A very brief definition of screening is ‘the detection of occult disease or defect through a test’. We can further elaborate on this, as discussed in the lecture, to incorporate ideas of identifying apparently healthy who have an increased risk of developing a disease. Screening programmes should be based on conclusive evidence that the process can alter the natural course of the disease. But how do we measure that, or in other words how do we ascertain that the benefits outweigh any potential harms, for example false-positives and false-negatives and labelling an individual as ‘sick’ and the possible psychological strain of this?
Reading the paper by Armstrong on the historical context of screening raised an interesting point about how screening for psychiatric illness was developed and introduced in the armed forces in WW2 following experiences dealing with cases of ‘shell-shock’ in soldiers after WW1. It raises an interesting point about screening tests that cannot rely on strict biological end-points (like blood-test results or positive swabs). The paper explains how screening questionnaires were given to new recruits to identify those who might be more susceptible than the average to the strains of the battlefield, and who might benefit from further psychological assessment. Obviously the questionnaire had to be easy and quick to administer whilst still being effective in picking out those who might be less able to cope with the demands of the battlefield, possibly endangering themselves and others around them and those at increased risk of suffering from PTSD after the war. This raises a variety of really interesting questions: How could they screen for the ‘psychiatric’ risk of a situation which the recruits had never found themselves in, how strict were they in barring those who ‘failed’ their screening tests and were they ever followed-up to find out what happened to the recruits if they were deemed unfit to join? Were those who failed screening offered any follow-up treatment or counselling, or were they simply barred from joining the army? This reflects the question about who benefits from screening.
In terms of transferring this to the modern day, I question how similar psychiatric screening tests for soldiers are these days? Are they more thorough? And is this because conditions of war are different or because we now understand so much more about the scope of mental illness so a higher number of conditions are screened for? Also how, if at all, have these screening questionnaires influenced how we screen for psychiatric illness in the general population?
