Predicting depression and PTSD before deployment could help soldiers cope

A set of validated, self-reported questions administered early in a soldier's career could predict mental health problems such as depression and post-traumatic stress disorder (PTSD) after return from deployment, according to a study published in the open access journal BMC Psychology.

The questions assess 14 psychological attributes such as adaptability, coping ability and optimism. They could be used to identify high-risk individuals and provide them with psychological and social resources to help them cope with stressors of deployment including combat trauma and extended separation from friends and family, researchers at Naval Postgraduate School and Research Facilitation Laboratory, USA suggest.

In addition to scoring psychological health attributes before deployment, the researchers also generated an individual, composite risk score for each soldier using baseline psychological attributes and demographic information such as gender, age, race/ethnicity, marital status, education, and military occupation group. They found that out of those whose score classified them as being at highest risk for psychological health disorders (i.e. at the top 5% of the score), 31% screened positive for depression, while 27% screened positive for PTSD after return from deployment.

Professor Yu-Chu Shen, lead author of the study said: "We found that soldiers who had the worst pre-military psychological health attribute scores - those in the bottom 5% of scores - carried much higher odds of screening positive for depression and PTSD after returning home than the top 95%. Soldiers who score worst before deployment might be more susceptible to developing debilitating mental health disorders when they are later exposed to combat environments."

The findings suggest that psychological screening before deployment, in combination with other personnel information, can be helpful in identifying individuals who carry significant risk for psychological health disorders, according to the authors. Being aware of this risk could enable tailored interventions to increase soldiers' psychological health prior to exposing them to combat. Identifying individuals at risk of adverse psychological outcomes could also translate into savings on costs resulting from treatment and lost productivity.

To investigate the association of psychological attributes in soldiers before deployment and their risk for depression and PTSD after their return, the authors used data from three sources on 63,138 soldiers who enlisted after 2008: the Army's personnel database, pre- and post-deployment health assessments, and the Global Assessment Tool (GAT).

GAT is an annual resilience and psychological health assessment completed by all members of the US Army. It consists of a 105-item questionnaire that captures 14 attributes of health and resilience that are considered important for life in the military. These attributes include optimism and catastrophizing, which may reflect how a person responds to the stress of combat; positive affect and organisational trust, which capture how a person may respond to leadership; and resilience and coping ability.

The authors caution that GAT in its current form is not designed to be used as a screening tool on which employment decisions should be based.

Professor Shen said: "In this study, we illustrate the potential value for psychological health screening such as GAT in public safety and national defense occupations. However, for any strategy based on screenings like this to be successful and effective, we also highlight the importance for future screening tools to be designed to detect and minimize strategic responding - that is personnel adapting their answers if they know that their career progression and chance of deployment may depend on their screening scores. Strategic responding may undermine the effectiveness of a screening tool in identifying the risk for mental health disorders."

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BioMed Central