Perceived Stigma and Barriers to Mental Health Care Utilization Among OEF-OIF Veterans

National Center for Posttraumatic Stress Disorder, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 09/2009; 60(8):1118-22. DOI: 10.1176/
Source: PubMed


This study examined whether social support and beliefs about mental health care are associated with stigma, barriers to care, and mental health care utilization in a sample of veterans of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom (OEF-OIF).
A sample of 272 predominantly reservist and National Guard OEF-OIF veterans in Connecticut completed a needs assessment survey.
Negative beliefs about mental health care, particularly psychotherapy, and decreased perceived unit support predicted increased perceptions of stigma and barriers to care. Negative beliefs about mental health care were also associated with decreased likelihood of mental health counseling and medication visits in the past six months, even after adjustment for demographic characteristics, psychiatric disorders, and support variables.
Educational interventions for modifying negative beliefs about mental health care and bolstering unit support may help decrease stigma and barriers to care and increase mental health treatment seeking among OEF-OIF veterans.

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Available from: Douglas C Johnson, Nov 20, 2015

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Article: Perceived Stigma and Barriers to Mental Health Care Utilization Among OEF-OIF Veterans

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    • "In addition, service members report negative attitudes about treatment (Kim, Britt, Klocko, Riviere, & Adler, 2011) and have poorer perceptions of unit support (Pietrzak et al., 2009), which affect willingness to seek treatment. These factors should be taken into consideration when developing treatment programs for active duty service members. "

    Cognitive and Behavioral Practice 09/2015; DOI:10.1016/j.cbpra.2015.08.007 · 1.33 Impact Factor
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    • "Soldiers are trained to push through injury and stress, rather than seek outside assistance (Tanielian & Jaycox, 2008). Implicit in this cultural lens is the notion that an effort to seek help for mental health struggles would be indicative of weakness (e.g., Pietrzak, Johnson, Goldstein, Malley, & Southwick, 2009). Given that soldiers report a general mistrust of mental health professionals (e.g., Hoge et al., 2004; Kim, Britt, Klocko, Riviere, & Adler, 2011), this culture thus does not facilitate help seeking behavior and, indeed, could potentially result in underreporting of risk. "
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    ABSTRACT: Objectives Increasing rates of suicide in the military indicate current assessment approaches are not yielding accurate determinations of risk. Concern that endorsement of suicidal ideation may result in obstacles to career advancement may be resulting in nondisclosure.Method To test this, we recruited a sample of US National Guard personnel (n = 789; 81.7% male; 63.2% white) and administered two measures of current thoughts of suicide. One measure was integrated into our risk assessment protocol and soldiers were thus aware that answers could result in referral to on site military mental health professionals. The other measure was not integrated into the risk assessment protocol and soldiers were thus aware that results would not be reported to on site military mental health professionals.ResultsAs hypothesized, a higher proportion of individuals reported current thoughts of suicide on the measure not integrated into the risk protocol (9.4%) than on the measure that was (6.0%). Also as hypothesized, a higher proportion of those willing to endorse current thoughts of suicide on the measure not integrated into the risk protocol denied current thoughts of suicide on the one that was (61.5%) than vice versa (39.0%). Limitations include cross-sectional self-report data and a lack of counter-balancing of measures.Conclusions The results indicate that increasing the confidentiality of risk assessments within the National Guard increases the likelihood of reporting of current thoughts of suicide.
    Journal of Clinical Psychology 09/2015; 71(10). DOI:10.1002/jclp.22198 · 2.12 Impact Factor
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    • "The finding that longer time to initiation of MHO services was associated with more symptomatic classes suggests that treatment engagement efforts may be crucial when working with veterans with PTSD. There may be a number of factors that delay returning veterans from seeking treatment for PTSD: these factors may include co-occurring disorders (Lu et al., 2011; Seal et al., 2010); practical barriers such as difficulties with transportation, scheduling (e.g., conflicting responsibilities at work, home, and school), and paperwork (Garcia et al., 2014; Vogt et al., 2006); and stigma associated with needing care for mental health issues (Hoge et al., 2004; Ouimette et al., 2011; Pietrzak et al., 2009; Stecker et al., 2013). In addition to these barriers, veterans with more elevated PTSD symptoms may find it more difficult to seek treatment, which delays their initiation of MH services. "
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    ABSTRACT: Background Recent studies have used latent class analysis (LCA) to identify subgroups of individuals who share similar patterns of PTSD symptom endorsement; however, further study is needed among female veterans, whose PTSD symptom expression may vary from that of their male counterparts. The current study examined latent PTSD symptom classes in female veterans who returned from recent military service in Iraq and Afghanistan, and explored military and demographic variables associated with distinct PTSD symptom presentations. Methods A retrospective analysis was conducted using existing medical records from female Iraq and Afghanistan veterans who were new users of VA mental health outpatient (MHO) care, had received a PTSD diagnosis anytime during the post-deployment period, and completed the PTSD checklist within 30 days of their first MHO visit (N=2425). Results The LCA results identified four latent classes of PTSD symptom profiles in the sample: High Symptom, Intermediate Symptom, Intermediate Symptom with High Emotional Numbing (EN), and Low Symptom. Race/ethnicity, age, time since last deployment, and distance from a VA facility emerged as predictors of PTSD symptom presentation. Limitations The current study was cross-sectional and utilized administrative data. The results may not be generalizable to female veterans from other service eras. Conclusions Longer times between end of last deployment and initiation of MHO services were associated with more symptomatic classes. Exploration of PTSD symptom presentation may enhance our understanding of the service needs of female veterans with PTSD, and suggests potential benefits to engaging veterans in MHO soon after last deployment.
    Journal of Affective Disorders 09/2014; 166:132–138. DOI:10.1016/j.jad.2014.04.061 · 3.38 Impact Factor
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