Magazine article Clinical Psychiatry News

More Soldiers Getting Care for Depression, PTSD: Participating Psychiatrists Optimistic

Magazine article Clinical Psychiatry News

More Soldiers Getting Care for Depression, PTSD: Participating Psychiatrists Optimistic

Article excerpt

New York -- A systems-level collaborative care model for the screening, referral, and treatment of depression and posttraumatic stress disorder in U.S. soldiers has led to an increase in the number of soldiers receiving mental health care, Col. Charles C. Engel, MC, USA, said at the American Psychiatric Association's Institute on Psychiatric Services.

A feasibility study of the Re-Engineering Systems for the Primary Care Treatment of Depression and PTSD in the Military model, or RESPECT-Mil, shows that the intervention often leads to clinical improvements, Dr. Engel reported.

So far, the model has been implemented in 35 of a planned 43 primary care clinics on 15 military bases in the United States, Germany, and Italy. The rollout began in 2007.

Preliminary data from the participating clinics indicate that screening for depression and PTSD has occurred in two-thirds of primary care visits, with a positive screen rate of 14%, said Dr. Engel, director of the Department of Defense Deployment Health Clinical Center at Walter Reed Army Medical Center, Washington, and associate professor in the department of psychiatry at the Uniformed Services University of the Health Sciences.

Of the 14% who screened positive, 60% received a diagnosis of depression or PTSD and started treatment, noted Dr. Engel, a psychiatric epidemiologist who has been instrumental in helping the departments of Veterans Affairs and Defense develop guidelines for depression, PTSD, and medically unexplained symptoms.

The need for addressing mental health issues in the U.S. military has never been greater. For example, earlier this year, Sen. Ben Nelson (D-Neb.), chairman of the Senate Armed Services Committee's Personnel Subcommittee, testified that suicides per 100,000 personnel between 2007 and 2008 increased in every branch: from 17 to 20 in the Army; from 11 to 12 in the Navy; from 17 to 19 in the Marine Corps; and from 10 to 12 in the Air Force.

"These numbers indicate that, despite the services' best efforts, there's still much work to be done to prevent military suicides," he said.

The RESPECT-Mil program, based on a three-component model that has been used extensively in civilian populations, addresses some of the challenges that historically have kept soldiers from receiving needed mental health services--including reluctance to seek behavioral health services, insufficient mental health workforce capacity, lack of competency in evidence-based mental health practice, and inadequate systems support for improving access to care, Dr. Engel said. It achieves those goals by integrating, through a manualized approach, the efforts of primary care physicians, nurse care facilitators, and psychiatrists, beginning with a mandate for universal screening for depression and PTSD for soldiers during routine primary care visits, he said.

Patients who screen positive on the two-question depression screen (PHQ-2) or the four-item PTSD screen undergo a diagnosis and severity assessment using the Patient Health Questionnaire-9 (PHQ-9) and the 17-item PTSD Check List, as well as a suicide and violence risk assessment, Dr. Engel said. "We've modified the assessment tools so that it's easy for clinicians to look at and determine whether patients are high or low probability for suffering from a trauma reaction or suicidal ideation."

When there is a presumptive diagnosis of either depression or PTSD, the primary care clinician will engage the patient in an initial course of therapy to determine the appropriate management framework based on the patient's symptoms and preferences and will offer follow-up monitoring with a psychiatrist-supervised care facilitator and, when necessary, a behavioral health specialist, Dr. …

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