Recommendations for follow-up care during post-deployment screening of Canadian Armed Forces personnel: how well does self-reported mental health predict referral decisions?

Abstract

Objective: Canadian Armed Forces (CAF) post-deployment screening aims to facilitate early care for members with mental health issues. The process consists of a questionnaire to screen for mental health problems, followed by an interview with a healthcare provider during which recommendations for follow-up care are provided if needed. In this study, we examined the association of self-reported mental health from the screening questionnaire with recommendation for follow-up care during the interview.

Design: Using screening data collected from CAF members who deployed from 2009 to 2012 (n=14 957), logistic regression analysis was conducted to examine the association of self-reported mental health from the screening questionnaire with clinicians' recommendation for follow-up care.

Results: In total, 19.7% of screened individuals were recommended for follow-up care. In the adjusted logistic regression model, some demographic characteristics, as well current and prior mental healthcare and self-reported mental health problems, had a substantial association with recommendation for follow-up. Compared with each mental health problem's lowest severity category, recommendation for follow-up care was higher by approximately 12%-17% for those with mild to severe depression, 7% for those with panic disorder, 8%-10% for those with mild to severe anxiety, 8% for those experiencing high levels of stressors, 4%-10% for those at risk of alcohol use disorder and 7%-12% for those at risk of post-traumatic stress disorder.

Conclusions: Although the presence of mental health problems was significantly associated with receiving a follow-up recommendation, the relationships between self-reported mental health and subsequent recommendations for care were not as high as expected. Although this may partly reflect time delays between the questionnaire and interview, further research is needed on the extent to which other factors contributed to referral decisions.

Keywords: anxiety disorders; depression & mood disorders; epidemiology; mental health.