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Ammerman BA, Piccirillo ML, O'Loughlin CM, Carter SP, Matarazzo B, May AM. The role of suicide stigma in self-disclosure among civilian and veteran populations. Psychiatry Res 2022; 309:114408. [PMID: 35150977 DOI: 10.1016/j.psychres.2022.114408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
Widespread attempts to implement suicide prevention efforts may be hindered by stigma regarding suicidal thoughts and behaviors (STBs). Despite extensive literature linking general mental health stigma to numerous negative outcomes (i.e., reduced help-seeking), limited research has extended findings to STB-specific stigma. Thus, the present study aimed to examine the association between three types of STB stigma (public, self, and anticipated) and self-disclosure, a specific form of help-seeking for some individuals, among civilians and a population at heightened suicide risk, U.S. veterans. Participants (n = 500) reported a lifetime history of suicidal ideation (n = 253 identified as a U.S. veteran; n = 132 reported being enrolled in Veteran Health Administration [VHA] care) who completed self-report measures about their STB experiences, including stigma and self-disclosure. Results highlighted a significant association between greater self-stigma, as well as greater anticipated stigma, and a reduced likelihood of STB disclosure, among veterans but not civilians. No significant associations as a result of VHA care status were found. Together, findings suggest that individuals' concerns related to STBs and STB disclosure may be grounded in past experiences in the military, and thus highlight the need for prevention efforts that protect against negative consequences related to STB disclosure.
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Affiliation(s)
- Brooke A Ammerman
- University of Notre Dame, Department of Psychology, Notre Dame, IN, 46556, USA.
| | | | | | - Sarah P Carter
- Uniformed Services University, Department of Medical & Clinical Psychology, Bethesda, MD 20814, USA
| | - Bridget Matarazzo
- Department of Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center for Veteran Suicide Prevention, University of Colorado, Anschutz Medical Campus, Department of Psychiatry, Aurora, CO 80045, USA
| | - Alexis M May
- Wesleyan University, Department of Psychology, Middletown, CT 06459, USA
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Campbell-Sills L, Flynn PJ, Choi KW, Ng THH, Aliaga PA, Broshek C, Jain S, Kessler RC, Stein MB, Ursano RJ, Bliese PD. Unit cohesion during deployment and post-deployment mental health: is cohesion an individual- or unit-level buffer for combat-exposed soldiers? Psychol Med 2022; 52:121-131. [PMID: 32517825 PMCID: PMC9341401 DOI: 10.1017/s0033291720001786] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Unit cohesion may protect service member mental health by mitigating effects of combat exposure; however, questions remain about the origins of potential stress-buffering effects. We examined buffering effects associated with two forms of unit cohesion (peer-oriented horizontal cohesion and subordinate-leader vertical cohesion) defined as either individual-level or aggregated unit-level variables. METHODS Longitudinal survey data from US Army soldiers who deployed to Afghanistan in 2012 were analyzed using mixed-effects regression. Models evaluated individual- and unit-level interaction effects of combat exposure and cohesion during deployment on symptoms of post-traumatic stress disorder (PTSD), depression, and suicidal ideation reported at 3 months post-deployment (model n's = 6684 to 6826). Given the small effective sample size (k = 89), the significance of unit-level interactions was evaluated at a 90% confidence level. RESULTS At the individual-level, buffering effects of horizontal cohesion were found for PTSD symptoms [B = -0.11, 95% CI (-0.18 to -0.04), p < 0.01] and depressive symptoms [B = -0.06, 95% CI (-0.10 to -0.01), p < 0.05]; while a buffering effect of vertical cohesion was observed for PTSD symptoms only [B = -0.03, 95% CI (-0.06 to -0.0001), p < 0.05]. At the unit-level, buffering effects of horizontal (but not vertical) cohesion were observed for PTSD symptoms [B = -0.91, 90% CI (-1.70 to -0.11), p = 0.06], depressive symptoms [B = -0.83, 90% CI (-1.24 to -0.41), p < 0.01], and suicidal ideation [B = -0.32, 90% CI (-0.62 to -0.01), p = 0.08]. CONCLUSIONS Policies and interventions that enhance horizontal cohesion may protect combat-exposed units against post-deployment mental health problems. Efforts to support individual soldiers who report low levels of horizontal or vertical cohesion may also yield mental health benefits.
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Affiliation(s)
| | - Patrick J. Flynn
- Department of Management, Innovation, and Entrepreneurship, Poole College of Management, North Carolina State University, Raleigh, NC, USA
| | - Karmel W. Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Boston, MA, USA
| | - Tsz Hin H. Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Pablo A. Aliaga
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Catherine Broshek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Paul D. Bliese
- Department of Management, Darla Moore School of Business, University of South Carolina, Columbia, SC, USA
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53
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Wingman-Connect Program increases social integration for Air Force personnel at elevated suicide risk: Social network analysis of a cluster RCT. Soc Sci Med 2022; 296:114737. [DOI: 10.1016/j.socscimed.2022.114737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/15/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022]
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Campbell M, Auchterlonie JL, Andris Z, Cooper DC, Hoyt T. Mental Health Stigma in Department of Defense Policies: Analysis, Recommendations, and Outcomes. Mil Med 2021; 188:e1171-e1177. [PMID: 34791390 DOI: 10.1093/milmed/usab471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/11/2021] [Accepted: 10/27/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Mental health stigma is one of the most frequently reported barriers to mental health help-seeking in the military. Previous research has identified that stigma-increasing language in the United States military policies was a potential deterrent to treatment-seeking. In response to a 2016 Government Accountability Office report recommendation, the current study conducted a comprehensive review of Department of Defense and military service-specific policies to identify stigmatizing language provisions and recommend appropriate language changes. METHODS This review of policies comprised three sequential phases. First, a key-term search strategy was conducted on mental health (Phase 1) and substance misuse policies (Phase 2) to identify language that may contribute to stigma. Recommended language changes were identified, and the results of each phase were briefed to service-level Directors of Psychological Health. Approximately three years after initial identification, all mental health policies from Phase 1 for which language change recommendations had been made were examined to determine whether or not recommended changes had been incorporated (Phase 3). RESULTS Out of 285 mental health and substance misuse policies, 191 (67%) contained potentially stigmatizing language. Subsequent review of implementation showed that partial or full recommended language changes had been made in 58.9% of 129 mental health-related policies that had been re-issued. CONCLUSIONS This collaborative effort to identify and modify potentially stigmatizing language contributed to a substantial reduction in problematic policies across the military services. Future efforts should focus on reviewing new and re-issued policies to ensure that stigma-increasing language is not present as part of routine issuance. These efforts are part of ongoing work to address the association that language and terminology have on stigma and barriers to care.
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Affiliation(s)
- Marjorie Campbell
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD 20910, USA
| | - Jennifer L Auchterlonie
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD 20910, USA
| | - Zoe Andris
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD 20910, USA
| | - Denise C Cooper
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD 20910, USA
| | - Tim Hoyt
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD 20910, USA
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Fikretoglu D, Sharp ML, Adler AB, Bélanger S, Benassi H, Bennett C, Bryant R, Busuttil W, Cramm H, Fear N, Greenberg N, Heber A, Hosseiny F, Hoge CW, Jetly R, McFarlane A, Morganstein J, Murphy D, O'Donnell M, Phelps A, Richardson DJ, Sadler N, Schnurr PP, Smith P, Ursano R, Hooff MV, Wessely S, Forbes D, Pedlar D. Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective. Clin Psychol Rev 2021; 91:102100. [PMID: 34871868 DOI: 10.1016/j.cpr.2021.102100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022]
Abstract
Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the past six years to update and broaden the discussion on pathways to mental healthcare in military populations. We find that at a broad population level, there is improvement in several indicators of mental health care access, with greater gains in initial engagement, time to first treatment contact, and subjective satisfaction with care, and smaller gains in objective indicators of adequacy of care. Among individual-level barriers to care-seeking, there is progress in improving recognition of need for care and reducing stigma concerns. Among organizational-level barriers, there are advances in availability of services and cultural acceptance of care-seeking. Other barriers, such as concerns around confidentiality, career impact, and deployability persist, however, and may account for some remaining unmet need. To address these barriers, new initiatives that are more evidence-based, theoretically-driven, and culturally-sensitive, are therefore needed, and must be rigorously evaluated to ensure they bring about additional improvements in pathways to care.
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Affiliation(s)
- Deniz Fikretoglu
- Defence Research and Development Canada, 1133 Sheppard Ave. West, Toronto, ON, Canada.
| | | | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | | | | | | | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | | | | | | | - Fardous Hosseiny
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rakesh Jetly
- Department of National Defence, Ottawa, ON, Canada
| | | | | | - Dominic Murphy
- Combat Stress, Leatherhead, Surrey, UK; King's College London, London, UK
| | - Meaghan O'Donnell
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Andrea Phelps
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Don J Richardson
- Parkwood Institute- St. Joseph's Health Care London, London, ON, Canada
| | - Nicole Sadler
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | | | - Patrick Smith
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | | | - Miranda Van Hooff
- Military and Emergency Services Health Australia (MESHA), Woodville, SA, Australia
| | | | - David Forbes
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - David Pedlar
- Canadian Institute for Military and Veteran Health Research, Queen's University, Kingston, ON, Canada
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Bogaers R, Geuze E, van Weeghel J, Leijten F, Rüsch N, van de Mheen D, Varis P, Rozema A, Brouwers E. Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military. BMJ Open 2021; 11:e049370. [PMID: 34706950 PMCID: PMC8559108 DOI: 10.1136/bmjopen-2021-049370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Many workers in high-risk occupations, such as soldiers, are exposed to stressors at work, increasing their risk of developing mental health conditions and substance abuse (MHC/SA). Disclosure can lead to both positive (eg, support) and negative (eg, discrimination) work outcomes, and therefore, both disclosure and non-disclosure can affect health, well-being and sustainable employment, making it a complex dilemma. The objective is to study barriers to and facilitators for disclosure in the military from multiple perspectives. DESIGN Qualitative focus groups with soldiers with and without MHC/SA and military mental health professionals. Sessions were audiotaped and transcribed verbatim. Content analysis was done using a general inductive approach. SETTING The study took place within the Dutch military. PARTICIPANTS In total, 46 people participated in 8 homogeneous focus groups, including 3 perspectives: soldiers with MHC/SA (N=20), soldiers without MHC/SA (N=10) and military mental health professionals (N=16). RESULTS Five barriers for disclosure were identified (fear of career consequences, fear of social rejection, lack of leadership support, lack of skills to talk about MHC/SA, masculine workplace culture) and three facilitators (anticipated positive consequences of disclosure, leadership support, work-related MHC/SA). Views of the stakeholder groups were highly congruent. CONCLUSIONS Almost all barriers (and facilitators) were related to fear for stigma and discrimination. This was acknowledged by all three perspectives, suggesting that stigma and discrimination are considerable barriers to sustainable employment and well-being. Supervisor knowledge, attitudes and behaviour were critical for disclosure, and supervisors thus have a key role in improving health, well-being and sustainable employment for soldiers with MHC/SA. Furthermore, adjustments could be made by the military on a policy level, to take away some of the fears that soldiers have when disclosing MHC/SA.
