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Schneider M, Werner S, Yavnai N, Ben Yehuda A, Shelef L. Israeli soldiers' intentions and actions toward seeking mental health help: Barriers and facilitators. J Clin Psychol 2023; 79:449-465. [PMID: 35988124 PMCID: PMC10087119 DOI: 10.1002/jclp.23431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 07/16/2022] [Accepted: 08/03/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND While military settings may increase psychological distress, soldiers frequently avoid seeking professional help. This study aimed to examine barriers and facilitators associated with intentions to seek help and actually seeking help from a mental health officer (MHO) and how these differ among soldiers who had sought help in the past and those who had not. METHOD This cross-sectional study included 263 combat and noncombat soldiers. The Health Belief Model and the Help-Seeking Model were the theoretical framework used to map the potential variables associated with soldiers' decision to seek help. RESULTS Stigma and administrative barriers were found to be significant barriers to both the intention to seek help and actually consulting an MHO. These findings were more definitive among combat soldiers. The belief in the effectiveness of mental health treatment was positively associated with the intention to seek help. Positive associations were found between well-being, perceived seriousness of one's condition, and belief in the effectiveness of mental health care and intention to seek MHO help. Distress and self-concealment were positively associated with actual consultation with an MHO. Public stigma about seeking help was associated with both the intention to seek mental health assistance and actually consulting an MHO. CONCLUSION Military commanders should make an effort to make soldiers feel safe to seek mental health assistance by creating a supportive organizational atmosphere to reduce the stigma associated with mental health care.
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Affiliation(s)
- Maayan Schneider
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shirli Werner
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nirit Yavnai
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan, Israel
| | - Ariel Ben Yehuda
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan, Israel
| | - Leah Shelef
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan, Israel.,Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Trego LL, Wilson C. A Social Ecological Model for Military Women's Health. Womens Health Issues 2021; 31 Suppl 1:S11-S21. [DOI: 10.1016/j.whi.2020.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/08/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
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Heyman RE, Slep AMS, Parsons AM, Ellerbeck EL, McMillan KK. Systematic Review of the Military Career Impact of Mental Health Evaluation and Treatment. Mil Med 2021; 187:e598-e618. [PMID: 34322709 DOI: 10.1093/milmed/usab283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/10/2021] [Accepted: 06/30/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Military leaders are concerned that active duty members' fear of career impact deters mental health (MH) treatment-seeking. To coalesce research on the actual and perceived consequences of MH treatment on service members' careers, this systematic review of literature on the U.S. Military since 2000 has been investigating the following three research questions: (1) is the manner in which U.S. active duty military members seek MH treatment associated with career-affecting recommendations from providers? (2) Does MH treatment-seeking in U.S. active duty military members impact military careers, compared with not seeking treatment? (3) Do U.S. active duty military members perceive that seeking MH treatment is associated with negative career impacts? MATERIALS AND METHODS A search of academic databases for keywords "military 'career impact' 'mental health'" resulted in 653 studies, and an additional 51 additional studies were identified through other sources; 61 full-text articles were assessed for eligibility. A supplemental search in Medline, PsycInfo, and Google Scholar replacing "career impact" with "stigma" was also conducted; 54 articles (comprising 61 studies) met the inclusion criteria. RESULTS As stipulated by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies were summarized on the population studied (U.S. Military Service[s]), sample used, intervention type, comparison group employed, outcome variables, and findings. Self-referred, compared with command-directed, service members appear to be less likely to face career-affecting provider recommendations in non-deployed and deployed settings although the data for the latter are not consistent. Of the two studies that tested if MH treatment actually negatively impacts military careers, results showed that those who sought treatment were more likely to be discharged although the casual nature of this relationship cannot be inferred from their design. Last, over one-third of all non-deployed service members, and over half of those who screened positive for psychiatric problems, believe that seeking MH treatments will harm their careers. CONCLUSIONS Despite considerable efforts to destigmatize MH treatment-seeking, a substantial proportion of service members believe that seeking help will negatively impact their careers. On one hand, these perceptions are somewhat backed by reality, as seeking MH treatment is associated with a higher likelihood of being involuntarily discharged. On the other hand, correlational designs cannot establish causality. Variables that increase both treatment-seeking and discharge could include (1) adverse childhood experiences; (2) elevated psychological problems (including both [a] the often-screened depression, anxiety, and posttraumatic stress problems and [b] problems that can interfere with military service: personality disorders, psychotic disorders, and bipolar disorder, among others); (3) a history of aggressive or behavioral problems; and (4) alcohol use and abuse. In addition, most referrals are self-directed and do not result in any career-affecting provider recommendations. In conclusion, the essential question of this research area-"Does seeking MH treatment, compared with not seeking treatment, cause career harm?"-has not been addressed scientifically. At a minimum, longitudinal studies before treatment initiation are required, with multiple data collection waves comprising symptom measurement, treatment, and other services obtained, and a content-valid measure of career impact.
