Military Brings Treatment Closer to Troops to Combat Growing Depression Issues

by U.S. Medicine

November 10, 2014

By Sandra Basu

WASHINGTON – Recent military actions in Iraq and Afghanistan have put the spotlight not only on PTSD and TBI, but also on depression, which often co-exists with both conditions.

“The previously rising suicide rate [in the Army] and the known association between suicide and depression was one of the factors that increased attention specifically on depression,” Lt. Col. Chris Ivany, MD, Army chief of behavioral health, told U.S. Medicine.

In response, servicemembers are screened for depression now at much higher rates than in previous conflicts.

“There has been a large effort to make sure there are standardized, high-quality, evidence-based screening tools used at structured points for all of our soldiers. So, a soldier who is in a unit who is deploying is screened prior to their deployment, after they return and screened a third time approximately 90 and 180 days after they return, and that is in addition to an annual screening that takes place. All of these screenings include standardized questions for depression,” Ivany explained.

Moreover, in recent years, the military has worked to bring mental health care closer to troops, which officials see as a way to reduce barriers, such as stigma, to seeking care. An initiative seeks to move small groups of mental health providers from major hospitals to clinics that are located on Army installations near where combat units live and work, Ivany pointed out.

“What we found when we moved to a model that essentially put mental health providers out with the units, as opposed to trying to convince soldiers and officers to come up to the hospital to receive care, was that soldiers used the care more frequently,” he explained.

The military also is reaching troops by screening for depression and PTSD on a regular basis in the primary care setting.

The model, called RESPECT-MIL, was developed by the Army and is being disseminated more broadly within DoD, according to Senior Scientist Charles Hoge, MD, of the Walter Reed Army Institute of Research.

“This has been “one of the most promising approaches to stigma reduction,” Hoge told U.S. Medicine, adding that reducing patients’ sense of shame continues to be a challenge.

In a study published in the American Journal of Public Health, Hoge and his colleagues found increased mental health services utilization and decreased stigma in U.S. soldiers between 2002 and 2011. The trends were evident in soldiers with and without PTSD, major depressive disorder (MDD) or PTSD and MDD; yet, more than half of soldiers with mental health problems did not report seeking care, according to the report.1

“Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of U.S. soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention,” the study authors wrote.

1 Quartana PJ, Wilk JE, Thomas JL, Bray RM, Rae Olmsted KL, Brown JM, Williams J, Kim PY, Clarke-Walper K, Hoge CW. Trends in mental health services utilization and stigma in US soldiers from 2002 to 2011. Am J Public Health. 2014 Sep;104(9):1671-9.

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