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

Bibliographic Data

ID11031802
AuthorsKaren H Seal (0000-0002-6676-9117, Karen H. Seal, Charles R. Marmar, and Shira Maguen are with the San Francisco Veterans Administration Medical Center and the University of California, San Francisco, and are affiliated with the San Francisco Veterans Administration Health Services Research and Development Research Enhancement Award Program. Daniel Bertenthal, Kristian Gima, and Ann Chu are with the San Francisco Veterans Administration Medical Center.), Daniel Bertenthal (0000-0002-8469-3259, Karen H. Seal, Charles R. Marmar, and Shira Maguen are with the San Francisco Veterans Administration Medical Center and the University of California, San Francisco, and are affiliated with the San Francisco Veterans Administration Health Services Research and Development Research Enhancement Award Program. Daniel Bertenthal, Kristian Gima, and Ann Chu are with the San Francisco Veterans Administration Medical Center.), Shira Maguen (0000-0002-1234-7234, Karen H. Seal, Charles R. Marmar, and Shira Maguen are with the San Francisco Veterans Administration Medical Center and the University of California, San Francisco, and are affiliated with the San Francisco Veterans Administration Health Services Research and Development Research Enhancement Award Program. Daniel Bertenthal, Kristian Gima, and Ann Chu are with the San Francisco Veterans Administration Medical Center.), Kristian Gima (Karen H. Seal, Charles R. Marmar, and Shira Maguen are with the San Francisco Veterans Administration Medical Center and the University of California, San Francisco, and are affiliated with the San Francisco Veterans Administration Health Services Research and Development Research Enhancement Award Program. Daniel Bertenthal, Kristian Gima, and Ann Chu are with the San Francisco Veterans Administration Medical Center.), Ann T Chu (0000-0003-3467-0400, United States Department of Veterans Affairs), Ann Chu (Karen H. Seal, Charles R. Marmar, and Shira Maguen are with the San Francisco Veterans Administration Medical Center and the University of California, San Francisco, and are affiliated with the San Francisco Veterans Administration Health Services Research and Development Research Enhancement Award Program. Daniel Bertenthal, Kristian Gima, and Ann Chu are with the San Francisco Veterans Administration Medical Center.), Charles R Marmar (0000-0001-8427-5607, Karen H. Seal, Charles R. Marmar, and Shira Maguen are with the San Francisco Veterans Administration Medical Center and the University of California, San Francisco, and are affiliated with the San Francisco Veterans Administration Health Services Research and Development Research Enhancement Award Program. Daniel Bertenthal, Kristian Gima, and Ann Chu are with the San Francisco Veterans Administration Medical Center.)
Year2008
Volume98
Issue4
Pages714-720
Publication date2008-04-01
Open AccessNo
TypeARTICLE
VenueAmerican Journal of Public Health (JOURNAL)
Journal identifiersISSN: 0090-0036 • E-ISSN: 1541-0048
PublisherAmerican Public Health Association (PUBLISHER • US)
DOI10.2105/ajph.2007.115519
PMID18309130
PMCIDPMC2377001
OpenAlexW2103132674
LanguageEN
Citations received16
References cited20

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

Afghan · Anxiety · Attendance · Depression (economics) · Family medicine · Mental health · Patient Health Questionnaire · Psychiatry · Psychological intervention · Public health · Veterans Affairs · Healthcare professionals’ stress and burnout · Internal Medicine · Medicine · Mental Health Treatment and Access · Nursing · Posttraumatic Stress Disorder Research

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