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Affiliation(s)
- Rebecca Bogaers
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands
- Brain Research and Innovation Centre, Netherlands Ministry of Defence, Utrecht, The Netherlands
| | - Elbert Geuze
- Brain Research and Innovation Centre, Netherlands Ministry of Defence, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Centre Utrecht Psychiatry, Utrecht, The Netherlands
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands
| | - Fenna Leijten
- Strategic Military Healthcare Department, Netherlands Ministry of Defence, Utrecht, The Netherlands
| | - Nicolas Rüsch
- Department of Psychiatry II, University of Ulm, Ulm, Germany
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands
| | - Piia Varis
- Department of Culture Studies, Tilburg School of Humanities and Digital Sciences Tilburg University, Tilburg, The Netherlands
| | - Andrea Rozema
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands
| | - Evelien Brouwers
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands
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Lui PP, Katedia S, Pham S, Giadolor W, Gobrial S, Stonebarger M, Adams N, Garcia O. Short-Term Changes in Internalizing Symptoms and Help-Seeking Attitudes During the Coronavirus Pandemic. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2021. [DOI: 10.1521/jscp.2021.40.5.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Existing data suggest that American adults experience added emotional difficulties amid the coronavirus disease outbreak. Psychotherapy can help mitigate mental health concerns; still, many individuals with unmet mental health needs refrain from professional help-seeking. According to theory of reasoned action, negative help-seeking attitudes are key barriers to engagement with mental health services. Given that individuals with severe distress are more likely to seek therapy than individuals with mild psychopathology symptoms, greater initial and increasing levels of internalizing symptoms amid the coronavirus outbreak likely are linked to increasingly favorable attitudes toward professional help-seeking. Method: In the early months of the coronavirus pandemic, American community adults, N = 831 [49.0% Asian Americans], Mage = 46.78, 50.2% women, were recruited for a panel survey study conducted over the course of three weeks. At each time point, participants completed questionnaires to assess their internalizing symptoms associated with depression and anxiety as well as their openness to and perceived value/need in treatment seeking. Results: Very few participants—especially Asian Americans —were seeking counseling during the study period. Latent growth curve results showed a general decline in internalizing symptoms, and no changes in openness to and perceived need in professional help-seeking. Whereas there were no time-varying correlations between internalizing symptoms and help-seeking attitudes, individuals with greater baseline internalizing symptoms generally were more open to seeking professional help and perceived less value in mental health services. Sensitivity analyses showed patterns in the Asian American subsample similar to those in the overall sample. Discussion: Implications for research and clinical practice are discussed.
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58
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Hoyt T, Holliday R, Simonetti JA, Monteith LL. Firearm Lethal Means Safety with Military Personnel and Veterans: Overcoming Barriers using a Collaborative Approach. ACTA ACUST UNITED AC 2021; 52:387-395. [PMID: 34421193 DOI: 10.1037/pro0000372] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Suicides by firearm have increased over the past decade among United States service members and veterans. As firearm access is a suicide risk factor, firearm-related lethal means safety is critical to suicide prevention. However, identity, occupational, and cultural barriers may deter efforts to promote lethal means safety with service members and veterans. The current manuscript describes a collaborative framework to guide mental health providers' in conducting firearm-related lethal means safety with service members and veterans, including within the context of Safety Planning. In approaching firearm lethal means safety conversations with patients, clinicians must work to overcome their own reticence, address patient concerns directly, and remain culturally sensitive to the values of the military and veteran communities. This approach is illustrated using case vignettes that encompass addressing firearm-related lethal means safety with service members and veterans.
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Affiliation(s)
- Tim Hoyt
- Psychological Health Center of Excellence, Defense Health Agency
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | - Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration.,Hospital Medicine Group, Rocky Mountain Regional VA Medical Center
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Department of Psychiatry, University of Colorado Anschutz Medical Campus
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Mental and physical health of international humanitarian aid workers on short-term assignments: Findings from a prospective cohort study. Soc Sci Med 2021; 285:114268. [PMID: 34365073 DOI: 10.1016/j.socscimed.2021.114268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 07/07/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023]
Abstract
Research findings show humanitarian work impacts one's health. We conducted a prospective observational study among 618 international humanitarian aid workers (iHAWs)' recruited from 76 countries to investigate health changes and ill-health risk factors after mostly short-term (<1 year) medical emergency assignments. The aid workers were assigned to 27 countries. Data collected between 2017 and 2020. We also compared a gold-standard clinical interview with self-report questionnaires to assess whether self-report scores overestimate the prevalence of clinical anxiety, depression and PTSD. Analyses consisted of repeated measures ANOVAs and adjusted odds ratios, using pre-assignment (T1), post-assignment (T2) and two-month follow-up data (T3). Humanitarian workers experienced on average, 2.6 experienced and witnessed potential traumatic events, and 4.8 male and 5.6 female assignment-related stressors. Self-report health indicators demonstrated a significant increase in emotional exhaustion, loss of vitality, decreased social functioning and emotional well-being between T1 and T2, all of which improved between T2 and T3. PTSD, depression, experienced role limitations, physical functioning, pain, and general health - remained stable. Anxiety levels decreased significantly between T1 and T2. The presence of DSM-5 disorders anxiety (6.6 %), depression (1.3 %) and PTSD (0.3 %) was low compared to norm populations, except for alcohol-use disorder (13 %). None of the reported T2 risk factors was significant at T3. Compared to the clinical interview, self-report cut-off thresholds inflated the presence of a potential anxiety disorder (3×), PTSD (8×) and depression (25×). Humanitarian work is highly stressful but most iHAWs remained healthy. Looking into how iHAWs stay healthy may be a more useful way forward.
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60
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Areán PA, Pratap A, Hsin H, Huppert TK, Hendricks KE, Heagerty PJ, Cohen T, Bagge C, Comtois KA. Perceived Utility and Characterization of Personal Google Search Histories to Detect Data Patterns Proximal to a Suicide Attempt in Individuals Who Previously Attempted Suicide: Pilot Cohort Study. J Med Internet Res 2021; 23:e27918. [PMID: 33955838 PMCID: PMC8138707 DOI: 10.2196/27918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Despite decades of research to better understand suicide risk and to develop detection and prevention methods, suicide is still one of the leading causes of death globally. While large-scale studies using real-world evidence from electronic health records can identify who is at risk, they have not been successful at pinpointing when someone is at risk. Personalized social media and online search history data, by contrast, could provide an ongoing real-world datastream revealing internal thoughts and personal states of mind. OBJECTIVE We conducted this study to determine the feasibility and acceptability of using personalized online information-seeking behavior in the identification of risk for suicide attempts. METHODS This was a cohort survey study to assess attitudes of participants with a prior suicide attempt about using web search data for suicide prevention purposes, dates of lifetime suicide attempts, and an optional one-time download of their past web searches on Google. The study was conducted at the University of Washington School of Medicine Psychiatry Research Offices. The main outcomes were participants' opinions on internet search data for suicide prediction and intervention and any potential change in online information-seeking behavior proximal to a suicide attempt. Individualized nonparametric association analysis was used to assess the magnitude of difference in web search data features derived from time periods proximal (7, 15, 30, and 60 days) to the suicide attempts versus the typical (baseline) search behavior of participants. RESULTS A total of 62 participants who had attempted suicide in the past agreed to participate in the study. Internet search activity varied from person to person (median 2-24 searches per day). Changes in online search behavior proximal to suicide attempts were evident up to 60 days before attempt. For a subset of attempts (7/30, 23%) search features showed associations from 2 months to a week before the attempt. The top 3 search constructs associated with attempts were online searching patterns (9/30 attempts, 30%), semantic relatedness of search queries to suicide methods (7/30 attempts, 23%), and anger (7/30 attempts, 23%). Participants (40/59, 68%) indicated that use of this personalized web search data for prevention purposes was acceptable with noninvasive potential interventions such as connection to a real person (eg, friend, family member, or counselor); however, concerns were raised about detection accuracy, privacy, and the potential for overly invasive intervention. CONCLUSIONS Changes in online search behavior may be a useful and acceptable means of detecting suicide risk. Personalized analysis of online information-seeking behavior showed notable changes in search behavior and search terms that are tied to early warning signs of suicide and are evident 2 months to 7 days before a suicide attempt.
