Clinical impressions and follow-up care recommendations in Canadian Armed Forces post-deployment screening

Introduction: Post-deployment screening in the Canadian Armed Forces (CAF) is intended to facilitate early care for individuals experiencing mental health issues following deployment. The screening process involves a self-report questionnaire and an interview with a mental health care provider, who may then recommend follow-up care. However, gaps remain in our understanding of the factors associated with clinicians’ decisions to recommend follow-up care. Methods: We examined the associations between self-reported mental health problems, clinicians’ perceptions of concern for those problems, and recommendations for follow-up care by using data collected during CAF post-deployment screening (n = 14,957). Results: For those individuals with the highest severity scores for posttraumatic stress disorder (PTSD), depression, or anxiety, about 50% to 70% were indicated as having a major concern, while a further 20% to 25% were indicated as having a minor concern. Reassuringly, about 80% of those with a clinician-indicated major concern for PTSD, depression, anxiety, or substance use were recommended for follow-up care. The discrepancy between clinician impressions and recommendations for care was partially explained by whether the individual was already receiving care. Discussion: While the concordance between self-reported mental health and clinicians’ concerns, as well as between concerns and recommendations for follow-up care, were generally high, some inconsistencies remain. These findings underscore the need to better understand and improve the consistency and effectiveness of the screening process, and to further understand the factors underlying clinical decision making.