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Ein N, Gervasio J, St. Cyr K, Liu JJW, Baker C, Nazarov A, Richardson JD. A rapid review of the barriers and facilitators of mental health service access among Veterans and their families. FRONTIERS IN HEALTH SERVICES 2024; 4:1426202. [PMID: 39105142 PMCID: PMC11298457 DOI: 10.3389/frhs.2024.1426202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/25/2024] [Indexed: 08/07/2024]
Abstract
Introduction Transitioning to civilian life after military service can be challenging for both Veterans and their families. Accessible mental health services are crucial during this period to provide support. The objective of this review was to conduct a rapid review to capture the barriers and identify facilitators that influence access to mental health services for Veterans and their families during the post-service transition period. Methods This review was conducted using the Cochrane Handbook for Systematic Reviews of Interventions as a methodological framework and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Rapid Review (PRISMA-RR). Results A total of 60 articles and 67 independent samples were included in the final data analyses. Across the included articles, this review identified 23 barriers and 14 facilitator themes. Issues navigating the mental health care system was identified as the main challenge among Veterans and their families, and those who received support navigating the system identified this as a significant facilitator. Applying the Theoretical Domains Framework, most of the identified barriers and facilitators were categorized into environmental context and resources domain. Discussion The heterogeneity in Veterans' and Veteran families' experiences with mental health care-seeking may suggest that access to mental health care for Veterans and Veteran families cannot be solved by addressing one type of barrier alone. Instead, coordinated efforts to address prioritized systemic, logistical, social, and inter-/intrapersonal obstacles are essential for improving access and optimizing mental health care outcomes. These insights underscore the complexity of considerations for Veterans and families accessing mental health care.
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Affiliation(s)
- Natalie Ein
- MacDonald Franklin OSI Research and Innovation Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
| | - Julia Gervasio
- MacDonald Franklin OSI Research and Innovation Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Kate St. Cyr
- MacDonald Franklin OSI Research and Innovation Centre, Lawson Health Research Institute, London, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jenny J. W. Liu
- MacDonald Franklin OSI Research and Innovation Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
| | - Clara Baker
- MacDonald Franklin OSI Research and Innovation Centre, Lawson Health Research Institute, London, ON, Canada
| | - Anthony Nazarov
- MacDonald Franklin OSI Research and Innovation Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - J. Don Richardson
- MacDonald Franklin OSI Research and Innovation Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- St. Joseph’s OSI Clinic, St. Joseph’s Health Care London, London, ON, Canada
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Osilla KC, Gore KL, Pedersen ER, Hummer JF, DeYoreo M, Manuel JK, McKay JR, Kim JP, Nameth K. Study protocol for a sequential multiple assignment randomized trial to reduce risky drinking among service members and their partners. Contemp Clin Trials 2023; 133:107324. [PMID: 37652360 PMCID: PMC10591961 DOI: 10.1016/j.cct.2023.107324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Military spouses and partners in relationships with a heavy drinking service member report high levels of mental health concerns and consequences, which are compounded when both partners drink heavily. Military spouses and partners -termed "concerned partners" (CPs)-may be an important gateway for motivating service members (SMs) to seek care. However, CPs may first need to reduce their own drinking and improve their communication to effectively support and encourage changes for their service member partner. Partners Connect is a web-based intervention aimed at improving communication and relationship quality and increasing SM help-seeking. METHODS The current study design is a two-stage Sequential Multiple Assignment Randomized Trial (SMART) to develop an adaptive CP intervention to decrease CP drinking and increase SM help-seeking. CPs aged 18 and older (n = 408) will be recruited via social media and followed for six months. In stage one, we will randomize CPs to either a 4-session web-based intervention (Partners Connect) or to receive communication resources from the Gottman Institute website. The goal is to have CPs invite their SM to complete an online personalized normative feedback (PNF) session. If their SM completes the PNF at stage one, CPs will be considered "responders," if the SM does not complete, CPs who are "non-responders" will be re-randomized during stage two to receive either (1) a CRAFT workbook or (2) phone-based CRAFT if in Partners Connect; or (1) Partners Connect or (2) a CRAFT workbook if in Gottman. DISCUSSION By first intervening with the service member's CP, we aim to better equip them to engage their service member partner in treatment services. In doing so, we develop a model that increases treatment accessibility and appeal among a group that may not otherwise seek care. CLINICALTRIALS gov Identifier: NCT05619185.
