Correlates of Perceived Need for Mental Health Care Among Active Military Personnel
ABSTRACT There is increasing concern about mental health problems and need for mental health care among soldiers after deployment. This study examined correlates of self-perceived need for mental health care among active military personnel.
Data were from a 2002 cross-sectional population-based survey of 8,441 active Canadian military personnel (2,592 women) aged 16 to 54 (response rate 81%). A fully structured lay-administered interview for past-year DSM-IV mental disorders and perceived need for mental health care was conducted. Five domains of self-perceived need were assessed: information, medication, counseling, social intervention, and skills training. Several deployment factors were assessed (length of deployment, number of deployments, and exposure to deployment-related traumatic events), as were long-term restriction in activities because of disability and suicidal ideation. Multiple logistic regression models were used to determine correlates of perceived need.
After adjustment for mental disorders, the strongest and most consistent correlates of perceived need were long-term restriction in activities, suicidal ideation, female gender, and regular service status (versus reserve status) (adjusted odds ratios ranging from 1.28 to 4.37). Deployment and exposure to combat and witnessing atrocities were moderately associated with an increase in self-perceived need for mental health care.
The findings suggest that a range of issues beyond the presence of common mental disorders need to be considered in understanding the factors that contribute to a sense of need for mental health treatment. Postdeployment screening programs should consider systematically assessing self-perceived need for mental health treatment.
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- "Females compared to males and respondents with low compared to high education were less likely to report lack of perceived need as a reason for not seeking treatment. While past research generally supports an association between female gender and greater perceived need for mental health treatment (Meadows et al., 2002, Sareen et al., 2010), the association with education is puzzling and may suggest that formal education by itself does not significantly promote recognition of mental health care needs. The finding that married/ cohabiting respondents had an elevated OR of reporting structural barriers, but only among mild cases, might reflect the fact that married people have more family responsibilities than single people that place demands on their time and financial resources, thereby creating barriers to seeking treatment that are only overcome when disorders become relatively serious. "
ABSTRACT: The aim was to examine barriers to initiation and continuation of treatment among individuals with common mental disorders in the US general population. Respondents in the National Comorbidity Survey Replication with common 12-month DSM-IV mood, anxiety, substance, impulse control and childhood disorders were asked about perceived need for treatment, structural barriers and attitudinal/evaluative barriers to initiation and continuation of treatment. Low perceived need was reported by 44.8% of respondents with a disorder who did not seek treatment. Desire to handle the problem on one's own was the most common reason among respondents with perceived need both for not seeking treatment (72.6%) and for dropping out of treatment (42.2%). Attitudinal/evaluative factors were much more important than structural barriers both to initiating (97.4% v. 22.2%) and to continuing (81.9% v. 31.8%) of treatment. Reasons for not seeking treatment varied with illness severity. Low perceived need was a more common reason for not seeking treatment among individuals with mild (57.0%) than moderate (39.3%) or severe (25.9%) disorders, whereas structural and attitudinal/evaluative barriers were more common among respondents with more severe conditions. Low perceived need and attitudinal/evaluative barriers are the major barriers to treatment seeking and staying in treatment among individuals with common mental disorders. Efforts to increase treatment seeking and reduce treatment drop-out need to take these barriers into consideration as well as to recognize that barriers differ as a function of sociodemographic and clinical characteristics.Psychological Medicine 12/2010; 41(8):1751-61. DOI:10.1017/S0033291710002291 · 5.43 Impact Factor
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ABSTRACT: Significant controversy exists as to whether soldiers are at increased risk for suicide and suicidal behaviors compared with civilians. Furthermore, little is known about whether risk factors for suicidal behaviors in civilian populations are generalizable to soldiers. The aim of the current study is to determine whether the prevalence and correlates of past-year suicidal ideation and suicide attempts differ in Canadian soldiers when compared with Canadian civilians. The current study utilized data from the Canadian Community Health Survey Cycle 1.2-Canadian Forces Supplement in conjunction with the 2001-2002 Canadian Community Health Survey Cycle 1.2. Logistic regression interaction models were used to explore differences between correlates of suicidal ideation and suicide attempts comparing Canadian soldiers with civilians. Although there was no significant difference between the 2 samples on prevalence of past-year suicidal ideation, the prevalence of past-year suicide attempts was significantly lower in the Canadian forces sample compared with the civilian population (odds ratio = 0.41, 95% confidence interval: 0.25, 0.67). Findings suggest that suicide attempts are less common in Canadian active military personnel than in the civilian population. Possible mechanisms for these differences are discussed.American journal of epidemiology 10/2010; 172(11):1250-8. DOI:10.1093/aje/kwq290 · 4.98 Impact Factor
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ABSTRACT: Combat exposure is associated with subsequent mental health symptoms, but progression to mental health disability is unclear. Army soldiers discharged with mental health disability (n = 4,457) were compared to two matched control groups: other disability discharge (n = 8,974) and routine discharge (n = 9,128). In multivariate logistic models, odds of mental health disability discharge versus other disability and routine discharge were significantly higher for soldiers deployed to combat zones; odds ratios increased with deployment time. Prior mental health hospitalization decreased these odds, though they remained significantly elevated. Mental health hospitalization with successful treatment may facilitate better coping during deployment. The frequency of disability after mental health hospitalization suggests remaining gaps in deployment-related mental health assessment and treatment.Journal of Traumatic Stress 02/2011; 24(1):34-43. DOI:10.1002/jts.20612 · 2.72 Impact Factor