title: Deployment-related depression screening, 2001-2008: comparing clinical versus research surveys.
abstract: BACKGROUND
  Potential adverse mental health effects of deployment, including depression, are an ongoing concern. Although a previous study assessed under-reporting of depression on post-deployment health assessments compared to anonymous surveys, those results were not examined at the individual level to identify demographic or military factors that may be associated with unwillingness to report depression symptoms.
  
  
  OBJECTIVE
  To compare self-reported depression symptoms on post-deployment health assessments with responses to the same depression questions on a research survey.
  
  
  METHODS
  This cross-sectional study analyzed depression screening responses from 2001 to 2008 from participants of the Millennium Cohort Study, a longitudinal military cohort study, who completed a post-deployment health assessment within 30 days of a research survey. Kappa statistics and percent positive and negative agreement were calculated. Demographic and military characteristics associated with discordant screening results were examined. Initial analyses were performed in 2011, with additional analyses in 2013.
  
  
  RESULTS
  Moderate agreement (κ=0.464) was observed between paired survey responses. A higher proportion of active duty members, the unmarried, and new accessions into military service endorsed depression symptoms on the research survey but not the military-linked survey. In stratified analyses, agreement was higher in Reserve/National Guard members than active duty (κ=0.561 vs 0.409). New active duty accessions showed lower agreement (κ=0.388), as did unmarried active duty participants (κ=0.304).
  
  
  CONCLUSIONS
  Deployment health surveys are important tools for identifying returning service members experiencing depression symptoms. However, these findings suggest that ongoing stigma and barriers to appropriate follow-up mental health care remain to be addressed in the military setting.
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Electronic address: marleen.welsh.ctr@usuhs.edu.
authors.forename: Marleen M
authors.initials: MM
authors.lastname: Welsh
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Federinko
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Burnett
authors.affiliation: Analytic Services, Inc., Falls Church, Virginia.
authors.forename: Gary D
authors.initials: GD
authors.lastname: Gackstetter
authors.affiliation: Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.affiliation: Deployment Health Research Department, Naval Health Research Center, San Diego, California.
authors.forename: Amber D
authors.initials: AD
authors.lastname: Seelig
authors.affiliation: Optum, Ann Arbor, Michigan.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Wells
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Tomoko I
authors.initials: TI
authors.lastname: Hooper
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003625:Data Collection; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D057566:Self Report; D013240:Stereotyping; D014481:United States / Q000453:epidemiology; D055815:Young Adult