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Affiliation(s)
- Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,ALACRITY Center, University of Washington, Seattle, WA, United States
| | - Abhishek Pratap
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States.,Sage Bionetworks, Seattle, WA, United States
| | - Honor Hsin
- Kaiser Permanente, Northern California, CA, United States
| | - Tierney K Huppert
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Center for Suicide Prevention and Research, University of Washington, Seattle, WA, United States
| | - Karin E Hendricks
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Center for Suicide Prevention and Research, University of Washington, Seattle, WA, United States.,University of South Alabama, Mobile, AL, United States
| | - Patrick J Heagerty
- School of Public Health, University of Washington, Seattle, WA, United States
| | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
| | - Courtney Bagge
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, United States.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Center for Suicide Prevention and Research, University of Washington, Seattle, WA, United States
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61
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Masculinity and stigma among emerging adult military members and veterans: implications for encouraging help-seeking. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01768-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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62
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Walker LE, Watrous J, Poltavskiy E, Howard JT, Janak JC, Pettey WBP, Zarzabal LA, Sim A, Gundlapalli A, Stewart IJ. Longitudinal mental health outcomes of combat-injured service members. Brain Behav 2021; 11:e02088. [PMID: 33662185 PMCID: PMC8119815 DOI: 10.1002/brb3.2088] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/13/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The relationship between traumatic injury and subsequent mental health diagnoses is not well understood and may have significant implications for patient screening and clinical intervention. We sought to determine the adjusted association between traumatic injury and the subsequent development of post-traumatic stress disorder (PTSD), depression, and anxiety. METHODS Using Department of Defense and Veterans Affairs datasets between February 2002 and June 2016, we conducted a retrospective cohort study of 7,787 combat-injured United States service members matched 1:1 to combat-deployed, uninjured service members. The primary exposure was combat injury versus no combat injury. Outcomes were diagnoses of PTSD, depression, and anxiety, defined by International Classification of Diseases 9th and 10th Revision Clinical Modification codes. RESULTS Compared to noninjured service members, injured service members had higher observed incidence rates per 100 person-years for PTSD (17.1 vs. 5.8), depression (10.4 vs. 5.7), and anxiety (9.1 vs. 4.9). After adjustment, combat-injured patients were at increased risk of development of PTSD (HR 2.92, 95%CI 2.68-3.17), depression (HR 1.47, 95%CI 1.36-1.58), and anxiety (HR 1.34, 95%CI 1.24-1.45). CONCLUSIONS Traumatic injury is associated with subsequent development of PTSD, depression, and anxiety. These findings highlight the importance of increased screening, prevention, and intervention in patients with exposure to physical trauma.
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Affiliation(s)
| | | | | | | | | | - Warren B P Pettey
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lee Ann Zarzabal
- PEO Defense Healthcare Management Systems (DHMS), San Antonio, TX, USA
| | - Alan Sim
- PEO Defense Healthcare Management Systems (DHMS), San Antonio, TX, USA
| | - Adi Gundlapalli
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ian J Stewart
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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The Role of Communication Affordances in Post-Traumatic Stress Disorder Facebook and WhatsApp Support Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094576. [PMID: 33925904 PMCID: PMC8123456 DOI: 10.3390/ijerph18094576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: Digital health research has indicated that people with stigmatized health problems are drawn to online support groups (OSGs) because these groups help them to manage such conditions. However, little is known about how media affordances-interactions between the technology and the user-reconfigure the ways in which stigmatized individuals use OSGs and interact with others like themselves. (2) Method: The current study applied an affordance framework to evaluate how Facebook and WhatsApp support groups can help military veterans and their partners cope with post-traumatic stress disorder (PTSD) and was based on interviews with 34 PTSD-OSG members in Israel. (3) Findings: This research identified five affordances that members appraised as enhancing their coping efforts in the digital world: visibility, availability, multimediality, surveillance, and synchronicity. (4) Conclusions: This study reveals the connection between a specific stigmatized mental health disorder (i.e., PTSD) and perceptions of communication technologies (i.e., affordances), and specifies the uses of technologies for coping with this mental health disorder. Moreover, this study may inform digital intervention designers about which communication affordances can potentially lead to better health outcomes.
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64
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Roche R, Manzi J, Bard K. A Patient-Centered Study Examining Self-Identification of Mental Health Challenges Among Female Military Officers. J Patient Cent Res Rev 2021; 8:134-139. [PMID: 33898646 PMCID: PMC8060039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Due to the expansion of leadership roles in the military for women, female military personnel now face stressors equal to, and yet unique from, their male counterparts. This pilot study surveyed 73 female U.S. Army officers regarding their experiences of leadership and mental wellness within the military. A mixed-methods survey was distributed via 2 private Facebook groups for female Army officers following an anonymized convenience sampling. This anonymous, patient-centered protocol was used to protect against known stigma surrounding disclosing mental health concerns in the military. Respondents were asked a series of questions including perceived mental health status and access to behavioral health services. Most respondents reported feelings of stress related to their roles as officers (86.6%). Self-reported feelings of anxiety (83.6%) and depression (65.7%) were high. In contrast, only 30.1% had ever received a formal diagnosis of anxiety or depression by a mental health professional. Our survey confirmed a large percentage, 65.7% of respondents, reported avoiding mental/behavioral health services. Female military officers are able to recognize their feelings as symptoms of anxiety and depression; however, many take active steps to hide these symptoms from their family members and senior officers and avoid seeking professional care.
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Affiliation(s)
- Rosellen Roche
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Joel Manzi
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Katelyn Bard
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
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Addressing Concealed Suicidality: A Flexible and Contextual Approach to Suicide Risk Assessment in Adults. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021. [DOI: 10.1007/s10879-021-09493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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66
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Rikkers W, Lawrence D. Mental health help-seeking experiences and service use among Australian first responders. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1080/00049530.2021.1882271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Wavne Rikkers
- Graduate School of Education, The University of Western Australia, Perth, Australia
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, Australia
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67
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The Relationships Between Self-reported Pain Intensity, Pain Interference, and Quality of Life Among Injured U.S. Service Members With and Without Low Back Pain. J Clin Psychol Med Settings 2021; 28:746-756. [PMID: 33550539 DOI: 10.1007/s10880-020-09759-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
Low back pain is a prevalent military and veteran health problem and individuals injured on deployment may be at particularly high risk of pain conditions. Given that increasing numbers of active duty and veteran military personnel are seeking care in community settings, it is critical that health care providers are aware of military health issues. The current study examined the prevalence of low back pain among individuals with deployment-related injuries, compared their self-reported pain intensity and interference ratings, and assessed the relationship between low back pain, self-reported pain ratings, and quality of life. Almost half of participants had low back pain diagnoses, and individuals with low back pain reported significantly higher intensity and interference due to their pain than individuals without low back pain. Finally, the relationship between low back pain and quality of life was explained by self-reported pain indices, underscoring the importance of patient-centered metrics in pain treatment.
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68
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Johnson EM, Possemato K. Problem recognition and treatment beliefs relate to mental health utilization among veteran primary care patients. Psychol Serv 2021; 18:11-22. [PMID: 30869974 PMCID: PMC6745017 DOI: 10.1037/ser0000341] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mental health concerns are prevalent among primary care patients, but many do not utilize services for these conditions. This study aims to conduct a comprehensive assessment of barriers and facilitators to mental health care utilization among veteran primary care patients with common mental health concerns. We hypothesized that beliefs and knowledge about mental illness and mental health care would be more strongly associated with recent mental health care utilization than stigma, help-seeking behaviors, or logistical barriers. Veterans (n = 116) enrolled in primary care with current symptoms of depression (58%), posttraumatic stress disorder (37%), and/or hazardous alcohol use (50%) who either recently used mental health services (47%) or had no recent mental health treatment utilization (53%) completed a telephone-based screening, medical records review, and mail survey of 10 measures of barriers and facilitators to mental health treatment utilization. Recognition of problems as a cause for concern, odds ratio = 5.95, 95% confidence interval [2.36, 15.01], and beliefs about psychotherapy, odds ratio = 2.53, 95% confidence interval [1.39, 4.60], emerged as stronger correlates of recent mental health care utilization than stigma, self-efficacy, and external barriers to treatment. Results suggest the use of specific theories, measures, and interventions that focus on patient recognition of problems and beliefs about treatment over those that focus on other treatment barriers and facilitators. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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69
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Kelber MS, Liu X, O'Gallagher K, Stewart LT, Belsher BE, Morgan MA, Workman DE, Skopp NA, McGraw K, Evatt DP. Women in combat: The effects of combat exposure and gender on the incidence and persistence of posttraumatic stress disorder diagnosis. J Psychiatr Res 2021; 133:16-22. [PMID: 33302161 DOI: 10.1016/j.jpsychires.2020.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022]
Abstract
Recent expansions in the roles of women in combat have prompted increased interest in the psychological toll combat exposure may have on female service members as compared to males. This study examined the interactive effects of gender and combat exposure on transitions in posttraumatic stress disorder (PTSD) diagnostic status (presence or absence of PTSD diagnosis). We used administrative data of 20,000 U.S. Army soldiers whose combat exposure was assessed after return from deployment between January 1, 2008 and June 30, 2014; soldiers' PTSD diagnostic status was determined using International Classification of Diseases-9 diagnoses at four time points separated by 12 months. We used a mixed-effects logit transition model to examine the effects of combat and gender on incidence, persistence, and prevalence of PTSD diagnosis. Incidence and prevalence of PTSD diagnosis were higher among women, but persistence of PTSD diagnosis was higher in men. Higher rates of new PTSD diagnosis among women were not dependent on combat exposure, suggesting that other types of trauma may be responsible for increased rates among women. Gender differences in prevalence and persistence of PTSD diagnosis were greater among combat-exposed soldiers than among those not exposed to combat. Men maintained a PTSD diagnosis over longer periods of time than women suggesting greater PTSD persistence, and this pattern was particularly pronounced among soldiers exposed to combat. These results have implications for the recent policy changes and gender-based prevention strategies, and suggest that women in combat roles may be no more vulnerable to PTSD than are their male counterparts. Though the gender differences were small, they are indicative of healthcare utilization patterns that may be important for prevention and that warrant further exploration.
