title: Getting beyond "Don't ask; don't tell": an evaluation of US Veterans Administration postdeployment mental health screening of veterans returning from Iraq and Afghanistan.
abstract: OBJECTIVE
  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.
authors.affiliation: San Francisco VA Medical Center, Division of General Internal Medicine, Box 111A-1, 4150 Clement St, San Francisco, CA 94121, USA. karen.seal@ucsf.edu
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
authors.forename: Daniel
authors.initials: D
authors.lastname: Bertenthal
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.forename: Kristian
authors.initials: K
authors.lastname: Gima
authors.forename: Ann
authors.initials: A
authors.lastname: Chu
authors.forename: Charles R
authors.initials: CR
authors.lastname: Marmar
mesh_terms: D000328:Adult; D000346:Afghanistan; D000437:Alcoholism / Q000453:epidemiology / Q000209:etiology; D003130:Combat Disorders; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008403:Mass Screening; D008603:Mental Health; D008605:Mental Health Services; D008875:Middle Aged; D011581:Psychological Tests; D011594:Psychometrics; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014857:Warfare