Screening troops for psychological vulnerability is futile

The idea of screening members of our armed services for psychological vulnerability before their deployment to war zones surely makes sense. However, historically, doing this has proved hugely problematic. For example, a screening programme introduced before the Second World War was deemed a costly failure after rates of psychiatric breakdown among the forces were as high or higher than in the First World War. Now according to a longitudinal study of British troops, screening for psychological vulnerability remains as futile as ever.

In 2002, prior to preparations for the Iraq war, Roberto Rona (Kings Centre for Military Health Research) and colleagues gave 2,873 personnel from the army, navy and RAF psychological screening questionnaires to complete, including a checklist for PTSD symptoms and questions about alcohol abuse. Hundreds of them went on to be deployed in Iraq.

The mental health of the sample was again assessed between 2004 and 2006 to see if their earlier scores on the psychological screening tools were usefully related to their having psychological problems later on. The only reliable link the researchers found between the participants’ original screening scores and their later mental health was for PTSD – that is personnel with PTSD symptoms in 2002 were particularly likely to have such symptoms later. However, because so few personnel had PTSD symptoms at baseline (< 3.2 per cent), the researchers concluded that even the use of a PTSD checklist may not be worthwhile. The results didn’t change if analysis was restricted to just those personnel who were deployed to Iraq.

“This study provides little support for the use of mental health screening before deployment for preventing mental disorders after deployment”, the researchers said.
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Rona, R.J., Hooper, R., Jones, M., Hull, L., Browne, T., Horn, O., Murphy, D., Hotopf, M. & Wessely, S. (2006). Mental health screening in armed forces before the Iraq war and prevention of subsequent psychological morbidity: follow-up study. BMJ, DOI:10.1136/bmj.38985.610949.55

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