Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial

• Published in: The Lancet (British edition) Vol. 389; no. 10077; pp. 1410 - 1423
• Main Authors: Rona, Roberto J, Prof, Burdett, Howard, PhD, Khondoker, Mizanur, PhD, Chesnokov, Melanie, MA Cantab, Green, Kevin, MSc, Pernet, David, BA, Jones, Norman, PhD, Greenberg, Neil, Prof, Wessely, Simon, Prof, Fear, Nicola T, Prof
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 08-04-2017; Elsevier Limited
• Subjects: Aircraft components; Alcohol; Alcoholic beverages; Alcoholism; Alcohols; Antibodies; Anxiety; Arches; Armed forces; Army; Brain; Clinical trials; Clusters; Cognitive ability; Correlation analysis; Diagnosis; Disorders; Documents; Drug abuse; Ethics; Evidence-based medicine; Grinding mills; Gulf War; Health; Health care access; Health services; Help seeking behavior; Information processing; Internal Medicine; Luteinizing hormone; Medical research; Medical screening; Mental depression; Mental disorders; Mental health; Military; Military deployment; Military medicine; Military personnel; Military psychology; Morbidity; Navy; Nervous system; Neurodegenerative diseases; Pharmacology; Post traumatic stress disorder; Psychiatry; Psychological stress; Psychotherapy; Questionnaires; Randomization; Reproduction (copying); Resilience; Searching; Therapy; Trajectories; Trauma; Traumatic brain injury; War; Working conditions; United Kingdom > UK; Canada; Afghanistan; Netherlands; United States > US; Iraq; Australia
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(16)32398-4

Summary Background The effectiveness of post-deployment screening for mental disorders has not been assessed in a randomised controlled trial. We aimed to assess whether post-deployment screening for post-traumatic stress disorder (PTSD), depression, anxiety, or alcohol misuse was effective. We defined screening as the presumptive identification of a previously unrecognised disorder using tests to distinguish those who probably had the disorder from those who probably did not so that those people with a probable disorder could be referred appropriately, and assessed effectiveness and consequences for help-seeking by the odds ratio at follow-up between those receiving tailored help-seeking advice and those who received general mental health advice. Methods We did a cluster randomised controlled trial among Royal Marines and Army personnel in the UK military after deployment to Afghanistan. Platoons were randomly assigned (1:1 initially, then 2:1) by stratified block randomisation with randomly varying block sizes of two and four to the screening group, which received tailored help-seeking advice, or the control group, which received general mental health advice. Initial assessment took place 6–12 weeks after deployment; follow-up assessments were done 10–24 months later. Follow-up measures were the PTSD Checklist–Civilian Version, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 scale, Alcohol Use Disorder Identification Test (AUDIT), and self-reported help-seeking from clinical and welfare providers comparing those receiving tailored advice and those receiving only general advice. All participants and all investigators other than the person who analysed the data were masked to allocation. The primary outcomes were PTSD, depression or generalised anxiety disorder, and alcohol misuse at follow-up. A key secondary outcome was assessment of whether post-deployment screening followed by tailored advice would modify help-seeking behaviour. Comparisons were made between screening and control groups, with primary analyses by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN19965528. Findings Between Oct 24, 2011, and Oct 31, 2014, 434 platoons comprising 10 190 personnel were included: 274 (6350 personnel) in the screening group and 160 (3840 personnel) in the control group. 5577 (88%) of 6350 personnel received screening and 3996 (63%) completed follow-up, whereas 3149 (82%) of 3840 received the control questionnaire and 2369 (62%) completed follow-up. 1958 (35%) of 5577 personnel in the screening group declined to see the tailored advice, but those with PTSD (83%) or anxiety or depression (84%) were more likely than non-cases (64%) to view the advice (both p<0·0001). At follow-up, there were no significant differences in prevalence between groups for PTSD (adjusted odds ratio 0·92, 95% CI 0·75–1·14), depression or anxiety (0·91, 0·71–1·16), alcohol misuse (0·88, 0·73–1·06), or seeking support for mental disorders (0·92, 0·78–1·08). Interpretation Post-deployment screening for mental disorders based on tailored advice was not effective at reducing prevalence of mental health disorders nor did it increase help-seeking. Countries that have implemented post-deployment screening programmes for mental disorders should consider monitoring the outcomes of their programmes. Funding The US Army Medical Research and Materiel Command–Military Operational Medicine Research Program (USAMRMC–MOMRP).