Article

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: 1.99). 09/2009; 60(8):1118-22. DOI: 10.1176/appi.ps.60.8.1118
Source: PubMed

ABSTRACT 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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    • "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 · 3.71 Impact Factor
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    • "Findings from the military and veteran literature on the impact of concerns about stigma on treatment seeking have been mixed, with several recent studies suggesting that anticipated stigma from others may be positively, rather than negatively, associated with mental health service use (Olmsted et al., 2011; Rosen et al., 2011; Stecker, Fortney, Hamilton, Sherbourne, & Ajzen, 2010). In contrast, several recent studies suggest a key role for personal beliefs about mental illness and mental health treatment as a barrier to care (Brown, Creel, Engel, Herrell, & Hoge, 2011; Kehle et al., 2010; Kim et al., 2011; Pietrzak et al., 2009; Stecker et al., 2007; Sudom, Zamorski, & Garber, 2012). No studies to our knowledge, however, have provided an in-depth examination of separate domains of personal beliefs about mental illness and mental health treatment as predictors of mental health service use. "
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    ABSTRACT: Many veterans who would benefit from mental health care do not seek treatment. The current study provided an in-depth examination of mental health-related beliefs and their relationship with mental health and substance abuse service use in a national sample of 640 U.S. Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans. Both concerns about mental health stigma from others and personal beliefs about mental illness and mental health treatment were examined. Data were weighted to adjust for oversampling of women and nonresponse bias. Results revealed substantial variation in the nature of OEF/OIF veterans' mental health beliefs, with greater anticipated stigma in the workplace (M = 23.74) than from loved ones (M = 19.30), and stronger endorsement of negative beliefs related to mental health treatment-seeking (M = 21.78) than either mental illness (M = 18.56) or mental health treatment (M = 20.34). As expected, individuals with probable mental health problems reported more negative mental health-related beliefs than those without these conditions. Scales addressing negative personal beliefs were related to lower likelihood of seeking care (ORs = 0.80-0.93), whereas scales addressing anticipated stigma were not associated with service use. Findings can be applied to address factors that impede treatment seeking.
    Journal of Traumatic Stress 06/2014; 27(3). DOI:10.1002/jts.21919 · 2.72 Impact Factor
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    • "In addition, behaviors honed in the warzone and perceived as adaptive and ego-syntonic by service members, such as avoidance and hypervigilance , come to represent mental health symptoms upon return home. Veterans are particularly attuned to perceptions of stigma associated with mental health care and voice concerns that they will be perceived as weak or that seeking mental health assistance could negatively impact their careers (Hoge et al., 2004; Pietrzak et al., 2009). The " warrior culture " of the U.S. military, with its values of strength and resilience, contributes to veterans' beliefs that mental health problems should be combated without outside help (Tanielian & Jaycox, 2008). "
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    ABSTRACT: Veterans with posttraumatic stress disorder (PTSD) symptoms frequently present to primary care providers (PCPs) and are reluctant to seek out or accept referrals to specialty mental health care. Most PCPs have not been trained to assess for and manage symptoms of PTSD. Web-based programs are increasingly used for medical education, but there are no published evaluations of online PTSD trainings for PCPs. We developed a 70-min Web-based training that focused on military-related PTSD for PCPs practicing in Veterans Affairs (VA) hospitals, but was applicable to PCPs treating veterans and other trauma-exposed patients outside VA settings. The training consisted of four modules: (1) Detection and Assessment; (2) Comorbid Conditions and Related Problems; (3) Pharmacological Interventions; and (4) Psychotherapeutic Interventions. Clinical vignettes dramatized key training concepts. Seventy-three PCPs completed the training and assessments pre- and posttraining and 30 days later. Paired t tests compared change in PTSD-related knowledge and comfort with PTSD-related skills, and qualitative methods were used to summarize participant feedback. After the training, mean knowledge score improved from 46% to 75% items correct, with sustained improvement at 30 days. Thirty days posttraining, PCPs reported significantly greater comfort regarding PTSD-related skills assessed; 47% reported using training content in their clinical practice. Qualitatively, PCPs appreciated the flexibility of asynchronous, self-paced online modules, but suggested more interactive content. Given the numerous barriers to specialty mental health treatment, coupled with a preference among veterans with PTSD for accessing treatment through primary care, improving PTSD competency among PCPs may help better serve veterans' mental health needs. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychological Services 12/2013; 11(2). DOI:10.1037/a0034855 · 1.08 Impact Factor
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