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Affiliation(s)
- Karen Chan Osilla
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA.
| | - Kristie L Gore
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202, USA
| | - Eric R Pedersen
- University of Southern California Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, USA
| | - Justin F Hummer
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA 90407-2138, USA
| | - Maria DeYoreo
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA 90407-2138, USA
| | - Jennifer K Manuel
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Ave, San Francisco, CA 94143, USA
| | - James R McKay
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Crescenz VAMC, Philadelphia, PA, USA
| | - Jane P Kim
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Katherine Nameth
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA
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Dundes L. Symbolism of the US battlefield cross: how boots, rifles, and helmets reinforce masculinity. FRONTIERS IN SOCIOLOGY 2023; 8:1148204. [PMID: 37207022 PMCID: PMC10188940 DOI: 10.3389/fsoc.2023.1148204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/05/2023] [Indexed: 05/21/2023]
Abstract
This paper explores the unconscious symbolism of the battlefield cross memorial, which is comprised of combat boots and a rifle, often with dog tags attached, topped by a helmet. While the memorial's manifest function is to provide solace, build solidarity, and convey respect for patriotic sacrifice in response to grief, the battlefield cross also exalts masculinity at a subliminal level. Because of the latent ways in which the components of the battlefield cross reinforce fallen soldiers' masculinity, the memorial provides an outlet for bereavement according to a masculine script that treats virility as sacrosanct. The resonance of the battlefield cross and its synergism with unrecognized gender coding in broader society illustrate how a powerful symbol intended to honor members of the military also valorizes machismo. This qualitative interpretation could help explain impediments to women achieving parity with men in the military.
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Clary KL, Habbal M, Smith DC, Fratila I. The Green Sheep: Exploring the Perceived Risks and Benefits of Cannabis Among Young Military Members and Veterans. CANNABIS (ALBUQUERQUE, N.M.) 2021; 4:31-46. [PMID: 37287531 PMCID: PMC10212263 DOI: 10.26828/cannabis/2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Medical and recreational cannabis are becoming more accessible and socially accepted across the United States. Emerging adults (EAs; 18 to 29) are the largest group of cannabis users. Studies have found that veterans are more likely to report cannabis use compared to nonveterans. While research exists on the use levels of cannabis, limited knowledge is available on the perceived risks and benefits of using cannabis among EA military and veteran populations. Helping professionals encounter veterans who use cannabis and must consider military cultural factors and attitudes towards cannabis that may influence or exacerbate cannabis use. We conducted a qualitative study with 23 EA veteran and military members with high-risk substance use and asked about their thoughts on the acceptability, risks, and perceived benefits associated with cannabis. Two qualitative coders used NVivo to find themes following the six steps of thematic analysis. Results provide in-depth understanding of EA military members and veterans' perceptions of cannabis. Overall, we found participants were receptive to using cannabis for pain ailments, mental health issues, and as an alternative to benzodiazepines, opioids, and alcohol. However, they acknowledged restrictions are needed to moderate cannabis use and mitigate negative outcomes. Lastly, participants recognized the incongruence of cannabis use with military job responsibilities and expectations. These findings shed light on potential risk and protective factors related to using cannabis for recreational or medical reasons and should be considered when consulting EA military members and veterans.
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Affiliation(s)
| | - Megan Habbal
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Douglas C. Smith
- School of Social Work, University of Illinois at Urbana-Champaign
| | - Iulia Fratila
- Community Health, University of Illinois at Urbana-Champaign
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