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Vidales CA, Smolenski DJ, Skopp NA, Vogel D, Wade N, Sheppard S, Speed K, Hood K, Cartwright P. Assessing the dimensionality and construct validity of the military stigma scale across current service members. MILITARY PSYCHOLOGY 2024; 36:49-57. [PMID: 38193877 PMCID: PMC10790807 DOI: 10.1080/08995605.2021.1997501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
US service members are at elevated risk for distress and suicidal behavior, compared to the general US population. However, despite the availability of evidence-based treatments, only 40% of Service members in need of mental health care seek help. One potential reason for the lower use of services is that service members experience stigma or concerns that the act of seeking mental health care from a mental health provider carries a mark of disgrace. The Military Stigma Scale (MSS) was designed to assess two theoretical dimensions of help-seeking stigma (public and self), specifically among service members. The goal of the current study was to further examine the validity of the MSS among 347 active duty service members. Examination of unidimensional, two-factor, and bifactor models revealed that a bifactor model, with a general (overall stigma), two specific factors (public and self-stigma), and one method factor (accounting for negatively worded items) provided the best fit to the data. Ancillary reliability analyses also supported the MSS measuring a broad stigma factor associated with seeking mental health care in the military. Subsequent model analyses showed that the MSS was associated with other stigma-related constructs. Overall, findings suggest that the MSS is a reliable and validated scale that can be used to assess military help-seeking stigma and to evaluate results of programs designed to reduce stigma.
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Affiliation(s)
| | - Derek J. Smolenski
- Psychological Health Center of Excellence (PHCoE), Silver Spring, Maryland, USA
| | - Nancy A. Skopp
- Psychological Health Center of Excellence (PHCoE), Silver Spring, Maryland, USA
| | - David Vogel
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - Nathaniel Wade
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - Sean Sheppard
- Uniformed Services University of the Health Sciences (USUHS), Madigan Army Medical Center, Bethesda, Maryland, USA
| | - Katrina Speed
- Department of Psychology, Mississippi State University (MSU), Tacoma, Washington, USA
| | - Kristina Hood
- Department of Psychology, Mississippi State University (MSU), Tacoma, Washington, USA
| | - Patricia Cartwright
- Department of Psychology, Mississippi State University (MSU), Tacoma, Washington, USA
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Yamazaki M, Nagamine M, Kitano M, Waki F, Edo N, Koga M, Tachimori H, Toda H. Identifying factors related to stigma toward psychiatric illness and mental health services and attitudes of help-seeking among Japan Ground Self-Defense Force members. J Psychiatr Res 2023; 165:241-247. [PMID: 37523976 DOI: 10.1016/j.jpsychires.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/09/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
The stigma that military personnel feel toward mental illness and mental healthcare hinders their access to mental health services. Stigma is influenced by culture-specifically, that held by military personnel is closely related to military culture. To our knowledge, this is the first large-scale investigation aimed at identifying the factors, including demographic factors and elements of military culture, related to stigma among members of the Japan Ground Self-Defense Force. An anonymous questionnaire was administered to 4754 members. The questionnaire included items regarding demographic factors, history of psychiatric visits, military rank, overseas deployment experience, disaster relief experience, supervisor leadership, unit cohesion, general psychological distress, stigma toward perceived mental illness, and attitudes toward help-seeking. Multiple regression analysis was used to identify the various factors related to stigma. Responses were obtained from 4305 (90.5%) participants, among which 3723 (78.3%) were valid. Multiple regression analyses revealed that a variety of factors including age, psychiatric consultation, leadership, and cohesiveness were markedly associated with stigma and attitudes toward help-seeking. This study revealed that various factors including demographic factors and military culture factors such as supervisor leadership and unit cohesion are related to stigma and attitudes toward mental health services among Japan Ground Self-Defense Force personnel. Further studies are needed to examine the results in depth.
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Affiliation(s)
- Masayuki Yamazaki
- Department of Psychiatry, School of Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Masanori Nagamine
- Department of Behavioral Health, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Masato Kitano
- Department of Behavioral Health, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Fumiko Waki
- Department of Behavioral Health, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Naoki Edo
- Department of Behavioral Health, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Minori Koga
- Department of Psychiatry, School of Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Hisateru Tachimori
- Endowed Course for Health System Innovation, School of Medicine, Keio University, 35, Shinano-machi, Shinjuku Ward, Tokyo, 160-0016, Japan.