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Affiliation(s)
- Richard E Heyman
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Amy M Smith Slep
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Aleja M Parsons
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Emma L Ellerbeck
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Katharine K McMillan
- Air Force Medical Readiness Agency, United States Air Force (via a contract with Analytical Services and Materials [USA]), JBSA Lackland AFB, TX 78236-1025, USA
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Bogaers R, Geuze E, van Weeghel J, Leijten F, van de Mheen D, Varis P, Rozema A, Brouwers E. Barriers and facilitators for treatment-seeking for mental health conditions and substance misuse: multi-perspective focus group study within the military. BJPsych Open 2020; 6:e146. [PMID: 33234172 PMCID: PMC7745246 DOI: 10.1192/bjo.2020.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Globally, millions are exposed to stressors at work that increase their vulnerability to develop mental health conditions and substance misuse (such as soldiers, policemen, doctors). However, these types of professionals especially are expected to be strong and healthy, and this contrast may worsen their treatment gap. Although the treatment gap in the military has been studied before, perspectives of different stakeholders involved have largely been ignored, even though they play an important role. AIMS To study the barriers and facilitators for treatment-seeking in the military, from three different perspectives. METHOD In total, 46 people participated, divided into eight homogeneous focus groups, including three perspectives: soldiers with mental health conditions and substance misuse (n = 20), soldiers without mental health conditions and substance misuse (n = 10) and mental health professionals (n = 16). Sessions were audio-taped and transcribed verbatim. Content analysis was done by applying a general inductive approach using ATLAS.ti-8.4.4 software. RESULTS Five barriers for treatment-seeking were identified: fear of negative career consequences, fear of social rejection, confidentiality concerns, the 'strong worker' workplace culture and practical barriers. Three facilitators were identified: social support, accessibility and knowledge, and healthcare within the military. The views of the different stakeholder groups were highly congruent. CONCLUSIONS Barriers for treatment-seeking were mostly stigma related (fear of career consequences, fear of social rejection and the 'strong worker' workplace culture) and this was widely recognised by all groups. Social support from family, peers, supervisors and professionals were identified as important facilitators. A decrease in the treatment gap for mental health conditions and substance misuse is needed and these findings provide direction for future research and destigmatising interventions.
