Evidence of under-reporting of behavioral health problems by high-risk individuals during a standardized screening

The military conducts health risk screening for Service Members (SMs) returning from combat. SMs complete a self-report assessment about common post-deployment health problems, including behavioral health, and then are interviewed by a health care provider. The intent of the interview is to review SM self-report responses, provide needed information, and make referrals for further evaluation where warranted. We conducted a survey of SM characteristics relevant to this process, including perceptions of stigma, attitudes toward help-seeking and self-disclosure, and social support. Anonymous surveys were collected from 6,714 SMs, with 2, 217 linked to SMs' de-identified screening results. A substantial minority (10-14%) of SMs admitted to underreporting physical, emotional, and alcohol use problems on the screening. More than a third (39%) of SMs agreed that they had experienced an emotional, alcohol, stress, or family problem since returning from deployment, or that family or friends had suggested they seek help for such a problem. However, almost half (43%) of these SMs did not report any such problem on the military's screening form. Further, these unreported problems were usually not uncovered (i.e., documented) by the health care provider during the interview. That is, providers documented five times fewer major concerns and three times fewer medical referrals for those who did not disclose problems on the screening form vs. those who did disclose. We discuss these and other findings in the context of SM characteristics associated with under-reporting and consider the implications for the health care provider's role in the screening process.