Getting beyond "don't ask; don't tell": An evaluation of US Veterans Administration postdeployment mental health screening of veterans returning from Iraq and Afghanistan

Objectives. We sought to evaluate outcomes of the Veterans Administration (VA) Afghan and Iraq Post-Deployment Screen for mental health symptoms. Methods. Veterans Administration clinicians were encouraged to refer Iraq or Afghanistan veterans who screened positive for posttraumatic stress disorder, depression, or high-risk alcohol use to a VA mental health clinic. Multivariate methods were used to determine predictors of screening, the proportions who screened positive for particular mental health problems, and predictors of VA mental health clinic attendance. Results. Among 750 Iraq and Afghanistan veterans who were referred to a VA medical center and 5 associated community clinics, 338 underwent postdeployment screening; 233 (69%) screened positive for mental health problems. Having been seen in primary care (adjusted odd ratio [AOR] = 13.3; 95% confidence interval [CI] = 8.31, 21.3) and at a VA community clinic (AOR = 3.28; 95% CI = 2.03, 5.28) predicted screening. African American veterans were less likely to have been screened than were White veterans (AOR = 0.45; 95% CI = 0.22, 0.91). Of 233 veterans who screened positive, 170 (73%) completed a mental health follow-up visit. Conclusions. A substantial proportion of veterans met screening criteria for co-occurring mental health problems, suggesting that the VA screens may help overcome a "don't ask, don't tell" climate that surrounds stigmatized mental illness. Based on data from 1 VA facility, VA postdeployment screening increases mental health clinic attendance among Iraq and Afghanistan veterans.