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Affiliation(s)
- Rebecca Bogaers
- Tranzo, Scientific Center for Care and Wellfare, Tilburg School of Social and Behavioral Sciences, Tilburg University; and Brain Research and Innovation Centre, Ministry of Defence, the Netherlands
| | - Elbert Geuze
- Brain Research and Innovation Centre, Ministry of Defence; and Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, the Netherlands
| | - Jaap van Weeghel
- Tranzo, Scientific Center for Care and Wellfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
| | - Fenna Leijten
- Strategic Military Healthcare Department, Ministry of Defence, the Netherlands
| | - Dike van de Mheen
- Tranzo, Scientific Center for Care and Wellfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
| | - Piia Varis
- Department of Culture Studies, Tilburg School of Humanities and Digital Sciences, Tilburg University, the Netherlands
| | - Andrea Rozema
- Tranzo, Scientific Center for Care and Wellfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
| | - Evelien Brouwers
- Strategic Military Healthcare Department, Ministry of Defence, the Netherlands
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A Latent Content Analysis of Barriers and Supports to Healthcare: Perspectives From Caregivers of Service Members and Veterans With Military-Related Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:342-353. [PMID: 29385014 DOI: 10.1097/htr.0000000000000373] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify barriers and supports that caregivers of individuals with military-related traumatic brain injury (TBI) encounter when navigating the military healthcare system; this information will be used as the foundation of a new patient-reported outcome measure. SETTING Community. PARTICIPANTS Forty-five caregivers of service members and veterans (SMV) who sustained a medically documented mild, moderate, severe, or penetrating TBI. DESIGN Latent content analysis. MAIN MEASURES Nine focus group discussions of barriers and supports to navigating the military healthcare system and community resources. RESULTS Latent content analysis indicated that caregivers discussed barriers (66%) and supports (34%) to obtaining care within the military healthcare system and the community. Caregivers most frequently discussed SMVs' interactions with healthcare, their own interactions with healthcare, family care, and community organizations. CONCLUSIONS Caregivers confront numerous challenges while pursuing healthcare services. Although much of the discussion focused on barriers and perceived unmet needs within the military healthcare system, caregivers also recognized supports within the military healthcare system and general community. Increased attention to accessibility and quality of services, as well as reducing financial burden, can lead to improved health-related quality of life for caregivers and their SMVs.
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Seidman AJ, Wade NG, Vogel DL, Armistead-Jehle P. The impact of stigma on behavioral health care utilization among active duty service members. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1522927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - David L. Vogel
- Department of Psychology, Iowa State University, Ames, Iowa
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Ursano RJ, Kessler RC, Naifeh JA, Mash HH, Fullerton CS, Ng THH, Aliaga PA, Wynn GH, Dinh HM, McCarroll JE, Sampson NA, Kao TC, Schoenbaum M, Heeringa SG, Stein MB. Suicide attempts in U.S. Army combat arms, special forces and combat medics. BMC Psychiatry 2017; 17:194. [PMID: 28545424 PMCID: PMC5445296 DOI: 10.1186/s12888-017-1350-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/05/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The U.S. Army suicide attempt rate increased sharply during the wars in Iraq and Afghanistan. Risk may vary according to occupation, which significantly influences the stressors that soldiers experience. METHODS Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), we identified person-month records for all active duty Regular Army enlisted soldiers who had a medically documented suicide attempt from 2004 through 2009 (n = 9650) and an equal-probability sample of control person-months (n = 153,528). Logistic regression analyses examined the association of combat occupation (combat arms [CA], special forces [SF], combat medic [CM]) with suicide attempt, adjusting for socio-demographics, service-related characteristics, and prior mental health diagnosis. RESULTS In adjusted models, the odds of attempting suicide were higher in CA (OR = 1.2 [95% CI: 1.1-1.2]) and CM (OR = 1.4 [95% CI: 1.3-1.5]), but lower in SF (OR = 0.3 [95% CI: 0.2-0.5]) compared to all other occupations. CA and CM had higher odds of suicide attempt than other occupations if never deployed (ORs = 1.1-1.5) or previously deployed (ORs = 1.2-1.3), but not when currently deployed. Occupation was associated with suicide attempt in the first ten years of service, but not beyond. In the first year of service, primarily a time of training, CM had higher odds of suicide attempt than both CA (OR = 1.4 [95% CI: 1.2-1.6]) and other occupations (OR = 1.5 [95% CI: 1.3-1.7]). Discrete-time hazard functions revealed that these occupations had distinct patterns of monthly risk during the first year of service. CONCLUSIONS Military occupation can inform the understanding suicide attempt risk among soldiers.