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Affiliation(s)
- Marija Spanovic Kelber
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA.
| | - Xian Liu
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Kevin O'Gallagher
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | | | - Bradley E Belsher
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Maria A Morgan
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Don E Workman
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nancy A Skopp
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Kate McGraw
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Daniel P Evatt
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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70
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Bogaers R, Geuze E, van Weeghel J, Leijten F, van de Mheen D, Varis P, Rozema A, Brouwers E. Barriers and facilitators for treatment-seeking for mental health conditions and substance misuse: multi-perspective focus group study within the military. BJPsych Open 2020; 6:e146. [PMID: 33234172 PMCID: PMC7745246 DOI: 10.1192/bjo.2020.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Globally, millions are exposed to stressors at work that increase their vulnerability to develop mental health conditions and substance misuse (such as soldiers, policemen, doctors). However, these types of professionals especially are expected to be strong and healthy, and this contrast may worsen their treatment gap. Although the treatment gap in the military has been studied before, perspectives of different stakeholders involved have largely been ignored, even though they play an important role. AIMS To study the barriers and facilitators for treatment-seeking in the military, from three different perspectives. METHOD In total, 46 people participated, divided into eight homogeneous focus groups, including three perspectives: soldiers with mental health conditions and substance misuse (n = 20), soldiers without mental health conditions and substance misuse (n = 10) and mental health professionals (n = 16). Sessions were audio-taped and transcribed verbatim. Content analysis was done by applying a general inductive approach using ATLAS.ti-8.4.4 software. RESULTS Five barriers for treatment-seeking were identified: fear of negative career consequences, fear of social rejection, confidentiality concerns, the 'strong worker' workplace culture and practical barriers. Three facilitators were identified: social support, accessibility and knowledge, and healthcare within the military. The views of the different stakeholder groups were highly congruent. CONCLUSIONS Barriers for treatment-seeking were mostly stigma related (fear of career consequences, fear of social rejection and the 'strong worker' workplace culture) and this was widely recognised by all groups. Social support from family, peers, supervisors and professionals were identified as important facilitators. A decrease in the treatment gap for mental health conditions and substance misuse is needed and these findings provide direction for future research and destigmatising interventions.
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Affiliation(s)
- Rebecca Bogaers
- Tranzo, Scientific Center for Care and Wellfare, Tilburg School of Social and Behavioral Sciences, Tilburg University; and Brain Research and Innovation Centre, Ministry of Defence, the Netherlands
| | - Elbert Geuze
- Brain Research and Innovation Centre, Ministry of Defence; and Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, the Netherlands
| | - Jaap van Weeghel
- Tranzo, Scientific Center for Care and Wellfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
| | - Fenna Leijten
- Strategic Military Healthcare Department, Ministry of Defence, the Netherlands
| | - Dike van de Mheen
- Tranzo, Scientific Center for Care and Wellfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
| | - Piia Varis
- Department of Culture Studies, Tilburg School of Humanities and Digital Sciences, Tilburg University, the Netherlands
| | - Andrea Rozema
- Tranzo, Scientific Center for Care and Wellfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
| | - Evelien Brouwers
- Strategic Military Healthcare Department, Ministry of Defence, the Netherlands
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Abstract
Individuals who witness team members exhibiting symptoms of an acute stress reaction (ASR) in the middle of a high-stress operational event may be negatively affected; ASR-related training may moderate this impact. In the present study, 560 Israeli soldiers were surveyed about ASR exposure, posttraumatic stress disorder (PTSD) symptoms, public stigma, and whether they had received ASR-related training. This training, called YaHaLOM, is a Hebrew acronym that outlines steps for managing ASR in team members. Controlling for combat exposure, greater exposure to ASR symptoms was associated with more overall PTSD symptoms, PTSD cluster symptoms, and public stigma. YaHaLOM training buffered these relationships for PTSD, intrusion and avoidance symptoms, and public stigma. The findings suggest that such training may help teams in high-risk occupations better manage ASR exposure.
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72
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Aikins DE, Pietrzak RH, Geraci JC, Benham T, Morrissey P, Southwick SM. Beyond stigma: Understanding the "inclined abstainers" in military behavioral health-care utilization. MILITARY PSYCHOLOGY 2020; 32:419-427. [PMID: 38536308 PMCID: PMC10013392 DOI: 10.1080/08995605.2020.1784822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
Low treatment utilization in Soldiers with combat-related Posttraumatic Stress Disorder (PTSD) is an ongoing issue. The critical concern is to better understand factors which prohibit a Soldier with PTSD who wants help from seeking treatment (an "inclined abstainer"). A total of 537 Active Duty Soldiers on a US Army post completed a brief survey comprising psychometrically validated measures of stigma, behavioral health treatment beliefs, resilience, PTSD symptoms, and treatment intentions. Health-care records were prospectively tracked for 12 months to determine the relation between survey answers and treatment utilization. Sixty-three percent of those who acknowledged having a mental health-related problem did not seek help within a one-year period. Greater severity of PTSD symptoms was associated with an increased likelihood of behavioral health engagement. Soldiers that were classified as "inclined abstainers" were also more likely to endorse negative beliefs about psychotherapy and report higher levels of resilience as compared to "inclined actors." These results suggest that a treatment model of PTSD emphasizing self-efficacy and self-reliance, while addressing negative beliefs about psychotherapy, may help promote engagement of behavioral health services among Active Duty Soldiers.
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Affiliation(s)
- Deane E. Aikins
- Department of Psychiatry, VA Detroit Healthcare System, Detroit, Michigan
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, Wayne
| | - Robert H. Pietrzak
- National Center for PTSD Behavioral Neuroscience Division, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Joseph C. Geraci
- Behavioral Health MEDDAC, United States Army
- Resilience Center for Veterans & Families, Teachers College, Columbia University, New York
| | - Todd Benham
- Behavioral Health MEDDAC, United States Army
| | | | - Steven M. Southwick
- National Center for PTSD Behavioral Neuroscience Division, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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73
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Kroshus E, Cameron KL, Coatsworth JD, D'Lauro C, Kim E, Lee K, Register-Mihalik JK, Milroy JJ, Roetert EP, Schmidt JD, Silverman RD, Warmath D, Wayment HA, Hainline B. Improving concussion education: consensus from the NCAA-Department of Defense Mind Matters Research & Education Grand Challenge. Br J Sports Med 2020; 54:1314-1320. [PMID: 32912847 DOI: 10.1136/bjsports-2020-102185] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/03/2022]
Abstract
Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioural health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.
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Affiliation(s)
- Emily Kroshus
- Department of Pediatrics, University of Washington, Seattle, Washington, USA .,Department of Pediatrics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kenneth L Cameron
- Orthopaedics, Keller Army Community Hospital, West Point, New York, USA
| | - J Douglas Coatsworth
- Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Christopher D'Lauro
- Behavioral Science and Leadership, US Air Force Academy, Colorado Springs, Colorado, USA
| | | | - Katherine Lee
- Health Readiness and Policy Oversight, Health Affairs, Department of Defense, Falls Church, Virginia, USA
| | - Johna K Register-Mihalik
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffery J Milroy
- Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - E Paul Roetert
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | | | - Ross D Silverman
- Richard M Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Dee Warmath
- Family and Consumer Sciences, University of Georgia, Athens, Georgia, USA
| | - Heidi A Wayment
- Psychological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Brian Hainline
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
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74
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Abstract
Perceived social isolation during the COVID-19 pandemic significantly has had an extraordinary global impact, with significant psychological consequences. Changes in our daily lives, feeling of loneliness, job losses, financial difficulty, and grief over the death of loved ones have the potential to affect the mental health of many. In an atmosphere of uncertainty, it is essential that clear and precise information is offered about the problem and how to manage it. In this contribution, a rationale is provided for an urgent call for a rapid response to the mental health impacts of COVID-19. Moreover, suggestions for individuals to regulate their emotions effectively and appropriately are provided.
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Affiliation(s)
- Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy,Psychology Research Laboratory, IRCCS, Istituto Auxologico Italiano, Milan, Italy,*Correspondence: Giada Pietrabissa,
| | - Susan G. Simpson
- Department of Justice and Society, University of South Australia, Adelaide, SA, Australia,Regional Eating Disorders Unit, NHS Lothian, Edinburgh, United Kingdom
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Pietrabissa G, Simpson SG. Psychological Consequences of Social Isolation During COVID-19 Outbreak. Front Psychol 2020; 11:2201. [PMID: 33013572 PMCID: PMC7513674 DOI: 10.3389/fpsyg.2020.02201] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/05/2020] [Indexed: 12/01/2022] Open
Abstract
Perceived social isolation during the COVID-19 pandemic significantly has had an extraordinary global impact, with significant psychological consequences. Changes in our daily lives, feeling of loneliness, job losses, financial difficulty, and grief over the death of loved ones have the potential to affect the mental health of many. In an atmosphere of uncertainty, it is essential that clear and precise information is offered about the problem and how to manage it. In this contribution, a rationale is provided for an urgent call for a rapid response to the mental health impacts of COVID-19. Moreover, suggestions for individuals to regulate their emotions effectively and appropriately are provided.
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Affiliation(s)
- Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Psychology Research Laboratory, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Susan G. Simpson
- Department of Justice and Society, University of South Australia, Adelaide, SA, Australia
- Regional Eating Disorders Unit, NHS Lothian, Edinburgh, United Kingdom
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76
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Mental Health Care Utilization and Psychiatric Diagnoses in a Sample of Military Suicide Decedents and Living Matched Controls. J Nerv Ment Dis 2020; 208:646-653. [PMID: 32502074 PMCID: PMC7483990 DOI: 10.1097/nmd.0000000000001192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article examines mental health care utilization and psychiatric diagnoses among US military personnel who died by suicide. We employed an existing electronic health record dataset including 800 US military suicide decedents and 800 matched controls. Suicide decedents were more likely to have received outpatient and inpatient mental health care and to have been diagnosed with depression, bipolar, and nonaffective psychotic disorders. Younger decedents and those in the US Marine Corps were less likely to receive MH care before suicide. Given that approximately half of the suicide decedents in our sample had no mental health care visits before their death, our study suggests the need for programs to increase treatment engagement by at-risk individuals. Such programs could address barriers to care such as stigma regarding mental illness and concerns that seeking mental health care would damage a service member's career.
