Fleet Leaders' Attitudes about Subordinates' Use of Mental Health Services

Nursing Research Service, Naval Medical Center, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
Military medicine (Impact Factor: 0.77). 12/2007; 172(11):1138-43. DOI: 10.7205/MILMED.172.11.1138
Source: PubMed


Mental disorders are a significant source of medical and occupational morbidity for sailors. Stigma, fear of negative career impact, and subordinates concern about leaders' attitudes are significant barriers to the use of mental health services. Semistructured interviews and military policies were data sources used to analyze the language, knowledge, and attitudes of Navy surface fleet leaders about mental illness and mental health treatment using Foucault's concept of discourse analysis. A discourse is a system of knowledge that influences language, perceptions, values, and social practices. The results showed that leaders' concerns about sailors' mental combat readiness, not mental illness stigma, was the dominant discourse about mental illness and mental health services use. In particular, organizational differences between the surface warfare and the mental health communities may influence leaders' attitudes more than stigma. This study provides an elaborated view of mental health knowledge and power within a Navy community.

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    • "retention, delayed treatment, reduced organizational efficiency, family disruption, and significant decrements to quality of life (Evren et al., 2011; Pan, Chung, Chen, Hsiung, & Rao, 2011; Westphal, 2007). It is important to recognize, however, that the majority of service members who are returning from combat deployment do not experience psychiatric problems. "
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    ABSTRACT: Objective: To conduct a blinded study to examine the diagnostic efficiency of the Department of Defense (DoD) Post-Deployment Health Reassessment (PDHRA) screens for major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and alcohol abuse. Method: Participants were 148 post-deployed soldiers who were completing the PDHRA protocol. Soldiers' mean age was 27.7 (standard deviation = 6.6) years, and 89.0% were male. Mental health professionals blinded to the PDHRA screening results administered the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition directly after the PDHRA assessment protocol. Results: All screens exhibited excellent negative predictive power. Sensitivity metrics were lower, consistent with the relatively low base rates observed for MDD (10.1%), PTSD (8.8%), and alcohol abuse (5.4%). Metrics obtained for the PTSD screen were consistent with previous research with a similar base rate. A two-item screen containing PTSD reexperiencing and hyperarousal symptom items revealed excellent psychometric properties (sensitivity = .92; specificity = .79). The alcohol abuse screen yielded high sensitivity (.86), but very poor precision; these metrics were somewhat improved when the screen was reduced to a single item. Conclusions: The PDHRA MDD, PTSD, and alcohol abuse screens appear to be functioning well in accurately ruling out these diagnoses, consistent with a population-level screening program. Cross validation of the current results is indicated. Additional refinement may yield more sensitive screening measures within constraints imposed by the low base rates in a typically healthy population.
    Journal of Clinical Psychology 12/2012; 68(12). DOI:10.1002/jclp.21887 · 2.12 Impact Factor
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    • "Untreated mental health problems in the military are associated with significant costs such as decreased retention, delayed treatment, reduced organizational efficiency, and family disruption (Westphal, 2007). Stigma further intensifies these problems by eroding self-esteem, engendering a sense of isolation, and negatively influencing overall well-being (Ritsher, Otilingam, & Grajales , 2003). "
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    ABSTRACT: This research developed and tested the Military Stigma Scale (MSS), a 26-item scale, designed to measure public and self-stigma, two theorized core components of mental health stigma. The sample comprised 1,038 active duty soldiers recruited from a large Army installation. Soldiers' mean age was 26.7 (standard deviation = 5.9) years, and 93.6% were male. The sample was randomly split into a scale development group (n = 520) and a confirmatory group (n = 518). Factor analysis conducted with the scale development group resulted in the adoption of two factors, named public and self-stigma, accounting for 52.1% of the variance. Confirmatory factor analysis conducted with the confirmatory group indicated good fit for the two-factor model. Both factors were components of a higher order stigma factor. The public and self-stigma scales for the exploratory and confirmatory groups demonstrated good internal consistency (α = .94 and .89; α = .95 and .87, respectively). Demographic differences in stigma were consistent with theory and previous empirical research: Soldiers who had seen a mental health provider scored lower in self-stigma than those who had not. The MSS comprises two internally consistent dimensions that appear to capture the constructs of public and self-stigma. The overall results indicate that public and self-stigma are dimensions of stigma that are relevant to active duty soldiers and suggest the need to assess these dimensions in future military stigma research.
    Journal of Clinical Psychology 09/2012; 68(9):1036-47. DOI:10.1002/jclp.21889 · 2.12 Impact Factor
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    • "In many organizations, however, norms regarding depression disclosure are particularly negative . For example, the majority of American military personnel believe that using mental health services will cause career harm, and more than 81% of those with mental health problems do not seek treatment (Westphal, 2007). Thus, it is expected that the degree to which group norms support disclosing depression plays a role in influencing managers' level of stigmatization of depressed employees. "
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    ABSTRACT: Managers' attitudes toward depressed employees play an important role in effectively managing depression in the workplace. The present study pilot tested a survey measure of managers' attitudes toward depressed employees (n=225). Exploratory factor analysis showed evidence of cognitive, affective, and behavioral dimensions in the measure of attitudes. Regression analyses examined relationships between the measure and a range of proposed individual and contextual correlates. Results showed that more negative attitudes toward depressed employees were endorsed by managers who reported a more internal locus of control, higher levels of stress, less familiarity with depression, and greater reticence to seek help. Managers who perceived their organizations to have unsupportive depression disclosure norms reported higher levels of stigma, and those whose organizations had a clear mental health strategy reported lower levels of stigma. The findings have important implications for developing human resource management strategies that deal with the increasing incidence and impact of depression in the workplace. © 2010 Wiley Periodicals, Inc.
    Human Resource Management 07/2010; 49(4):647 - 668. DOI:10.1002/hrm.20370 · 1.52 Impact Factor
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