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Affiliation(s)
- Robert J. Ursano
- 0000 0001 0421 5525grid.265436.0Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Ronald C. Kessler
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115 USA
| | - James A. Naifeh
- 0000 0001 0421 5525grid.265436.0Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Holly Herberman Mash
- 0000 0001 0421 5525grid.265436.0Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Carol S. Fullerton
- 0000 0001 0421 5525grid.265436.0Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Tsz Hin Hinz Ng
- 0000 0001 0421 5525grid.265436.0Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Pablo A. Aliaga
- 0000 0001 0421 5525grid.265436.0Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Gary H. Wynn
- 0000 0001 0421 5525grid.265436.0Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Hieu M. Dinh
- 0000 0001 0421 5525grid.265436.0Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - James E. McCarroll
- 0000 0001 0421 5525grid.265436.0Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Nancy A. Sampson
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115 USA
| | - Tzu-Cheg Kao
- 0000 0001 0421 5525grid.265436.0Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Michael Schoenbaum
- 0000 0004 0464 0574grid.416868.5Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Blvd, Room 7137, MSC 9635, Bethesda, MD 20892 USA
| | - Steven G. Heeringa
- 0000000086837370grid.214458.eInstitute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48106-1248 USA
| | - Murray B. Stein
- 0000 0001 2181 7878grid.47840.3fDepartments of Psychiatry and Family Medicine & Public Health, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, California, 92037 USA ,0000 0004 0419 2708grid.410371.0VA San Diego Healthcare System, 8810 Rio San Diego Drive, San Diego, CA 92108 USA
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Schnyder N, Panczak R, Groth N, Schultze-Lutter F. Association between mental health-related stigma and active help-seeking: systematic review and meta-analysis. Br J Psychiatry 2017; 210:261-268. [PMID: 28153928 DOI: 10.1192/bjp.bp.116.189464] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/22/2016] [Accepted: 09/06/2016] [Indexed: 11/23/2022]
Abstract
BackgroundMental disorders create high individual and societal costs and burden, partly because help-seeking is often delayed or completely avoided. Stigma related to mental disorders or mental health services is regarded as a main reason for insufficient help-seeking.AimsTo estimate the impact of four stigma types (help-seeking attitudes and personal, self and perceived public stigma) on active help-seeking in the general population.MethodA systematic review of three electronic databases was followed by random effect meta-analyses according to the stigma types.ResultsTwenty-seven studies fulfilled eligibility criteria. Participants' own negative attitudes towards mental health help-seeking (OR = 0.80, 95% CI 0.73-0.88) and their stigmatising attitudes towards people with a mental illness (OR = 0.82, 95% CI 0.69-0.98) were associated with less active help-seeking. Self-stigma showed insignificant association (OR = 0.88, 95% CI 0.76-1.03), whereas perceived public stigma was not associated.ConclusionsPersonal attitudes towards mental illness or help-seeking are associated with active help-seeking for mental problems. Campaigns promoting help-seeking by means of fighting mental illness-related stigma should target these personal attitudes rather than broad public opinions.
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Affiliation(s)
- Nina Schnyder
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Radoslaw Panczak
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Nicola Groth
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Frauke Schultze-Lutter
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
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Hom MA, Stanley IH, Schneider ME, Joiner TE. A systematic review of help-seeking and mental health service utilization among military service members. Clin Psychol Rev 2017; 53:59-78. [PMID: 28214634 DOI: 10.1016/j.cpr.2017.01.008] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 11/10/2016] [Accepted: 01/24/2017] [Indexed: 11/20/2022]
Abstract
Research has demonstrated that military service members are at elevated risk for a range of psychiatric problems, and mental health services use is a conduit to symptom reduction and remission. Nonetheless, there is a notable underutilization of mental health services in this population. This systematic review aimed to identify and critically examine: (1) rates of service use; (2) barriers and facilitators to care; and (3) programs and interventions designed to enhance willingness to seek care and increase help-seeking behaviors among current military personnel (e.g., active duty, National Guard, Reserve). Overall, 111 peer-reviewed articles were identified for inclusion. Across studies, the rate of past-year service use among service members with mental health problems during the same time frame was 29.3% based on weighted averages. Studies identified common barriers to care (e.g., concerns regarding stigma, career impact) and facilitators to care (e.g., positive attitudes toward treatment, family/friend support, military leadership support) among this population. Although programs (e.g., screening, gatekeeper training) have been developed to reduce these barriers, leverage facilitators, and encourage service use, further research is needed to empirically test the effectiveness of these interventions in increasing rates of service utilization. Critical areas for future research on treatment engagement among this high-risk population are discussed.
