The Case for Postdeployment Mental Health Screening Was Not Made

The audit evaluation by Seal et al. of the Veterans Administration Postdeployment Mental Health Screening1 demonstrated that half of eligible veterans were not screened (52%) while attending a primary care setting; of those who were screened, the majority were identified as possible cases of posttraumatic stress disorder (69%), but many were not interested in pursuing matters further by attending a mental health facility. Readers are entitled to wonder if the reality was that clinicians, veterans, and administrators were not keen on the screening program itself, because the sampling frame was made up of only those attending primary care facilities, and not all veterans entitled to screening. One might also wonder why the authors only contemplated ways of increasing participation rate in the screening program without reflecting more on the relative lack of enthusiasm in the program. The researchers showed little interest in discussing further the value of a screening program based on fair or only satisfactory sensitivities and specificities, and with low certainty of an accurate diagnosis. It is a pity that the authors did not use the opportunity to raise questions about a costly (in terms of time and resources) screening program that identifies too many veterans with a possible posttraumatic stress disorder but has yet to be assessed for its effectiveness or efficacy. A randomized controlled trial is the only way to assess if a screening program does more good than harm and represents value for money.2,3

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• Getting Beyond “Don’t Ask; Don’t Tell”

  Karen H Seal, Daniel Bertenthal et al.•American Journal of Public Health•2008

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