Author: Clare Wilson
Date Published: 16 February 2017
Mental health checks do not help soldiers with psychological problems after returning from war. So says the first test of such screening, carried out on the UK army.
The surprise result suggests other kinds of psychological screening, on schoolchildren or new mothers, for instance, may also be flawed. “The implications go far beyond this specific situation. If mental health screening is ever to work, it would be in high-risk groups like this one,” says Allen Frances of Duke University, North Carolina, who wasn’t involved in the study.
In the past decade, there has been growing awareness of combat veterans with problems such as depression or post-traumatic stress disorder (PTSD). Countries such as the US, Canada, Australia and the Netherlands have introduced mental health check-ups when military personnel get home and there are calls for such an approach in the UK too, especially after violent incidents involving former soldiers.
But in other areas of medicine, screening is coming under scrutiny. There is controversy about cancer screening, for instance, which can lead to people getting toxic treatments for tumours that wouldn’t have caused them any harm. It is generally accepted that screening should only be introduced once large trials show it does more good than harm.
Now such a trial has been carried out on British soldiers, paid for by the US Department of Defense, which already screens all its own troops.
In the trial, nearly 9000 soldiers were given a questionnaire about the symptoms of PTSD, depression, anxiety or alcohol problems soon after returning from Afghanistan. Nearly two-thirds were then offered a letter revealing if their symptoms pointed to one of these conditions and, if so, were strongly urged to seek help, such as by making a doctor’s appointment. The rest just got a general letter of thanks highlighting various sources of psychological support.
Over the next one to two years, there was no difference in the rates of mental health conditions between the two groups. The number of people with a problem who sought help was about a third in both groups. In the screening group, about a third declined to even see the letter revealing their results.
Because screening brings no benefits, it is likely to do harm overall, says Simon Wessely of King’s College London. One risk comes from classifying people as having a mental health problem when they do not have one, or would have recovered from it anyway if left alone. “If we label normal emotional reactions as problems it can become self-perpetuating,” he says.
People may also end up getting treatment they don’t need, such as antidepressants, which can have side effects. Even talking therapy can sometimes do more harm than good, says Wessely.
Call to ban fishing
But the screening may have seemed ineffective because those in the control group also did the questionnaire, which could have prompted them to seek help or at least focus on their symptoms, says Alexander McFarlane at the University of Adelaide, Australia.
Frances, on the other hand, says that without evidence showing that screening is effective, scarce resources should be targeted to people who seek help, rather than going on “wasteful fishing expeditions”.
Some US schools, for instance, have screening programmes that try to identify children with mental health problems, and there have been calls for such schemes in the UK too. “It would be wiser to be more sensitive to those kids who are really in trouble,” says Frances.
In the UK, women who have just had a baby are screened for postnatal depression, although this isn’t recommended by the UK National Screening Committee.
- Mental health screening does not necessarily help soldiers recover from psychological problems after returning from war and might actually harm them more than it helps.
- People are likely to overthink and end up taking drugs that they do not need, causing further harm to themselves.
- To what extent is health screening beneficial for the individual?
- PTSD in soldiers shows the effect of war on people. Soldiers violate their moral codes to shoot at children wearing explosives or hurt a civilian who turned out to be unarmed.
Post by: Ming Jun