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.