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Affiliation(s)
- Melanie A Hom
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States.
| | - Ian H Stanley
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States
| | - Matthew E Schneider
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States
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Pugh MJ, Finley EP, Wang CP, Copeland LA, Jaramillo CA, Swan AA, Elnitsky CA, Leykum LK, Mortensen EM, Eapen BA, Noel PH, Pugh JA. A retrospective cohort study of comorbidity trajectories associated with traumatic brain injury in veterans of the Iraq and Afghanistan wars. Brain Inj 2016; 30:1481-1490. [DOI: 10.1080/02699052.2016.1219055] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Phillips KM, Clark ME, Gironda RJ, McGarity S, Kerns RW, Elnitsky CA, Andresen EM, Collins RC. Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era Veterans. ACTA ACUST UNITED AC 2016; 53:413-32. [PMID: 27532156 DOI: 10.1682/jrrd.2014.05.0126] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/02/2015] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Robert W. Kerns
- Pain Research, Informatics, Multi-morbidities, and Education, Center of Innovation, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT; and School of Medicine, Yale University, New Haven, CT
| | - Christine A. Elnitsky
- School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC
| | - Elena M. Andresen
- School of Public Health, Oregon Health and Science University; and Portland State University, Portland, OR
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Misra-Hebert AD, Santurri L, DeChant R, Watts B, Rothberg M, Sehgal AR, Aron DC. Understanding the Health Needs and Barriers to Seeking Health Care of Veteran Students in the Community. South Med J 2015; 108:488-93. [PMID: 26280777 PMCID: PMC4544768 DOI: 10.14423/smj.0000000000000326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Access to care at Veterans Affairs facilities may be limited by long wait times; however, additional barriers may prevent US military veterans from seeking help at all. We sought to understand the health needs of veterans in the community to identify possible barriers to health-seeking behavior. METHODS Focus groups were conducted with veteran students at a community college until thematic saturation was reached. Qualitative data analysis involved both an inductive content analysis approach and deductive elements. RESULTS A total of 17 veteran students participated in 6 separate focus groups. Health needs affecting health-seeking behavior were identified. Themes included lack of motivation to improve health, concern about social exclusion and stigma, social interactions and behavior, limited access to affordable and convenient health care, unmet basic needs for self and family, and academics competing with health needs. CONCLUSIONS Veterans face a range of personal, societal, and logistical barriers to accessing care. In addition to decreasing wait times for appointments, efforts to improve the transition to civilian life; reduce stigma; and offer assistance related to work, housing, and convenient access to health care may improve health in veteran students.
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Affiliation(s)
- Anita D Misra-Hebert
- From the Center for Value Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, the Department of Health Promotion and Human Performance, Jerry & Vickie Moyes College of Education, Weber State University, Ogden, Utah, Veterans Services and Programs, Cuyahoga Community College, Cleveland, Ohio, the Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, and the Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio
| | - Laura Santurri
- From the Center for Value Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, the Department of Health Promotion and Human Performance, Jerry & Vickie Moyes College of Education, Weber State University, Ogden, Utah, Veterans Services and Programs, Cuyahoga Community College, Cleveland, Ohio, the Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, and the Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio
| | - Richard DeChant
- From the Center for Value Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, the Department of Health Promotion and Human Performance, Jerry & Vickie Moyes College of Education, Weber State University, Ogden, Utah, Veterans Services and Programs, Cuyahoga Community College, Cleveland, Ohio, the Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, and the Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio
| | - Brook Watts
- From the Center for Value Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, the Department of Health Promotion and Human Performance, Jerry & Vickie Moyes College of Education, Weber State University, Ogden, Utah, Veterans Services and Programs, Cuyahoga Community College, Cleveland, Ohio, the Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, and the Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio
| | - Michael Rothberg
- From the Center for Value Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, the Department of Health Promotion and Human Performance, Jerry & Vickie Moyes College of Education, Weber State University, Ogden, Utah, Veterans Services and Programs, Cuyahoga Community College, Cleveland, Ohio, the Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, and the Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio
| | - Ashwini R Sehgal
- From the Center for Value Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, the Department of Health Promotion and Human Performance, Jerry & Vickie Moyes College of Education, Weber State University, Ogden, Utah, Veterans Services and Programs, Cuyahoga Community College, Cleveland, Ohio, the Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, and the Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio