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Duncan JM, Reed-Fitzke K, Ferraro AJ, Wojciak AS, Smith KM, Sánchez J. Identifying Risk and Resilience Factors Associated With the Likelihood of Seeking Mental Health Care Among U.S. Army Soldiers-in-Training. Mil Med 2020; 185:e1247-e1254. [PMID: 32077952 DOI: 10.1093/milmed/usz483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/08/2019] [Accepted: 09/10/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The Department of Defense aims to maintain mission readiness of its service members. Therefore, it is important to understand factors associated with treatment seeking in order to identify areas of prevention and intervention early in a soldier's career that can promote positive functioning and increase their likelihood of seeking mental health care when necessary. METHOD Using a theory of planned behavior lens, this study identified potential barriers (risk) and facilitators (resilience) to treatment seeking among 24,717 soldiers-in-training who participated in the New Soldiers Study component of the "Army Study to Assess Risk and Resilience in Servicemembers" (Army STARRS). Approval for this study was granted by the University of Iowa IRB # 201706739. Hierarchal linear regression modeling and independent samples t-tests were used to examine associations between demographics and study variables, intersections of risk and resilience, and to explore differences in the likelihood of seeking help based on mental health diagnoses. RESULTS A four-stage hierarchical linear regression was conducted, using likelihood of help-seeking as the dependent variable, to identify the most salient factors related to help-seeking. "Step one" of the analysis revealed soldiers-in-training who identified as female, Hispanic or Other ethnicity, and married, divorced, or separated reported a greater likelihood of seeking help. "Step two" of the analysis indicated soldiers-in-training with a history of sexual trauma, experience of impaired parenting, and clinical levels of mental health symptomatology (anxiety, depression, PTSD) reported a greater likelihood of seeking help. Inversely, soldiers-in-training with a history of emotional trauma and parental absence/separation reported a lower likelihood of seeking help. "Step three" of the analysis demonstrated soldiers-in-training with a prior history of seeking help and larger social networks had a greater likelihood of seeking help. "Step four" of the analysis revealed several interactive effects between risk and resilience factors. Specifically, soldiers-in-training who reported greater depressive symptomatology in combination with prior history of treatment seeking reported a greater likelihood of help seeking, whereas soldiers-in-training who reported prior sexual trauma and PTSD in combination with large social networks reported a lower likelihood of seeking help. Finally, a greater percentage of soldiers-in-training with clinical levels of anxiety, depression, and PTSD indicated they would likely seek help in comparison to soldiers-in-training without clinical symptoms. CONCLUSION Findings suggest few soldiers-in-training are likely to seek help when experiencing a problem. General efforts to encourage help-seeking when needed are warranted with particular focus on subsets of soldiers-in-training (eg, men, those with a history of some adverse childhood experiences). Strengths of this study include the examination of a large sample of soldiers-in-training to identify possible leverage points for early intervention or prevention prior to entering stressful military operating environments. Limitations of this study include the examination of only one military branch and exclusion of soldiers not "in-training." Future studies could consider replicating the current study using a sample of military personnel longitudinally to track behavioral trends as well as looking at military populations outside of basic combat training.
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Affiliation(s)
- James M Duncan
- Dale Bumpers College of Agricultural, Food and Life Sciences, The University of Arkansas, 118 Human Environmental Sciences Building, 987 W. Maple St., Fayetteville, AR 72701
| | - Kayla Reed-Fitzke
- College of Education, The University of Iowa, 361 Lindquist Center, 240 South Madison Street, Iowa City, IA 52242
| | - Anthony J Ferraro
- College of Health & Human Sciences, The Kansas State University, 312 Justin Hall, 1324 Lovers Lane Manhattan, KS 66506
| | - Armeda S Wojciak
- College of Education, The University of Iowa, 361 Lindquist Center, 240 South Madison Street, Iowa City, IA 52242
| | - Kevin M Smith
- College of Education, The University of Iowa, 361 Lindquist Center, 240 South Madison Street, Iowa City, IA 52242
| | - Jennifer Sánchez
- College of Education, The University of Iowa, 361 Lindquist Center, 240 South Madison Street, Iowa City, IA 52242
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78
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Thériault FL, Gardner W, Momoli F, Garber BG, Kingsbury M, Clayborne Z, Cousineau-Short DY, Sampasa-Kanyinga H, Landry H, Colman I. Mental Health Service Use in Depressed Military Personnel: A Systematic Review. Mil Med 2020; 185:e1255-e1262. [PMID: 32073617 DOI: 10.1093/milmed/usaa015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/23/2019] [Accepted: 05/22/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Major depression is a leading cause of morbidity in military personnel and an important impediment to operational readiness in military organizations. Although treatment options are available, a large proportion of individuals with depression do not access mental health services. Quantifying and closing this treatment gap is a public health priority. However, the scientific literature on the major depression treatment gap in military organizations has never been systematically reviewed. METHODS We systematically searched the EMBASE, MEDLINE, and PsychINFO databases for studies measuring recent mental health service use in personnel serving in the armed forces of a Five-Eye country (Australia, Canada, New Zealand, the United Kingdom, or the United States). We excluded studies conducted with retired veterans. Because of the substantial heterogeneity in included studies, we did not pool their results. Instead, we computed median period prevalence of mental health service use. RESULTS Twenty-eight studies were included in the systematic review; 12 had estimated mental health service use in personnel with depression, and another 16 had estimated mental health service use in personnel with depression or another mental health disorder. The period prevalence of mental health service use in depressed military personnel ranged from 20 to 75% in 12 included studies, with a median of 48%, over 2-12 months. The other 16 studies yielded similar conclusions; they reported period prevalence of mental health service use in personnel with any mental health disorder ranging from 14 to 75%, with a median of 36%, over 1-12 months. The median was higher in studies relying on diagnostic interviews to identify depressed personnel, compared to studies relying on screening tools (60% vs. 44%). CONCLUSIONS There is a large treatment gap for major depression in particular, and for mental health disorders in general, among military personnel. However, our results highlight the association between the use of measurement tools and treatment gaps: estimated treatment gaps were larger when depressed patients were identified by screening tools instead of diagnostic interviews. Researchers should be wary of overestimating the mental health treatment gap when using screening tools in future studies.
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Affiliation(s)
- François L Thériault
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada
| | - William Gardner
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,CHEO Research Institute, Children Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Franco Momoli
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,CHEO Research Institute, Children Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.,Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Bryan G Garber
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada
| | - Mila Kingsbury
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Zahra Clayborne
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Daniel Y Cousineau-Short
- Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada.,Department of Health Sciences, Carleton University, 2305 Health Sciences Building, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada
| | - Hugues Sampasa-Kanyinga
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Hannah Landry
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Ian Colman
- Centre for Fertility and Health, Norwegian Institute of Public Health, Postbox 222 Skøyen, N-0213 Oslo, Norway
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79
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Lear MK, Penzenik ME, Forster JE, Starosta A, Brenner LA, Nazem S. Characteristics of nonsuicidal self-injury among veterans. J Clin Psychol 2020; 77:286-297. [PMID: 32662073 DOI: 10.1002/jclp.23027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/23/2020] [Accepted: 06/11/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The current study aimed to (a) assess basic nonsuicidal self-injury (NSSI) characteristics using a validated clinical interview among a sample of veterans not recruited for specific diagnostic or environmental criteria and (b) examine the relation between NSSI and medical severity of prior suicide attempts (SAs) among veterans. DESIGN We conducted secondary data analyses among a combined sample of veterans (N = 165) from two parent studies conducted at a large VA Medical Center that implemented identical recruitment protocols. No psychiatric criteria were utilized for inclusion or exclusion purposes. RESULTS Approximately 16% of participants reported NSSI history and almost 21% reported SA history. NSSI history was associated with probability of prior SA but not the medical severity of prior SA. CONCLUSIONS NSSI is a prevalent concern among veterans and is associated with probability of SA. It remains unclear whether prior NSSI is associated with more medically serious SA in this population.
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Affiliation(s)
- Mary K Lear
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, Oregon, USA
| | - Molly E Penzenik
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy Starosta
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
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80
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Hom MA, de Terte I, Bennett C, Joiner TE. Resilience and attitudes toward help-seeking as correlates of psychological well-being among a sample of New Zealand Defence Force personnel. MILITARY PSYCHOLOGY 2020; 32:329-340. [PMID: 38536362 PMCID: PMC10013528 DOI: 10.1080/08995605.2020.1754148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
Research is needed to examine factors that contribute to psychological well-being among military service members. This study examined associations between various indices of psychological well-being, resilience, and help-seeking stigma among New Zealand Defence Force (NZDF) personnel (N = 2,805). Participants completed self-report measures of psychological well-being, resilience, help-seeking stigma, and past-year help-seeking behaviors. Greater resilience and a lower degree of help-seeking stigma were each significantly associated with better psychological well-being (i.e., greater psychological flourishing, less psychological distress, and better overall mental health). Though effects were relatively small, engagement in help-seeking behaviors moderated the relationship between (1) greater resilience and less psychological distress and (2) greater resilience and better overall mental health, such that these relationships were stronger among those who had sought help for their mental health in the past year. Findings suggest that greater resilience and less mental health help-seeking stigma may independently contribute to better psychological well-being among NZDF personnel; thus, enhancing resilience and reducing help-seeking stigma may serve to promote psychological well-being in this population. Improving resilience among NZDF personnel who seek help, in particular, may contribute to better psychological well-being. However, longitudinal research among service members is needed to establish a temporal relationship between these constructs.