| | - Hiroyuki Toda
- Department of Psychiatry, School of Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
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Bogaers R, Geuze E, van Weeghel J, Leijten F, van de Mheen D, Greenberg N, Rozema AD, Brouwers E. Mental health issues and illness and substance use disorder (non-)disclosure to a supervisor: a cross-sectional study on beliefs, attitudes and needs of military personnel. BMJ Open 2023; 13:e063125. [PMID: 37045564 PMCID: PMC10105997 DOI: 10.1136/bmjopen-2022-063125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES Research suggests that military personnel frequently delay disclosing mental health issues and illness (MHI), including substance use disorder, to supervisors. This delay causes missed opportunities for support and workplace accommodations which may help to avoid adverse occupational outcomes. The current study aims to examine disclosure-related beliefs, attitudes and needs, to create a better understanding of personnel's disclosure decision making. DESIGN A cross-sectional questionnaire study among military personnel with and without MHI. Beliefs, attitudes and needs regarding the (non-)disclosure decision to a supervisor were examined, including factors associated with (non-)disclosure intentions and decisions. Descriptive and regression (logistic and ordinal) analyses were performed. SETTING The study took place within the Dutch military. PARTICIPANTS Military personnel with MHI (n=324) and without MHI (n=554) were participated in this study. OUTCOME MEASURE (Non-)disclosure intentions and decisions. RESULTS Common beliefs and attitudes pro non-disclosure were the preference to solve one's own problems (68.3%), the preference for privacy (58.9%) and a variety of stigma-related concerns. Common beliefs and attitudes pro disclosure were that personnel wanted to be their true authentic selves (93.3%) and the desire to act responsibly towards work colleagues (84.5%). The most reported need for future disclosure (96.8%) was having a supervisor who shows an understanding for MHI. The following factors were associated both with non-disclosure intentions and decisions: higher preference for privacy (OR (95% CI))=(1.99 (1.50 to 2.65)intention, 2.05 (1.12 to 3.76)decision) and self-management (OR (95% CI))=(1.64 (1.20 to 2.23)intention, 1.79 (1.00 to 3.20)decision), higher stigma-related concerns (OR (95% CI))=(1.76 (1.12 to 2.77)intention, 2.21 (1.02 to 4.79)decision) and lower quality of supervisor-employee relationship (OR (95% CI))=(0.25 (0.15 to 0.42)intention, 0.47 (0.25 to 0.87)decision). CONCLUSION To facilitate (early-)disclosure to a supervisor, creating opportunities for workplace support, interventions should focus on decreasing stigma and discrimination and align with personnels' preference for self-management. Furthermore, training is needed for supervisors on how to recognise, and effectively communicate with, personnel with MHI. Focus should also be on improving supervisor-employee relationships.
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Affiliation(s)
- Rebecca Bogaers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg School of Social and Behavioral Sciences, Tilburg, The Netherlands
- Brain Research and Innovation Centre, Dutch Ministry of Defence, Utrecht, The Netherlands
| | - Elbert Geuze
- Brain Research and Innovation Centre, Dutch Ministry of Defence, Utrecht, The Netherlands
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaap van Weeghel
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg School of Social and Behavioral Sciences, Tilburg, The Netherlands
| | - Fenna Leijten
- Directorate-General of Policy, Directorate of Strategy and Knowledge, Dutch Ministry of Defence, Den Haag, The Netherlands
| | - D van de Mheen
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg School of Social and Behavioral Sciences, Tilburg, The Netherlands
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
| | - A D Rozema
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg School of Social and Behavioral Sciences, Tilburg, The Netherlands
| | - Evelien Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg School of Social and Behavioral Sciences, Tilburg, The Netherlands
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Seol JH, Sohn YW, Yoo M, Park Y. Decent Work, Posttraumatic Stress Disorder, and Posttraumatic Growth From the Psychology of Working Perspective: A Three-Wave Study of Military Personnel. JOURNAL OF CAREER ASSESSMENT 2023. [DOI: 10.1177/10690727231163321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Abstract
Scholarly interest in the relationship between decent work and mental health based on the Psychology of Working Theory has recently increased. This study evaluated the indirect effects of survival, social contribution, and self-determination needs satisfaction on the relationship between decent work and trauma-related mental health among military personnel. We conducted a three-wave survey over 1 year. Results showed that decent work predicted satisfaction of the three basic needs. Additionally, survival needs directly predicted posttraumatic stress disorder symptoms, while social contribution and self-determination needs directly predicted posttraumatic growth. Finally, decent work had a significant indirect effect on posttraumatic stress disorder symptoms via survival needs, whereas decent work had significant indirect effects on posttraumatic growth via social contribution and self-determination needs. Our findings suggest that the more military personnel perceive their work as decent and feel that their three basic needs are fulfilled, the more posttraumatic stress disorder symptoms diminish, and posttraumatic growth increases. We discuss the implications and need for follow-up studies.
