Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada.
BMJ Open. 2019 Jul 19;9(7):e029355. doi: 10.1136/bmjopen-2019-029355.
Canadian Armed Forces (CAF) personnel who return from certain international deployments are required to complete post-deployment screening (PDS) 90 to 180 days post-deployment; the primary goal of PDS is early detection of mental health problems that aims for reduced delays to care provision. We investigated service members' compliance with the PDS completion requirement and the factors associated with this compliance; a secondary objective was to investigate completion timing.
The study used a retrospective cohort of CAF personnel (n=28 460) who had deployments over 01 January 2009 to 31 December 2014; inferences were based on a probabilistic sample (n=3004).
The primary outcome was PDS completion. We assessed the timing of PDS completion, comparing non-compliant (early, late or no completion) with compliant completions (90 to 180 days post-deployment) among deployments that required screening. Kaplan-Meier plots summarised time-to-completion and logistic regression assessed the covariate associations with compliant completion. Covariate-adjusted marginal compliance prevalence differences (MPD) were computed.
67.3% (95% CI65.0 to 69.6) of deployments that required PDS had one completed; 43.3% (95%CI 40.6 to 46.0) were completed within the compliant period. Compliant completion was higher with lower ranks (MPD=10.6%, relative to officers), combat arms occupations (MPD=8.4%), Afghanistan deployments (MPD=19.2%), longer deployments (MPD=10.1%) and among those without a past mental health problem (MPD=9.7%).
Our findings suggest that some selective processes may be occurring where those perceived to be at higher risk for post-deployment mental health problems are more compliant with PDS completion. However, PDS completion and compliant completion were lower than expected and this suggests a need to reinforce instruction on the guidelines and objectives of PDS among service members in the CAF.
从某些国际部署返回的加拿大武装部队（CAF）人员必须在部署后 90 至 180 天内完成部署后筛查（PDS）；PDS 的主要目标是早期发现心理健康问题，以减少提供护理的延迟。我们调查了服务人员对 PDS 完成要求的遵守情况以及与该遵守情况相关的因素；次要目标是调查完成时间。
本研究使用了一个 CAF 人员（n=28460）的回顾性队列，这些人员在 2009 年 1 月 1 日至 2014 年 12 月 31 日期间部署；推断基于概率样本（n=3004）。
主要结果是 PDS 完成情况。我们评估了 PDS 完成的时间，比较了需要筛查的部署中不符合规定（早期、晚期或未完成）与符合规定（部署后 90 至 180 天）的完成情况。Kaplan-Meier 图总结了完成时间，逻辑回归评估了与符合规定完成的协变量相关性。计算了调整协变量的边际符合流行率差异（MPD）。
需要进行 PDS 的部署中，有 67.3%（95%CI65.0 至 69.6）完成了一次；43.3%（95%CI 40.6 至 46.0）在规定期限内完成。级别较低（相对于军官，MPD=10.6%）、战斗武器职业（MPD=8.4%）、阿富汗部署（MPD=19.2%）、部署时间较长（MPD=10.1%）和没有过去心理健康问题的人员（MPD=9.7%）的符合规定完成率更高。
我们的研究结果表明，可能存在一些选择性过程，即那些被认为有更高的部署后心理健康问题风险的人更符合 PDS 完成的要求。然而，PDS 完成和符合规定的完成率低于预期，这表明需要加强对 CAF 服务人员的 PDS 指南和目标的指导。