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Affiliation(s)
- Melanie A. Hom
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Ian de Terte
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Clare Bennett
- Defense Health Directorate, New Zealand Defence Force, Wellington, New Zealand
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
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81
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Incidence of major depression diagnoses in the Canadian Armed Forces: longitudinal analysis of clinical and health administrative data. Soc Psychiatry Psychiatr Epidemiol 2020; 55:581-588. [PMID: 31559441 DOI: 10.1007/s00127-019-01754-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/20/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Major depression is a leading cause of morbidity in military populations. However, due to a lack of longitudinal data, little is known about the rate at which military personnel experience the onset of new episodes of major depression. We used a new source of clinical and administrative data to estimate the incidence of major depression diagnoses in Canadian Armed Forces (CAF) personnel, and to compare incidence rates between demographic and occupational factors. METHODS We extracted all data recorded in the electronic medical records of CAF Regular Force personnel, at every primary care and mental health clinical encounter since 2016. Using a 12-month lookback period, we linked data over time, and identified all patients with incident diagnoses of major depression. We then linked clinical data to CAF administrative records, and estimated incidence rates. We used multivariate Poisson regression to compare adjusted incidence rates between demographic and occupational factors. RESULTS From January to December 2017, CAF Regular Force personnel were diagnosed with major depression at a rate of 29.2 new cases per 1000 person-years at risk. Female sex, age 30 years and older, and non-officer ranks were associated with significantly higher incidence rates. CONCLUSIONS We completed the largest study to date on diagnoses of major depression in the Canadian military, and have provided the first estimates of incidence rates in CAF personnel. Our results can inform future mental health resource allocation, and ongoing major depression prevention efforts within the Canadian Armed Forces and other military organizations.
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82
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Start AR, Amiya RM, Dixon AC, Britt TW, Toblin RL, Adler AB. LINKS Training and Unit Support for Mental Health: a Group-randomized Effectiveness Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:784-794. [PMID: 32242289 DOI: 10.1007/s11121-020-01106-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The LINKS curriculum, adapted from Britt et al. (2018a), was designed to improve unit climate, knowledge, and attitudes about mental health treatment seeking in military personnel. The present study extends this research by examining implementation options, comparing the effectiveness of LINKS to an active control condition with training delivered by non-experts and comparing modules that varied in training length. Eight Army platoons were randomly assigned to one of four conditions: (1) 1-h Active Control, (2) 2-h Active Control, (3) 1-h LINKS, or (4) 2-h LINKS. Two platoons were assigned to each condition. Surveys were administered at pre-training (T1), post-training (T2), and 3 months later (T3). Eighty-four participants completed all study phases. Regardless of training content, participants receiving the 2-h modules reported greater training acceptability than those receiving the 1-h modules. At T3, participants in the LINKS conditions reported more mental health knowledge than participants in the Active Control conditions. Sustained effects were also observed on a number of treatment barriers and facilitators, with the LINKS conditions generally leading to better outcomes. At T3, 2-h LINKS condition participants reported receiving more mental health treatment relative to the other conditions. Findings suggest that LINKS can be effectively delivered by non-expert trainers, is a viable intervention for targeting mental health treatment-seeking, and is optimally packaged in a 2-h module. The training might benefit from additional leadership training efforts.
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Affiliation(s)
- Amanda R Start
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Rachel M Amiya
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Alexis C Dixon
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Thomas W Britt
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA.,Department of Psychology, Clemson University, Clemson, SC, USA
| | - Robin L Toblin
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA.
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83
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Adler A, Jager-Hyman S, Brown GK, Singh T, Chaudhury S, Ghahramanlou-Holloway M, Stanley B. A Qualitative Investigation of Barriers to Seeking Treatment for Suicidal Thoughts and Behaviors Among Army Soldiers with a Deployment History. Arch Suicide Res 2020; 24:251-268. [PMID: 31237808 DOI: 10.1080/13811118.2019.1624666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study aimed to identify barriers to treatment seeking and service utilization among previously deployed Army soldiers who recently experienced a suicidal crisis. Confidential interviews were conducted on a psychiatric inpatient unit with 12 Army soldiers with a deployment history following a suicidal crisis. Qualitative analysis focused on statements coded as "barriers to seeking help" and "explicit recommendations." Suicidal Army soldiers with a deployment history experienced different barriers to seeking help, including stigma and logistical challenges (e.g., long wait times for appointments). Negative and positive perceptions of support were reported for various resources - for example, family, crisis hotlines, chaplains, and command. Suicidal Army soldiers, interviewed in this study, experienced a number of challenges and frustrations associated with various helping resources. This study highlights the need for greater attention toward understanding these challenges and subsequently addressing them through appropriate resource allocation and additional training for those working directly with Army soldiers at risk for suicide.
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84
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Nazarov A, Fikretoglu D, Liu A, Richardson JD, Thompson M. Help-seeking for mental health issues in deployed Canadian Armed Forces personnel at risk for moral injury. Eur J Psychotraumatol 2020; 11:1729032. [PMID: 32194921 PMCID: PMC7067158 DOI: 10.1080/20008198.2020.1729032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 10/31/2022] Open
Abstract
Objective: Potentially morally injurious experiences (PMIE) (events that transgress an individual's subjective moral standards) have been associated with psychologically distressing moral emotions such as shame and guilt. Military leaders and clinicians have feared that those with PMIEs may be less likely to seek help due to the withdrawing nature of shame/guilt; however, to date, help-seeking patterns of military personnel with PMIEs has not been explored. Our objective is to address this research gap. Method: Data from a nationally-representative mental health survey of active Canadian military personnel were analysed. To assess the association between exposure to three PMIEs and past-year help-seeking across different provider categories (i.e. professionals, para-professionals (those delegated with mental health advisory tasks but are not licenced to practice as medical professionals), non-professionals), a series of logistic regressions were conducted, controlling for exposure to other deployment and non-deployment-related psychological trauma, psychiatric variables, military factors, and sociodemographic variables. Analytical data frame included only personnel with a history of Afghanistan deployment (N = 4854). Results: Deployed members exposed to PMIEs were more likely to seek help from their family doctor/general practitioner (OR = 1.72; 95%CI = 1.25-2.36), paraprofessionals (OR = 1.72; 95%CI = 1.25-2.36), and non-professionals (OR = 1.44; 95%CI = 1.06-1.95) in comparison to members not exposed to PMIEs. Those exposed to PMIEs were also more likely to seek professional care from the civilian health care system (OR = 1.94; 95%CI = 1.27-2.96). Conclusion: Contrary to long-held, but untested, assumptions regarding the impact of PMIEs on help-seeking, we found those with PMIEs are more likely to seek help from gatekeeper professionals (i.e. general practitioners), para-professionals, and non-professionals rather than specialized mental health professionals (e.g. psychologists). Increased utilization of civilian professionals raises concerns that active military members may be avoiding military health services. Clinically, this highlights the need to increase awareness of moral injury to ensure that actively serving military members are provided with appropriate advice and treatment.
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Affiliation(s)
- Anthony Nazarov
- The MacDonald Franklin OSI Research Centre, Lawson Health ResearchInstitute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Deniz Fikretoglu
- Department of National Defence, Defence Research and Development Canada, Toronto, Ontario, Canada.,Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Aihua Liu
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - J Don Richardson
- The MacDonald Franklin OSI Research Centre, Lawson Health ResearchInstitute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Operational Stress Injury Clinic, St. Joseph's Health Care, London, Ontario, Canada
| | - Megan Thompson
- Department of National Defence, Defence Research and Development Canada, Toronto, Ontario, Canada
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85
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Physical Therapy as a Force Multiplier: Population Health Perspectives to Address Short-Term Readiness and Long-Term Health of Military Service Members. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000129] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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86
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Byrow Y, Pajak R, Specker P, Nickerson A. Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees: A systematic review. Clin Psychol Rev 2019; 75:101812. [PMID: 31901882 DOI: 10.1016/j.cpr.2019.101812] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 01/04/2023]
Abstract
Despite elevated rates of psychological disorders amongst individuals from a refugee background, levels of mental health help-seeking in these populations are low. There is an urgent need to understand the key barriers that prevent refugees and asylum-seekers from accessing help for psychological symptoms. This review synthesises literature examining perceptions of mental health and barriers to mental health help-seeking in individuals from a refugee background. Our analysis, which complies with PRISMA reporting guidelines, identified 62 relevant studies. Data extraction and thematic analytic techniques were used to synthesise findings from quantitative (n = 26) and qualitative (n = 40) studies. We found that the salient barriers to help-seeking were: (a) cultural barriers, including mental health stigma and knowledge of dominant models of mental health; (b) structural barriers, including financial strain, language proficiency, unstable accommodation, and a lack of understanding of how to access services, and (c) barriers specific to the refugee experience, including immigration status, a lack of trust in authority figures and concerns about confidentiality. We discuss and contextualise these key themes and consider how these findings can inform the development of policies and programs to increase treatment uptake and ultimately reduce the mental health burden amongst refugees and asylum-seekers.
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Affiliation(s)
- Yulisha Byrow
- School of Psychology, University of New South Wales, Sydney, Australia.
| | - Rosanna Pajak
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Philippa Specker
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
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87
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Crowell-Williamson GA, Fruhbauerova M, DeCou CR, Comtois KA. Perceived burdensomeness, bullying, and suicidal ideation in suicidal military personnel. J Clin Psychol 2019; 75:2147-2159. [PMID: 31332803 PMCID: PMC11000627 DOI: 10.1002/jclp.22836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Suicide is a major public health concern among military servicemembers and previous research has demonstrated an association between bullying and suicide. This study evaluated the association between workplace bullying and suicidal ideation via perceived burdensomeness and thwarted belongingness which were hypothesized to mediate this association. METHOD Four hundred and seventy-one suicidal Army Soldiers and U.S. Marines completed self-report measures of suicidal ideation, thwarted belongingness, perceived burdensomeness, and bullying. A series of regressions were used to test the hypothesized mediation model using the baseline data from a larger clinical trial. RESULTS Perceived burdensomeness was a significant mediator of the association between bullying and the level of suicidal ideation, but thwarted belongingness was not a significant mediator. CONCLUSIONS Perceived burdensomeness may represent a malleable target for intervention to prevent suicide among military service members, and should be evaluated further as an intervening variable with regard to suicidality in the setting of bullying victimization.
