Introducing Psychosis Screening for a High-Risk Group: U.S. Service Members Exiting Active Duty

Delayed treatment for psychosis is associated with poor outcomes, yet many veterans living with psychotic disorders seek health care services long after the onset of illness. Most transitioning service members and veterans (TSMVs) are in the age range when psychotic disorders emerge; however, no standardized screening for psychotic symptoms exists for this population. This novel project aimed to introduce screening and assessment of TSMVs for psychotic symptoms.

This cross-sectional study added an item querying for perceptual disturbances to a program for all TSMVs leaving active duty at partnered U.S. military installations. Of TSMVs who screened positive, clinicians assessed a random subset for attenuated psychosis syndrome (APS) and threshold psychosis.

Of 5,019 TSMVs screened, 504 (10.0%) screened positive. TSMVs screening positive were nearly three times more likely to report lifetime suicidal ideation (37.7%), more than four times more likely to report past suicide attempts (22.4%), and approximately three times more likely to report depression (52.2%) and anxiety (58.9%) than were those screening negative. Of 120 TSMVs with a positive screen who were contacted for follow-up, 67 (55.8%) initiated a brief clinical structured interview; of those, 66 (98.5%) completed it. Twelve (18.2%) of these 66 TSMVs were diagnosed as having APS and five (7.6%) as having threshold psychosis.

The one-item screening and brief interview were feasible and acceptable. TSMVs screening positive had greater risk for suicide and general mental health risks, and follow-up interviews identified previously undetected APS and threshold psychosis. Screening TSMVs for psychotic symptoms has potential to identify risk and improve outcomes.