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