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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.115519v1 98/4/714    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Seal, K. H. Articles by Marmar, C. R. Search for Related Content PubMed PubMed Citation Articles by Seal, K. H. Articles by Marmar, C. R. Related Collections Epidemiology Mental Health Screening Alcohol

Karen H. Seal, MD, MPH, Daniel Bertenthal, MPH, Shira Maguen, PhD, Kristian Gima, BA, Ann Chu, MS and Charles R. Marmar, MD

Karen H. Seal, Charles R. Marmar, and Shira Maguen are with the San Francisco Veterans Administration Medical Center and the University of California, San Francisco, and are affiliated with the San Francisco Veterans Administration Health Services Research and Development Research Enhancement Award Program. Daniel Bertenthal, Kristian Gima, and Ann Chu are with the San Francisco Veterans Administration Medical Center.

Correspondence: Requests for reprints should be sent to Karen H. Seal, MD, MPH, San Francisco VA Medical Center, Division of General Internal Medicine, Box 111A-1, 4150 Clement St, San Francisco, CA 94121 (e-mail: karen.seal{at}ucsf.edu).

ABSTRACT

Objectives. We sought to evaluate outcomes of the Veterans Administration (VA) Afghan and Iraq Post-Deployment Screen for mental health symptoms.

Methods. Veterans Administration clinicians were encouraged to refer Iraq or Afghanistan veterans who screened positive for posttraumatic stress disorder, depression, or high-risk alcohol use to a VA mental health clinic. Multivariate methods were used to determine predictors of screening, the proportions who screened positive for particular mental health problems, and predictors of VA mental health clinic attendance.

Results. Among 750 Iraq and Afghanistan veterans who were referred to a VA medical center and 5 associated community clinics, 338 underwent postdeployment screening; 233 (69%) screened positive for mental health problems. Having been seen in primary care (adjusted odd ratio [AOR]=13.3; 95% confidence interval [CI]=8.31, 21.3) and at a VA community clinic (AOR=3.28; 95% CI=2.03, 5.28) predicted screening. African American veterans were less likely to have been screened than were White veterans (AOR=0.45; 95% CI=0.22, 0.91). Of 233 veterans who screened positive, 170 (73%) completed a mental health follow-up visit.

Conclusions. A substantial proportion of veterans met screening criteria for co-occurring mental health problems, suggesting that the VA screens may help overcome a "don’t ask, don’t tell" climate that surrounds stigmatized mental illness. Based on data from 1 VA facility, VA postdeployment screening increases mental health clinic attendance among Iraq and Afghanistan veterans.

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