployed regular Army soldiers in the last three quarters of 2011. The survey had a 65% completion rate.

Survey respondents completed the Composite International Diagnostic Interview screening scales and a modified version of the post-traumatic stress disorder checklist to determine current mental disorders. They were also asked how many months in the past year each identified disorder had caused problems for them and how seriously they interfered with their functioning at home, work, social life and personal relationships.

Respondents were considered to be in current treatment if they had received medication, psychological counseling or spiritual counseling in the past 12 months and had responded positively to a follow-up question that asked whether they were still in treatment. Those in counseling were asked to specify whether they received care from a mental health professional, general medical professional, spiritual adviser or self-help group.

Researchers led by U.S. Public Health Service Capt. Lisa Colpe, PhD, MPH, chief of the Office of Clinical and Population Epidemiology Research in the Division of Services and Intervention Research at the National Institute of Mental Health, found that seven characteristics predicted whether someone would be in treatment.

The factors included being or having been married, not being non-Hispanic black, history of deployment, diagnoses of bipolar disorder or panic disorder, having any disorder for an extended period of time and having PTSD. The more factors a soldier had, the higher the likelihood of current treatment, with PTSD given twice the weight of other variables.

Soldiers who had six or seven factors comprised 15% of the total sample, but 25% of those reported that they were receiving care. Of them, 71.5% were in treatment, whereas only 32.2% of those with four or five factors were receiving therapy and 11.4% of those with two or three of the variables. Less than 5% of those with only one factor were currently receiving treatment.

“We attempted to identify a set of characteristics that could be used to help target groups who aren’t getting services,” said Colpe, but the study showed that the few soldiers had a high number of predictors.

[Click image to Enlarge]  Proportions of Cases Treated in Each Treatment Sector Among Soldiers With a 30-Day DSM-IV Mental Disorder Who Are Currently in Treatment in the Army STARRS Q2–4 2011 AAS (n = 324)  *Significant association between number of disorders and proportional treatment in the sector based on a 0.05-level 2-sided test. a AAS respondents within each row who are currently receiving any mental health treatment. (b) Mental health specialty defined as treatment by a psychiatrist, psychologist, drug or alcohol counselor, mental health counselor or social worker, or marriage and family counselor. psychologist, drug or alcohol counselor, mental health counselor or social worker, or marriage and family counselor. (c) General medical defined as treatment either by a military medic or by a general medical doctor, nurse, or physician’s assistant. (d) Human services defined as counseling by a military chaplain or by a civilian minister, priest, rabbi, or other spiritual advisor. (e) Self-help defined as participating in a self-help or support group (without a mental health professional running the group) either at a military facility or associated with the military, or in a civilian self-help or support group. (f) Weighted “row” percentages denoting the proportion of AAS respondents within each row who are currently receiving each type of mental health treatment.

[Click image to Enlarge]
Proportions of Cases Treated in Each Treatment Sector Among Soldiers With a 30-Day DSM-IV Mental Disorder Who Are Currently in Treatment in the Army STARRS Q2–4 2011 AAS (n = 324)
*Significant association between number of disorders and proportional treatment in the sector based on a 0.05-level 2-sided test. a AAS respondents within each row who are currently receiving any mental health treatment. (b) Mental health specialty defined as treatment by a psychiatrist, psychologist, drug or alcohol counselor, mental health counselor or social worker, or marriage and family counselor. psychologist, drug or alcohol counselor, mental health counselor or social worker, or marriage and family counselor. (c) General medical defined as treatment either by a military medic or by a general medical doctor, nurse, or physician’s assistant. (d) Human services defined as counseling by a military chaplain or by a civilian minister, priest, rabbi, or other spiritual advisor. (e) Self-help defined as participating in a self-help or support group (without a mental health professional running the group) either at a military facility or associated with the military, or in a civilian self-help or support group. (f) Weighted “row” percentages denoting the proportion of AAS respondents within each row who are currently receiving each type of mental health treatment.

As she and her colleagues noted in the study, “untreated soldiers are not concentrated in a particular segment of the population that might be targeted for special outreach efforts,” which will make reaching them more challenging.

Overall, “treatment rates are pretty low. It’s only when you look at disorders that are severely impairing or long in duration that treatment rates get above 50%, and even then, only for certain disorders,” Colpe told U.S. Medicine.

Of those soldiers who considered their mental disorder “severely impairing,” 32% were receiving treatment, twice the rate of those who did not think it severely affected their ability to function effectively. Severe impairment doubled the treatment rate, regardless of type of disorder (internalizing or externalizing), although less than 40% of those with any externalizing disorder were currently in treatment.

Among those with internalizing disorders who considered the condition severely impairing, 59% with panic disorder were in treatment, as were 52% of those with PTSD. Nearly 47% of soldiers with severely impairing bipolar disorder said they were currently receiving treatment, as did 43.8% of those with generalized anxiety disorder. Only 29% of those with severe impairment from major depression said they were in treatment.

“The comparatively high treatment rates associated with PD, BPD, PTSD and GAD among the internalizing disorders might reflect higher levels of psychological distress associated with those disorders,” the authors said. Soldiers might also see symptoms of these disorders as more “understandable consequences of military life and legitimate reasons for seeking treatment,” they noted.

While direct comparison of the Army data with civilian data is challenging, civilians who rate their conditions as severe are also twice as likely to be in treatment than those who say it is mild, according to Colpe.

The rate of treatment within the Army cohort might be so low for reasons also seen in the general population: “The demographics of the soldier population, with 90% under the age of 40 and 42% under the age of 25, and 85% male, are characteristics associated with lower treatment rates in the civilian population, too,” she pointed out.

1 Colpe LJ, Naifeh JA, Aliaga PA, Sampson NA, Heering SG, Stein MB, et al. Mental Health Treatment Among Soldiers with Current Mental Disorders in the Army Study to Assess Risk and Resilience in Service Members (Army STARRS). Military Medicine. 2015. 180, 10:1041-1051.