Milliken et al compares the results of the post-deployment health assessment (PDHA) and the post-deployment health re-assessment (PDHRA) of roughly 100,000 soldiers in a paper published in the Journal of the American Medical Association. Here is the link: http://jama.ama-assn.org/cgi/content/abstract/298/18/2141

The findings are that more soldiers report mental health problems on the PDHRA 3 to 6 months after returning home than on the PDHA in the immediate post-deployment period. There is also an interesting finding that soldiers who responded positively to the PDHA had less symptoms on the PDHRA with little or no treatment.

Comment: My observations as a clinician were that on deployment the warfighter has a gameface and problems are pushed out of sight and out of mind. The warfighter goes through a honeymoon period after returning home and then after block leave is when the problems return to the forefront. The time after block leave appears to be the critical intervention point.

There is a lot of emphasis on deploying psychiatrists to combat zones. The problem with this practice is it decreases the availability of staffing at the time it is needed most in the 3 to 6 months following returning home. Clearly we need to have mental assets in the field but until there is enough uniformed providers for support throughout the entire deployment cycle we have to decided at what point they will be most effectively utilized.