States: Alaska, Washington
Client(s): Dept. of Defense, TRICARE Management Activity
Services: Health Care & Public Health Planning, Applied Research & Evaluation
Technical Expertise: Behavioral Health, Health Care Reform
Nearly one million U.S. Soldiers have been deployed to Iraq and Afghanistan in the past five years. The health consequences of deployment are great, including an array of mental health problems. Research conducted after deployment has shown that military personnel are at increased risk for mental and physical health problems including post-traumatic stress disorder (PTSD), depression, substance abuse, and injuries. The Department of Defense established the Post-Deployment Health Re-Assessment Program, or PDHRA, which assesses Soldiers 3-6 months after return, to facilitate the delivery of mental health care.
The Post-Deployment Health Reassessment program (PDHRA) was designed to improve service members' access to care following deployment. JSI was contracted to evaluate the PDHRA and provide feedback on the implementation and the program's educational efforts to combat stigma as well as improve the overall effectiveness of the screening, referral, and engagement process. The evaluation documented the validity of the initial screening process, the Post-Deployment Health Assessment (PDHA) as well as the PDHRA. The study also evaluated the systems used to implement the PDHRA in order to identify the most effective process. In addition, JSI assisted the Department of Defense in developing health surveillance reports for the PDHRA process.
Consistent with other studies, JSI researchers found an increase in prevalence of PTSD, depression and family/work conflicts in the 3-6 months post-return. A substantial number of Soldiers had symptoms that persisted over time or emerged only a few months post-deployment. Co-existing deployment-related psychological or physical traumas were related to all three mental health outcomes. Further, results suggested that many Soldiers received primary care referrals for the initial evaluation of their mental health concerns rather than being referred for to treatment by mental health clinicians. This is a potential problem, as research has documented the weakness of the general medical system in providing adequate MH treatment. A further issue is that health providers referred only half of those Soldiers interested in receiving information/assistance for their mental health problems, implying a general need to examine the Soldier-clinician encounter around referrals; specifically, how to balance provider judgments against Soldiers' perceived needs.
Overall, Soldiers reported being satisfied with the PDHRA screening program. The project's survey revealed relatively high levels of satisfaction with the instruments used in the process and the encounter with the PDHRA clinicians. However, many Soldiers were concerned about the impact of reporting MH concerns on their military careers. Even though programs are in place at some bases to reduce stigma towards mental illness, Soldiers still reported stigma as a problem.