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. 2008 Apr;98(4):714-20.
doi: 10.2105/AJPH.2007.115519. Epub 2008 Feb 28.

Getting beyond "Don't ask; don't tell": an evaluation of US Veterans Administration postdeployment mental health screening of veterans returning from Iraq and Afghanistan

Karen H Seal  1 , Daniel Bertenthal, Shira Maguen, Kristian Gima, Ann Chu, Charles R Marmar
Affiliations

Getting beyond "Don't ask; don't tell": an evaluation of US Veterans Administration postdeployment mental health screening of veterans returning from Iraq and Afghanistan

Karen H Seal et al. Am J Public Health. 2008 Apr.

Abstract

Objectives: We sought to evaluate outcomes of the Veterans Administration (VA) Afghan and Iraq Post-Deployment Screen for mental health symptoms.

Methods: Veterans Administration clinicians were encouraged to refer Iraq or Afghanistan veterans who screened positive for posttraumatic stress disorder, depression, or high-risk alcohol use to a VA mental health clinic. Multivariate methods were used to determine predictors of screening, the proportions who screened positive for particular mental health problems, and predictors of VA mental health clinic attendance.

Results: Among 750 Iraq and Afghanistan veterans who were referred to a VA medical center and 5 associated community clinics, 338 underwent postdeployment screening; 233 (69%) screened positive for mental health problems. Having been seen in primary care (adjusted odd ratio [AOR]=13.3; 95% confidence interval [CI]=8.31, 21.3) and at a VA community clinic (AOR=3.28; 95% CI=2.03, 5.28) predicted screening. African American veterans were less likely to have been screened than were White veterans (AOR=0.45; 95% CI=0.22, 0.91). Of 233 veterans who screened positive, 170 (73%) completed a mental health follow-up visit.

Conclusions: A substantial proportion of veterans met screening criteria for co-occurring mental health problems, suggesting that the VA screens may help overcome a "don't ask, don't tell" climate that surrounds stigmatized mental illness. Based on data from 1 VA facility, VA postdeployment screening increases mental health clinic attendance among Iraq and Afghanistan veterans.

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Figures

FIGURE 1—
FIGURE 1—
Mental health appointments scheduled and completed following postdeployment screening among 750 veterans of Operation Iraqi Freedom or Operation Enduring Freedom seen at the San Francisco Veterans Administration Medical Center and associated community-based outpatient clinics: September 11, 2001, to June 30, 2006. Notes. OIF/OEF = Operation Iraqi Freedom or Operation Enduring Freedom; MH = mental health.
FIGURE 2—
FIGURE 2—
The proportions of veterans of Operation Iraqi Freedom or Operation Enduring Freedom who screened positive for symptoms of posttraumatic stress disorder, depression, high-risk alcohol use, and comorbid symptoms: September 11, 2001, to June 30, 2006. Note. PTSD = posttraumatic stress disorder. The proportions presented are those of veterans seen at the San Francisco Veterans Administration Medical Center and associated community-based outpatient clinics who screened positive for mental health symptoms (n = 233).
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References

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