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Military Broadens Online MH Screening

After the early success of its online mental health tool, the military expands the use of anonymous health screenings to include a phone version and an alcohol-dependence test.

The U.S. military's online mental health screening tool, developed to address rising stress levels in troops at home and abroad, has proven more effective than the Department of Defense's (DoD) traditional screening programs in gathering candid responses on possible mental health problems.

The new Web site, which allows anonymous self-screenings for signs of depression, bipolar disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), and alcohol abuse, had elicited more openness than the four in-person assessments the military uses, according to preliminary findings of ongoing research on the program.

"People tend to be more candid when using an online or telephone-based screening than in person, and we can speculate that it is because there is more privacy or they are more comfortable," said Air Force Col. Joyce Adkins, a psychologist in the Pentagon's Office of Health Affairs and program manager of the Mental Health Self-Assessment Program.

The program, which went online in January and has been widely publicized to members of the military and their families, assesses answers to questions about recent behavior and mood swings. If the responses indicate possible problems, the site refers participants to a central locator office that provides contact information for local clinicians.

The initial findings answer the criticisms of some veterans leaders who described the online surveys as inadequate substitutes for face-to-face encounters with psychiatrists or mental health professionals. The findings of higher degrees of candor among online respondents in the DoD program are similar to the findings reported by other researchers of online mental health screening tools.

A study titled "Psychology of the Internet" published in 1999 by Cambridge University Press found that people tend to disclose more information about themselves to computers than in face-to-face contact. A 2004 study in the Journal of Clinical Psychology found that computer-based assessment can gather information of greater quantity and higher quality than clinician-administered assessment.

In addition, a 2003 study in the Journal of Medical Internet Research found that a Web-based depression and anxiety test was reliable for identifying patients with and without major depressive disorder and several anxiety disorders—panic disorder with and without agoraphobia, social phobia/social anxiety disorder, obsessive-compulsive disorder, and PTSD.

"I don't know that people are being dishonest otherwise, but they are more candid across the board" with the online approach, Adkins maintained.

Michele ybarra, Ph.D., who has researched online mental health tools, said studies of this emerging area of care indicate that those who use online screening tools are then more likely to seek inperson care from mental health clinicians than people who fail to take advantage of them.

"The concern was that people would use these tools to say, `Oh, I'm not that bad off so I don't need any help,' but we have found they do just the opposite of that," said Ybarra, president of internet Solutions for Kids Inc, a not-for-profit research company.

The military's standard screening tools for mental illness among troops are included as part of its mandatory health assessments that occur immediately before and after deployment and then three to six months after return.

A recent study found that a third of service members returning from Iraq who completed the postdeployment survey received counseling (Psychiatric News, June 16).

A fourth screening tool, the Periodic Health Assessment (PHA), is given to all members of the military and their families annually.

"The PHA is designed for everybody, every year, to do a global health assessment," Adkins said.

The new screening tool and the military's more traditional mental health screening programs ask similar questions, and both require more research to better assess their effectiveness, said capt. Thomas Grieger, M.C., an associate professor of psychiatry at the Uniformed Services University of the Health Sciences. Both a Government Accountability Office study and a DoD National Quality Management Program study questioned whether adequate referrals followed the use of such screening tools.

"you would know if you might have a problem, but it would not definitively tell you that your problem is significant, nor would it be able to tell you that it isn't," said Grieger, who represents the Society of Uniformed Services Psychiatrists in the APA assembly. "It just says that you have some symptoms."

Adkins emphasized that the online program is designed to supplement—not replace—the more formal programs. The online program, Adkins said, helps to fill a void when face-to-face screening and counseling are not immediately available to a service member or relative. it is also described as primarily an educational tool for those under stress and those who know someone under stress.

Other measures of the site's success include its level of use. While Adkins declined to specify the overall number of users, she said its use has steadily increased since its launch to the point that "thousands" use it each week.

Following the success of the online mental-assessment program, the military now plans to add an anonymous phone-based version for those without Internet access. It is scheduled to be launched by the end of the year.

Also planned is an early intervention, cognitive-behavioral psychoeducational program to provide preemptive education in depression, PTSD, and generalized anxiety disorder to those whose screenings did not indicate that they may need treatment.

The DoD also is developing a Web-based psychoeducation program on alcohol abuse that is in the pilot stage.

Military clinicians knew that a key component of the online program's success would be its ability to be "relevant, convenient, targeted, and trusted." To meet the last goal, the DoD chose the nonprofit company Screening for Mental Health Inc., which created the National Depression Screening Day program, to design the online tool.

Paul Davidson, executive director of the nonprofit National Gulf War Resource center, said the reluctance of members of the military to seek mental health assistance is affected by fears that just asking for help will impact their status within their unit and the military careers. He praised the online tool as providing a place where they can feel comfortable to answer honestly and find out if they need professional help.

"For some this may be their only way to find out if they should seek help," he told Psychiatric News.

The online screening tool is posted at <www.militarymentalhealth.org/welcome.asp>.

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