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Affiliation(s)
- Gavin A Crowell-Williamson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Martina Fruhbauerova
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Christopher R DeCou
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Katherine A Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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88
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Azevedo DSS, Lima EP, Gunn V, Muntaner C, Ng E, Assunção AA. Anxiety and contradictory class position in the hierarchy of Brazilian firefighters. Am J Ind Med 2019; 62:1007-1013. [PMID: 31483067 DOI: 10.1002/ajim.23046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Workers holding intermediate hierarchical positions in an institution may have a higher risk of occupational stress-related, ill health. This study examined the prevalence rates and odds ratios (ORs) of anxiety disorders among a hierarchical group of firefighters. METHODS This cross-sectional study samples firefighters from Minas Gerais, Brazil, who answered a structured questionnaire in 2011 (survey completion rate = 89.5%). The outcome of interest was a medical diagnosis of anxiety disorder. Bivariate and multivariate analyses were conducted among five hierarchical occupational positions: privates (lowest position), corporals, sergeants (intermediate position), sub lieutenants, and officers (highest position). RESULTS Overall, 8.4% of the sample reported an anxiety disorder, with the highest rate observed among intermediate workers (sergeants = 14.2%), followed by corporals (10%), privates (5.6%), sub lieutenants (5%), and officers (2.1%). Compared with privates, the unadjusted OR for sergeants was 2.49 (95% confidence interval, 1.35, 4.58). This finding remained statistically significant after adjustment for several control variables but was eliminated by age. CONCLUSION The mental health of firefighters is affected by social class position. Mental health promotion efforts should focus on longitudinal research and work toward interventions aimed at modifying the hierarchical structure of workplaces.
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Affiliation(s)
| | - Eduardo P. Lima
- Department of Preventive MedicineFaculty of Medicine at UFMG Belo Horizonte Brazil
| | - Virginia Gunn
- Department of Preventive Medicine, Lawrence S. Bloomberg Faculty of NursingUniversity of Toronto Toronto Ontario Canada
| | - Carles Muntaner
- Department of Preventive Medicine, Lawrence S. Bloomberg Faculty of NursingUniversity of Toronto Toronto Ontario Canada
| | - Edwin Ng
- Department of Preventive Medicine, School of Social WorkUniversity of Waterloo Waterloo Ontario Canada
| | - Ada A. Assunção
- Department of Preventive MedicineFaculty of Medicine at UFMG Belo Horizonte Brazil
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89
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Hurtado SL, Simon-Arndt CM, Schmied EA, Belding JN, Subala RS, Richardson CM. Use of an Educational Video to Reduce Barriers to Military Mental Health Care. Psychiatr Serv 2019; 70:915-920. [PMID: 31272334 DOI: 10.1176/appi.ps.201800547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although there is significant need for mental health care among service members, stigma surrounding these services, along with myths associated with behavioral health treatment, discourages care seeking. This study evaluated the effect of a video designed to demystify mental health treatment on barriers to seeking care among military personnel. METHODS Participants were 294 active duty U.S. Marine Corps personnel who were randomly assigned to the intervention video only, the intervention video with discussion, or an attentional control video. Participants completed questionnaires that assessed social stigma regarding mental health treatment and willingness to seek help at pretest, posttest, and 6-week follow-up; personal desire for mental health care was assessed at pretest and 6-week follow-up. RESULTS Participants who viewed the intervention video in either condition showed significant and similar decreases in social stigma and increases in willingness to seek help at posttest (p<.001), whereas participants in the control group showed no change at posttest in either variable. Although social stigma did not differ by intervention group at the 6-week follow-up, participants in either intervention were 2.56 times more likely than participants in the control group to report a personal desire for mental health care at the 6-week follow-up (p=.05). There were no significant differences between the two interventions on the main outcomes. CONCLUSIONS A video in which mental health care providers explain the treatment process may be effective as an initial stand-alone social stigma reduction intervention. Additional efforts are likely needed to sustain effects and to realize increases in help-seeking behavior.
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Affiliation(s)
- Suzanne L Hurtado
- Department of Health and Behavioral Sciences, Naval Health Research Center, San Diego (Hurtado, Simon-Arndt, Schmied, Belding, Subala); Leidos, San Diego (Simon-Arndt, Schmied, Belding, Subala); Veterans Administration Medical Center-Dallas, Dallas (Richardson)
| | - Cynthia M Simon-Arndt
- Department of Health and Behavioral Sciences, Naval Health Research Center, San Diego (Hurtado, Simon-Arndt, Schmied, Belding, Subala); Leidos, San Diego (Simon-Arndt, Schmied, Belding, Subala); Veterans Administration Medical Center-Dallas, Dallas (Richardson)
| | - Emily A Schmied
- Department of Health and Behavioral Sciences, Naval Health Research Center, San Diego (Hurtado, Simon-Arndt, Schmied, Belding, Subala); Leidos, San Diego (Simon-Arndt, Schmied, Belding, Subala); Veterans Administration Medical Center-Dallas, Dallas (Richardson)
| | - Jennifer N Belding
- Department of Health and Behavioral Sciences, Naval Health Research Center, San Diego (Hurtado, Simon-Arndt, Schmied, Belding, Subala); Leidos, San Diego (Simon-Arndt, Schmied, Belding, Subala); Veterans Administration Medical Center-Dallas, Dallas (Richardson)
| | - Rosemarie S Subala
- Department of Health and Behavioral Sciences, Naval Health Research Center, San Diego (Hurtado, Simon-Arndt, Schmied, Belding, Subala); Leidos, San Diego (Simon-Arndt, Schmied, Belding, Subala); Veterans Administration Medical Center-Dallas, Dallas (Richardson)
| | - Colleen M Richardson
- Department of Health and Behavioral Sciences, Naval Health Research Center, San Diego (Hurtado, Simon-Arndt, Schmied, Belding, Subala); Leidos, San Diego (Simon-Arndt, Schmied, Belding, Subala); Veterans Administration Medical Center-Dallas, Dallas (Richardson)
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90
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Cuyler M, Guerrero L. Mental health help-seeking intentions and organizational climate among military members. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1630229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mishaw Cuyler
- Experiential Consulting Group, LLC, San Antonio, Texas
| | - Laura Guerrero
- Department of Management, University of Houston – Clear Lake, Houston, Texas
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Zuromski KL, Dempsey CL, Ng THH, Riggs-Donovan CA, Brent DA, Heeringa SG, Kessler RC, Stein MB, Ursano RJ, Benedek D, Nock MK. Utilization of and barriers to treatment among suicide decedents: Results from the Army Study to Assess Risk and Resilience Among Servicemembers (Army STARRS). J Consult Clin Psychol 2019; 87:671-683. [PMID: 31008631 DOI: 10.1037/ccp0000400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine suicide decedents' use of mental health treatment and perceived barriers to initiating and maintaining treatment. METHOD We used a psychological autopsy study conducted as part of the Army Study to Assess Risk and Resilience Among Servicemembers (Army STARRS) that compared suicide decedents (n = 135) to soldiers in two control conditions: those propensity-score-matched on known sociodemographic and Army history variables (n = 137) and those with a history of suicidal thoughts in the past 12 months (n = 118). Informants were next of kin and Army supervisors. RESULTS Results revealed that suicide decedents were significantly more likely to be referred to services and to use more intensive treatments (e.g., medication, overnight stay in hospital) than propensity-matched controls. However, decedents also were more likely to perceive significant barriers to treatment-seeking. All differences observed in the current study were between propensity-matched controls and decedents, with no observed differences between suicide ideators and decedents. CONCLUSIONS Many suicide decedents used some form of mental health care at some point in their lives; however, they also were more likely than propensity-matched controls to perceive barriers that may have prevented service use. The lack of differences between suicide ideators and decedents suggests that more information is needed, beyond knowledge of treatment utilization or perceived barriers, to identify and intervene on those at highest risk for suicide. These findings underscore the importance of reducing attitudinal barriers that may deter suicidal soldiers from seeking treatment, and also improving risk detection among those who are attending treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Catherine L Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - Tsz Hin Hinz Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - Charlotte A Riggs-Donovan
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | - Murray B Stein
- Department of Psychiatry and Family Medicine & Public Health, University of California, San Diego
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - David Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
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92
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Johnson EM, Possemato K. Correlates and predictors of mental health care utilization for veterans with PTSD: A systematic review. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2019; 11:851-860. [PMID: 30998061 DOI: 10.1037/tra0000461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Treatment utilization among veterans with posttraumatic stress disorder (PTSD) is low. Understanding correlates and predictors of mental health care for veterans with PTSD is critical to facilitating treatment utilization. However, given the size of the literature base and disparate findings, it is difficult to interpret available research. Correlates and predictors of mental health care for veterans with PTSD published between 2012 and 2016 were examined to (a) define the scope of recent literature and (b) summarize predictive evidence. METHOD This 2-phase systematic review conducted scientific database searches. Phase 1 defined the scope of recent literature (n = 51) and tabulated types of correlates, outcomes, and sources of bias. Phase 2 summarized results from prospective studies (n = 17) evaluating mental health care utilization (PROSPERO ID No. CRD42017082686). RESULTS Demographics-social network characteristics (61%) and evaluated need (61%) were the most common correlates of mental health utilization. Facilitators with the strongest evidence for predicting utilization (both initiation and retention) were characteristics of the episode of care (e.g., mental health in primary care) and greater PTSD symptom severity. Study biases favoring Department of Veterans Affairs (VA) enrollees (92%) and excluding outside VA care outcomes (86%) limit generalizability of results. CONCLUSIONS Efforts focused on providing mental health in primary care, interventions to address mental health beliefs, and outreach to racial-ethnic minority veterans and those with mild to moderate PTSD could increase mental health care utilization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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93
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Hoyt T, Repke DM. Development and Implementation of U.S. Army Guidelines for Managing Soldiers at Risk of Suicide. Mil Med 2019; 184:426-431. [PMID: 30901390 DOI: 10.1093/milmed/usy284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/24/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Despite significant efforts in suicide prevention over the past several years, suicide rates in the U.S. Army remain largely unchanged. This paper describes a collaborative effort between line-unit leaders, medical personnel, and installation services to synchronize suicide risk identification and communication between these disparate entities. METHODS Under the direction of the Installation Director of Psychological Health at Joint Base Lewis-McChord, a Behavioral Health Process Action Team was chartered to identify best practice and formulate policy for identifying and managing service members at risk for suicide. RESULTS Compliance with the new policy reached 100% within 6 months of implementation, as measured by peer review of records. This installation policy was subsequently identified as a best practice and adopted Army-wide as the standard of practice. DISCUSSION Knowledge transfer of research findings into policy and practice is crucial for suicide prevention. The current policy shows good integration of current research with practice in military settings. CONCLUSIONS Combined efforts in crafting policy for risk identification and communication resulted in a policy that was acceptable and feasible from the perspective of commanders and clinicians. Synchronization efforts between commanders, clinicians, and support services are crucial to ensure effective intervention to prevent suicide behavior.
