Importance of anonymity to encourage honest reporting in mental health screening after combat deployment

Christopher H Warner, George N Appenzeller, Thomas Grieger, Slava Belenkiy, Jill Breitbach, Jessica Parker, Carolynn M Warner, Charles Hoge
Archives of General Psychiatry 2011, 68 (10): 1065-71

CONTEXT: US soldiers are required to undergo screening for depression, posttraumatic stress disorder (PTSD), and other mental health problems on return from service in Iraq or Afghanistan as part of routine postdeployment health assessments.

OBJECTIVE: To assess the influence of the anonymity of screening processes on willingness of soldiers to report mental health problems after combat deployment.

DESIGN: Anonymous and nonanonymous surveys.

SETTING: US military.

PATIENTS: US infantry soldiers' reporting of mental health problems on the routine Post-Deployment Health Assessment was compared with their reporting on an anonymous survey administered simultaneously.

MAIN OUTCOME MEASURES: The Primary Care PTSD Screen, the Patient Health Questionnaire-2 (modified), the suicidal ideation question from the Patient Health Questionnaire-9, and several other questions related to mental health were used on both surveys. Soldiers were also asked on the anonymous survey about perceptions of stigma and willingness to report honestly.

RESULTS: Of 3502 US Army soldiers from one infantry brigade combat team undergoing the routine Post-Deployment Health Assessment in 2008, a total of 2500 were invited to complete the anonymous survey, and 1712 of these participated (response rate, 68.5%). Reporting of depression, PTSD, suicidal ideation, and interest in receiving care were 2-fold to 4-fold higher on the anonymous survey compared with the routine Post-Deployment Health Assessment. Overall, 20.3% of soldiers who screened positive for depression or PTSD reported that they were uncomfortable reporting their answers honestly on the routine postdeployment screening.

CONCLUSIONS: Current postdeployment mental health screening tools are dependent on soldiers honestly reporting their symptoms. This study indicates that the Post-Deployment Health Assessment screening process misses most soldiers with significant mental health problems. Further efforts are required to reduce the stigma of reporting and improve willingness to receive care for mental health problems.

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