A Qualitative Study of Determinants of PTSD Treatment Initiation

Center for Chronic Diseases Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
Psychiatry Interpersonal & Biological Processes (Impact Factor: 3.05). 09/2009; 72(3):238-55. DOI: 10.1521/psyc.2009.72.3.238
Source: PubMed


Although there are effective treatments for Posttraumatic Stress Disorder (PTSD), many PTSD sufferers wait years to decades before seeking professional help, if they seek it at all. An understanding of factors affecting treatment initiation for PTSD can inform strategies to promote help-seeking. We conducted a qualitative study to identify determinants of PTSD treatment initiation among 44 U.S. military veterans from the Vietnam and Afghanistan/Iraq wars; half were and half were not receiving treatment. Participants described barriers to and facilitators of treatment initiation within themselves, the post-trauma socio-cultural environment, the health care and disability systems, and their social networks. Lack of knowledge about PTSD was a barrier that occurred at both the societal and individual levels. Another important barrier theme was the enduring effect of experiencing an invalidating socio-cultural environment following trauma exposure. In some cases, system and social network facilitation led to treatment initiation despite individual-level barriers, such as beliefs and values that conflicted with help-seeking. Our findings expand the dominant model of service utilization by explicit incorporation of factors outside the individual into a conceptual framework of PTSD treatment initiation. Finally, we offer suggestions regarding the direction of future research and the development of interventions to promote timely help-seeking for PTSD.

Download full-text


Available from: Louise E Parker,
151 Reads
  • Source
    • "Adopting a nuanced, multidimensional, and situated notion of culture is an imperative first step toward identifying the multitude of factors that inform and structure health beliefs and practices, such as help seeking for mental illness, among those with a background in the U.S. military (see calls for cultural analyses in Hsu & Ketchen, 2013; Vogt, 2011). Defining the U.S. military as a field that hosts numerous habitus moves research closer to answering the call to integrate factors outside the individual , such as sociocultural, social network, and systemlevel factors (Sayer et al., 2009) into a more complex conceptual framework for exploring help seeking for mental illness in research. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This theoretical treatise uses the scientific literature concerning help seeking for mental illness among those with a background in the U.S. military to posit a more complex definition of military culture. The help-seeking literature is used to illustrate how hegemonic masculinity, when situated in the military field, informs the decision to seek formal treatment for mental illness among those men with a background in the U.S. military. These analyses advocate for a nuanced, multidimensional, and situated definition of U.S. military culture that emphasizes the way in which institutional structures and social relations of power intersect with individual values, beliefs, and motivations to inform and structure health-related practices. © The Author(s) 2015.
    American journal of men's health 07/2015; DOI:10.1177/1557988315596037 · 1.15 Impact Factor
    • "A third set of facilitators relates to beliefs about mental illness and treatment. These were described in a small qualitative study of Vietnam and OEF/ OIF veterans with PTSD, which identified beliefs that treatment is socially acceptable, helpful , and provided by a trustworthy system (Sayer et al., 2009). Another set of facilitators described in the civilian literature relates to the presence of a social network that is accepting and encouraging of treatment seeking (Vogel et al., 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite significant mental health needs among sexual assault (SA) victims in the military, little is known about treatment-seeking patterns or factors associated with service use. This study examined service use behavior, barriers, and facilitators of mental health treatment-seeking in an active duty sample of 927 U.S. Army soldiers with mental health problems. SA victims (n = 113) did not differ from non-victims on barriers or facilitators after adjusting for demographic and mental health variables, with stigma rated as the largest barrier. Most SA victims (87.6%) had sought informal support and 59.3% had sought formal treatment. One third of treatment-seekers had dropped out of treatment. Multivariate logistic regression analyses identified several correlates of treatment-seeking among SA victims: Black race (OR = 7.57), SA during the military (OR = 4.34), positive treatment beliefs (OR = 2.22), social support for treatment (OR = 2.14), self-reliance (OR = 0.47), and stigma towards treatment seekers (OR = 0.43). Mental health symptoms were not associated with treatment seeking. Findings suggested that treatment-facilitating interventions should focus on improving recognition of mental health symptoms, altering perceptions related to self-reliance, and reducing stigma. Interventions should also enlist support for treatment-seeking from unit members, leaders, and significant others. © 2015 International Society for Traumatic Stress Studies.
    Journal of Traumatic Stress 07/2015; 28(4). DOI:10.1002/jts.22026 · 2.72 Impact Factor
  • Source
    • "Many service members and veterans, however, are not opposed to seeking treatment. Some prefer to use less conventional avenues for therapy if they do not want to share information with a therapist or suffer the side effects of taking medicine (Edlund, Fortney, Reaves, Pyne, & Mittal, 2008; Kim, Britt, Klocko, Riviere, & Adler, 2011; Zinzow et al., 2012; Sayer et al., 2009). With social media networks such as Facebook and Twitter becoming more prominent in today's culture, some service members and veterans are turning to creative ways of self-therapy such as blogging and support pages to help ease the pain of their mental anguish (Tan, 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: As the war in Afghanistan for many United States service members is coming to an end, focus on veteran recovery and mental health maintenance is emerging. Veterans’ mental health problems have been cited as an individual and familial problem (Segrin, 2012). As a result, further examination that includes partners as well as challenges and resilience among military couples is needed to assess a more comprehensive view of the repercussions of mental illness on the veteran. The following literature review seeks to highlight the effects of mental illness on military couples through the explanatory framework of the relational turbulence model (Knobloch & Solomon, 2004). Couple resilience and implications for mental health practitioners are also discussed.
    Social Work in Mental Health 11/2014; 12(5-6):560-574. DOI:10.1080/15332985.2014.891553
Show more