Many federal programs aimed at preventing psychological problems in military service members and their families have not been evaluated correctly to determine if they are working and are not supported by science, a new report commissioned by the Defense Department says.
"A lot of their programs don't have any good data behind them," said Kenneth Warner, a professor of public health at the University of Michigan who led the Institute of Medicine committee that produced the report. "We remain uncertain about which approaches work and which ones are ineffective."
The 291-page report was especially critical of the Pentagon's biggest and costliest prevention program, known as Comprehensive Soldier and Family Fitness, which is used throughout the Army.
Based on the principles of positive psychology, it includes training in assertiveness, negotiation and coping strategies such as maintaining an optimistic outlook on life. About 900,000 soldiers receive the training each year at a cost of $50 million. The program was recently expanded to include families of service members.
The Army has portrayed it as a success based on internal reviews that found that soldiers saw small improvements on some measures of psychological health.
But the medical committee concluded that the gains were not clinically meaningful. The program did not reduce rates post-traumatic stress disorder or depression.
"The effects were so small," Warner said. "The amount of money being spent was so large. It did not look like a meaningful investment."
An Army spokesman, Lt. Col. S. Justin Platt, defended the program, saying that it was not designed to prevent PTSD and depression but rather to improve social, emotional, spiritual, family and physical well-being. He said that the Army stands by its conclusions and that military families found the training effective.
"First-hand testimonies that tell how the program changed their life, saved their marriage or saved the life of a fellow soldier are more powerful than any report," he said in an email.
Although military leaders would have preferred a long-term scientific study before rolling out the program throughout the Army, they had to act quickly and rely on the best available evidence, Platt said.
Years of war have taken a heavy toll on the psychological health of U.S. troops. Rates of mental illness among active-duty troops rose 62% between 2000 and 2011, according to the Institute of Medicine report. More than 935,000 current or former service members were diagnosed with adjustment disorders, depression, post-traumatic stress disorder and other mental health problems over that time. The suicide rate nearly doubled between 2005 and 2010.
Families have also suffered, with researchers charting elevated rates of anxiety and depression in military spouses and children.
More than 90 prevention programs are scattered throughout the military. Experts said the total cost is difficult to calculate, but that it could easily top $1 billion.
The Institute of Medicine, the health arm of the National Academies, reviewed a broad sample of those programs — from resilience training to education and awareness campaigns designed to prevent suicide.
Although some programs have proven results, most did not.
The committee was unable to find any evidence-based programs to prevent domestic abuse in military families. And although sexual assault in the military has received growing attention, the military has no way to measure whether its prevention programs are working, the study concluded.
At the same time, some proven interventions are not being used, the committee found. Researchers said there is ample evidence to suggest that limiting access to personal firearms on military bases would reduce suicides. About 60% of service members who take their own lives do it with guns — usually their own.
"Means restriction has been demonstrated to work," said David Rudd, psychologist and suicide expert at the University of Memphis who served on the committee.
But in 2011, Congress prohibited the Defense Department from regulating legally owned personal firearms and ammunition on military bases.