Does recommended mental health follow-up care occur after postdeployment screening in the Canadian Armed Forces? A retrospective cohort study

OBJECTIVE: To determine Canadian service members’ level of adherence to a recommendation for mental health services follow-up that was assigned by clinicians during postdeployment screening. DESIGN: Retrospective cohort study. SETTING: Canadian military population. PARTICIPANTS: The cohort consisted of personnel (n=28 460) with a deployment within the 2009–2014 time frame. A stratified random sample (n=3004) was selected for medical chart review. However, we restricted our analysis to individuals whose completed screening resulted in a recommendation for mental health services follow-up (sample n=316 (weighted n=2034) or 11.2% of screenings. INTERVENTIONS: Postdeployment health screening. PRIMARY OUTCOME MEASURE: The outcome was adherence to a screening-indicated mental health services follow-up recommendation, assessed within 90 days, a preferred delay, and within 365 days, a delay considered partially associated with the screening recommendation. RESULTS: Adherence within 90 days of screening was 71.1% (95% CI 59.7% to 82.5%) for individuals with ‘major’ mental health concerns, 36.1% (95% CI 23.9% to 48.4%) for those with ‘minor’ mental health concerns, and 46.8% (95% CI 18.6% to 75.0%), for those with psychosocial mental health concerns; the respective 365-day adherence fractions were 85.3% (95% CI 76.1% to 94.5%), 55.7% (95% CI 42.0% to 69.4%) and 48.6% (95% CI 20.4% to 76.9%). Logistic regression indicated that a 90-day adherence among those with a ‘major’ mental health concern was higher among those screening after 2012 (adjusted OR (AOR) 5.45 (95% CI 1.08 to 27.45)) and lower, with marginal significance, among those with deployment durations greater than 180 days (AOR 0.35 (95% CI 0.11 to 1.06)). CONCLUSIONS: On an individual level, screening has the potential to identify when a care need is present and a follow-up assessment can be recommended; however, we found that adherence to this recommendation is not absolute, suggesting that administrative checks and possibly, process refinements would be beneficial to ensure that care-seeking barriers are minimised.