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Affiliation(s)
- Tim Hoyt
- Connected Health Branch, Defense Health Agency, 9933 West Hayes Street, Box 339500 MS 34, Joint Base Lewis-McChord, WA
| | - Diana M Repke
- Department of Behavioral Health, Madigan Army Medical Center, 9040 Jackson Avenue, Joint Base Lewis-McChord, WA
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94
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Mark KM, Murphy D, Stevelink SAM, Fear NT. Rates and Associated Factors of Secondary Mental Health Care Utilisation among Ex-Military Personnel in the United States: A Narrative Review. Healthcare (Basel) 2019; 7:E18. [PMID: 30695993 PMCID: PMC6473317 DOI: 10.3390/healthcare7010018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 11/16/2022] Open
Abstract
Little is known about ex-serving military personnel who access secondary mental health care. This narrative review focuses on studies that quantitatively measure secondary mental health care utilisation in ex-serving personnel from the United States. The review aimed to identify rates of mental health care utilisation, as well as the factors associated with it. The electronic bibliographic databases OVID Medline, PsycInfo, PsycArticles, and Embase were searched for studies published between January 2001 and September 2018. Papers were retained if they included ex-serving personnel, where the majority of the sample had deployed to the recent conflicts in Iraq or Afghanistan. Fifteen studies were included. Modest rates of secondary mental health care utilisation were found in former military members-for mean percentage prevalence rates, values ranged from 12.5% for at least one psychiatric inpatient episode, to 63.2% for at least one outpatient mental health appointment. Individuals engaged in outpatient care visits most often, most likely because these appointments are the most commonly offered source of support. Post-traumatic stress disorder, particularly re-experiencing symptoms, and comorbid mental health problems were most consistently associated with higher mental health care utilisation. Easily accessible interventions aimed at facilitating higher rates of help seeking in ex-serving personnel are recommended.
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Affiliation(s)
- Katharine M Mark
- King's Centre for Military Health Research, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
| | - Dominic Murphy
- King's Centre for Military Health Research, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
- Combat Stress, Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey KT22 0BX, UK.
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK.
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
- Academic Department of Military Mental Health, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
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95
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Stevelink SAM, Jones N, Jones M, Dyball D, Khera CK, Pernet D, MacCrimmon S, Murphy D, Hull L, Greenberg N, MacManus D, Goodwin L, Sharp ML, Wessely S, Rona RJ, Fear NT. Do serving and ex-serving personnel of the UK armed forces seek help for perceived stress, emotional or mental health problems? Eur J Psychotraumatol 2019; 10:1556552. [PMID: 30693074 PMCID: PMC6338286 DOI: 10.1080/20008198.2018.1556552] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/16/2018] [Accepted: 11/26/2018] [Indexed: 10/25/2022] Open
Abstract
Background: UK armed forces personnel are at risk of occupational psychological injury; they are often reluctant to seek help for such problems. Objective: We aimed to examine and describe sources of support, prevalence and associates of help-seeking among UK serving and ex-serving personnel. Method: A total of 1450 participants who self-reported a stress, emotional or mental health problem in the past 3 years were sampled from a health and wellbeing study and subsequently completed a telephone interview comprising measures of mental disorder symptoms, alcohol misuse and help-seeking behaviour. Results: Seven per cent of participants had not sought any help, 55% had accessed medical sources of support (general practitioner or mental health specialist), 46% had received formal non-medical (welfare) support and 86% had used informal support. Gender, age, perceived health, functional impairment, social support, deployment, alcohol and comorbidity impacted upon the choice of help source. Conclusions: This study found that the majority of those with perceived mental health problems sought some form of help, with over half using formal medical sources of support.
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Affiliation(s)
- Sharon A. M. Stevelink
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Norman Jones
- Academic Department of Military Mental Health, Department of Psychological Medicine, King’s College London, London, UK
| | - Margaret Jones
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Daniel Dyball
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charandeep K. Khera
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - David Pernet
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Shirlee MacCrimmon
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Dominic Murphy
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Combat Stress, Leatherhead, UK
| | - Lisa Hull
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Neil Greenberg
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Deirdre MacManus
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Laura Goodwin
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Marie-Louise Sharp
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Simon Wessely
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Roberto J. Rona
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nicola T. Fear
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Academic Department of Military Mental Health, Department of Psychological Medicine, King’s College London, London, UK
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96
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Azevedo DSDSD, Lima EDP, Assunção AÁ. Fatores associados ao uso de medicamentos ansiolíticos entre bombeiros militares. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190021. [DOI: 10.1590/1980-549720190021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/18/2017] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Introdução: O uso de ansiolíticos é uma opção no tratamento de sintomas psíquicos. Contudo, ainda que o uso seja controlado há riscos de dependência, intoxicação e alterações cognitivas. O uso não controlado entre trabalhadores agrava tais problemas. Objetivos: Identificar a prevalência do uso de ansiolíticos e conhecer os fatores associados ao consumo em bombeiros militares. Método: Pesquisa transversal de base censitária investigou 711 bombeiros de Belo Horizonte, Minas Gerais, por meio de autorrelato. Regressão logística multinomial foi utilizada para verificar associação entre características sociodemográficas, condições de vida, trabalho e saúde e consumo de ansiolíticos de modo controlado ou não. Resultados: A prevalência do uso de ansiolíticos foi 9,9%. Para 7,5% dos bombeiros o consumo ocorreu sem indicação e/ou controle terapêutico especializado. O uso controlado foi associado ao relato compatível com Transtorno Mental Comum (OR = 23,6; IC95% 6,54 - 85,11). O uso não controlado foi associado ao tempo de serviço (OR = 2,57; IC95% 1,03 - 6,40), ao tabagismo (OR = 3,22; IC95% 1,50 - 6,91) e ao Transtorno Mental Comum (OR = 4,02; IC95% 2,17 - 7,45). Conclusão: A alta prevalência de consumo indica alerta para as ações dos programas de saúde ocupacional.
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97
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Murphy DM, Busuttil W, Turgoose D. Understanding the Needs of Veterans with PTSD. Healthcare (Basel) 2018; 6:healthcare6030100. [PMID: 30111694 PMCID: PMC6165474 DOI: 10.3390/healthcare6030100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dominic M Murphy
- Research Department, Combat Stress, Leatherhead, Surrey KT22 0BX, UK.
- Department of Psychological Medicine, King's Centre for Military Health Research, King's College London, London WC2R 2LS, UK.
| | - Walter Busuttil
- Research Department, Combat Stress, Leatherhead, Surrey KT22 0BX, UK.
| | - David Turgoose
- Research Department, Combat Stress, Leatherhead, Surrey KT22 0BX, UK.
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98
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Ghahramanlou-Holloway M, LaCroix JM, Koss K, Perera KU, Rowan A, VanSickle MR, Novak LA, Trieu TH. Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E828. [PMID: 29690594 PMCID: PMC5923870 DOI: 10.3390/ijerph15040828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/16/2022]
Abstract
Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines (N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines (N = 40) was matched to a non-treatment-seeking sample of Marines (N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls (p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed.
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Affiliation(s)
- Marjan Ghahramanlou-Holloway
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Jessica M LaCroix
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Kari Koss
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Kanchana U Perera
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Anderson Rowan
- School of Psychology and Counseling, Regent University, Virginia Beach, VA 23464, USA.
| | - Marcus R VanSickle
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Laura A Novak
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Theresa H Trieu
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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99
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Cerully JL, Acosta JD, Sloan J. Mental Health Stigma and Its Effects on Treatment-Related Outcomes: A Narrative Review. Mil Med 2018. [DOI: 10.1093/milmed/usx219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Joie D Acosta
- RAND Corporation, 1200 South Hayes Street, Arlington, VA
| | - Jennifer Sloan
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA
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100
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Rüsch N, Rose C, Holzhausen F, Mulfinger N, Krumm S, Corrigan PW, Willmund GD, Zimmermann P. Attitudes towards disclosing a mental illness among German soldiers and their comrades. Psychiatry Res 2017; 258:200-206. [PMID: 28864120 DOI: 10.1016/j.psychres.2017.08.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/12/2017] [Indexed: 11/17/2022]
Abstract
Many soldiers with mental illness (SWMIs) struggle with the decision whether to disclose their condition in or outside the military. This study therefore explored views on (self-)labeling as 'mentally ill', experiences of discrimination and coping, risks and benefits of (non-)disclosure, service use, disclosure decisions and consequences of disclosing. Active-duty SWMIs as well as soldiers without mental illness (commanding officers; enlisted ranks) and military social workers participated in focus groups. Transcripts were analyzed using qualitative content analysis. SWMIs perceived negative stereotypes about their group (weakness, incompetence, blame, malingering) and saw stigma as a barrier to help-seeking. Being labeled 'mentally ill' was seen as harmful for one's career. Self-labeling led to poor self-esteem, greater need for help and feelings of weakness. Many SWMIs had experienced discrimination, such as gossip or inappropriate comments. Social isolation was a disadvantage of secrecy. Most SWMIs preferred selective disclosure and many did not disclose to their family. Military staff without mental illness expressed partly different views and described organizational challenges posed by SWMIs. Our findings suggest that disclosure decisions are personal and difficult and that stigma remains a barrier to re-integration and recovery of SWMIs in the military. Implications for interventions to support SWMIs are discussed.
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Affiliation(s)
- Nicolas Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany.
| | - Carolyn Rose
- Center for Military Mental Health, Berlin, Germany
| | - Fabian Holzhausen
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
| | - Nadine Mulfinger
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
| | - Silvia Krumm
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
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