| | - David C Aron
- From the Center for Value Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, the Department of Health Promotion and Human Performance, Jerry & Vickie Moyes College of Education, Weber State University, Ogden, Utah, Veterans Services and Programs, Cuyahoga Community College, Cleveland, Ohio, the Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, and the Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio
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Ramchand R, Rudavsky R, Grant S, Tanielian T, Jaycox L. Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan. Curr Psychiatry Rep 2015; 17:37. [PMID: 25876141 DOI: 10.1007/s11920-015-0575-z] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review summarizes the epidemiology of posttraumatic stress disorder (PTSD) and related mental health problems among persons who served in the armed forces during the Iraq and Afghanistan conflicts, as reflected in the literature published between 2009 and 2014. One-hundred and sixteen research studies are reviewed, most of which are among non-treatment-seeking US service members or treatment-seeking US veterans. Evidence is provided for demographic, military, and deployment-related risk factors for PTSD, though most derive from cross-sectional studies and few control for combat exposure, which is a primary risk factor for mental health problems in this cohort. Evidence is also provided linking PTSD with outcomes in the following domains: physical health, suicide, housing and homelessness, employment and economic well-being, social well-being, and aggression, violence, and criminality. Also included is evidence about the prevalence of mental health service use in this cohort. In many instances, the current suite of studies replicates findings observed in civilian samples, but new findings emerge of relevance to both military and civilian populations, such as the link between PTSD and suicide. Future research should make effort to control for combat exposure and use longitudinal study designs; promising areas for investigation are in non-treatment-seeking samples of US veterans and the role of social support in preventing or mitigating mental health problems in this group.
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Affiliation(s)
- Rajeev Ramchand
- RAND Corporation, 1100 South Hayes Street, Arlington, VA, 22202-5050, USA,
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14
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Sharp ML, Fear NT, Rona RJ, Wessely S, Greenberg N, Jones N, Goodwin L. Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiol Rev 2015; 37:144-62. [PMID: 25595168 DOI: 10.1093/epirev/mxu012] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Approximately 60% of military personnel who experience mental health problems do not seek help, yet many of them could benefit from professional treatment. Across military studies, one of the most frequently reported barriers to help-seeking for mental health problems is concerns about stigma. It is, however, less clear how stigma influences mental health service utilization. This review will synthesize existing research on stigma, focusing on those in the military with mental health problems. We conducted a systematic review and meta-analysis of studies between 2001 and 2014 to examine the prevalence of stigma for seeking help for a mental health problem and its association with help-seeking intentions/mental health service utilization. Twenty papers met the search criteria. Weighted prevalence estimates for the 2 most endorsed stigma concerns were 44.2% (95% confidence interval: 37.1, 51.4) for "My unit leadership might treat me differently" and 42.9% (95% confidence interval: 36.8, 49.0) for "I would be seen as weak." Nine studies found no association between anticipated stigma and help-seeking intentions/mental health service use and 4 studies found a positive association. One study found a negative association between self-stigma and intentions to seek help. Counterintuitively, those that endorsed high anticipated stigma still utilized mental health services or were interested in seeking help. We propose that these findings may be related to intention-behavior gaps or methodological issues in the measurement of stigma. Positive associations may be influenced by modified labeling theory. Additionally, other factors such as self-stigma and negative attitudes toward mental health care may be worth further attention in future investigation.
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Predictors of healthcare service utilization for mental health reasons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:10559-86. [PMID: 25321874 PMCID: PMC4210995 DOI: 10.3390/ijerph111010559] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 01/04/2023]
Abstract
This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care.
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Besterman-Dahan K, Lind JD, Crocker T. “YOU NEVER HEARD JESUS SAY TO MAKE SURE YOU TAKE TIME OUT FOR YOURSELF”: MILITARY CHAPLAINS AND THE STIGMA OF MENTAL ILLNESS. ANNALS OF ANTHROPOLOGICAL PRACTICE 2014. [DOI: 10.1111/napa.12032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Karen Besterman-Dahan
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital; Tampa FL
| | - Jason D. Lind
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital; Tampa FL
| | - Theresa Crocker
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital; Tampa FL
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