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Affiliation(s)
- Jeong Hoon Seol
- Department of Psychology, Yonsei University, Seoul, Republic of Korea
| | - Young Woo Sohn
- Department of Psychology, Yonsei University, Seoul, Republic of Korea
| | - Minjun Yoo
- Department of Humanities, R.O.K Naval Academy, Changwon, Republic of Korea
| | - Yonguk Park
- Department of Psychology, Yonsei University, Seoul, Republic of Korea
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Ellis J, Korman MB. Development of an Evidence-Informed Solution to Emotional Distress in Public Safety Personnel and Healthcare Workers: The Social Support, Tracking Distress, Education, and Discussion CommunitY (STEADY) Program. Healthcare (Basel) 2022; 10:1777. [PMID: 36141388 PMCID: PMC9498760 DOI: 10.3390/healthcare10091777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 02/08/2023] Open
Abstract
Public safety personnel (PSP) and healthcare workers (HCWs) are frequently exposed to traumatic events and experience an increased rate of adverse mental health outcomes compared to the public. Some organizations have implemented wellness programming to mitigate this issue. To our knowledge, no programs were developed collaboratively by researchers and knowledge users considering knowledge translation and implementation science frameworks to include all evidence-informed elements of posttraumatic stress prevention. The Social Support, Tracking Distress, Education, and Discussion Community (STEADY) Program was developed to fill this gap. It includes (1) peer partnering; (2) distress tracking; (3) psychoeducation; (4) peer support groups and voluntary psychological debriefing following critical incidents; (5) community-building activities. This paper reports on the narrative literature review that framed the development of the STEADY framework and introduces its key elements. If successful, STEADY has the potential to improve the mental well-being of PSP and HCWs across Canada and internationally.
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Affiliation(s)
- Janet Ellis
- Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Melissa B. Korman
- Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5T 2S8, Canada
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Fors Brandebo M, Börjesson M, Hilmarsson H. Longitudinal studies on cohesion in a military context – A systematic review. MILITARY PSYCHOLOGY 2022. [DOI: 10.1080/08995605.2022.2041995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria Fors Brandebo
- Department of Security, Strategy and Leadership, Swedish Defence University, Karlstad, Sweden
| | - Marcus Börjesson
- Department of Security, Strategy and Leadership, Swedish Defence University, Karlstad, Sweden
| | - Hilmar Hilmarsson
- Department of Security, Strategy and Leadership, Swedish Defence University, Karlstad, Sweden
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Seeking treatment for mental illness and substance abuse: A cross-sectional study on attitudes, beliefs, and needs of military personnel with and without mental illness. J Psychiatr Res 2022; 147:221-231. [PMID: 35065512 DOI: 10.1016/j.jpsychires.2022.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Often, military personnel do not seek treatment for mental illness or wait until they reach a crisis point. Effective, selective, and indicated prevention is best achieved by seeking treatment early. AIMS We aimed to examine military personnel's attitudes, beliefs, and needs around seeking treatment for mental illness. We compared those who sought treatment to those who did not and those with and without the intention to seek treatment. Finally, we examined factors associated with intentions of not seeking treatment. METHOD We conducted a cross-sectional questionnaire study of military personnel with (N = 324) and without (N = 554) mental illness. Descriptive and regression analyses (logistic and ordinal) were performed. RESULTS The majority of the personnel believed treatment was effective (91.6%); however, most preferred to solve their own problems (66.0%). For personnel with mental illness, compared to those who sought treatment, those who did not had a higher preference for self-management and found advice from others less important. For those without mental illness, those with no intention to seek treatment indicated a higher preference for self-management, stigma-related concerns, denial of symptoms, lower belief in treatment effectiveness and found it less important to be an example, compared to those with treatment-seeking intentions. A clear indication of where to seek help was the most reported need (95.7%). Regression analyses indicated that not seeking treatment was most strongly related to preference for self-management (OR(95%CI) = 4.36(2.02-9.39); no intention to seek treatment was most strongly related to a lower belief that treatment is effective (OR(95%CI) = .41(0.28-0.59) and with not having had positive earlier experiences with treatment seeking (OR(95%CI) = .34(0.22-0.52). CONCLUSIONS To facilitate (early) treatment seeking, interventions should align with a high preference for self-management, mental illness stigma should be targeted, and a clear indication of where to seek treatment is needed.
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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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Lane R, Robles P, Brondolo E, Jansson A, Diduk-Smith RM. Antecedents of Suicide Among Active Military, Veteran, and Nonmilitary Residents of the Commonwealth of Virginia: The Role of Intimate Partner Problems. Arch Suicide Res 2021; 25:790-809. [PMID: 32476621 DOI: 10.1080/13811118.2020.1765927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Intimate partner problems increase suicide risk, particularly among active service members and veterans. Age, marital status and military service status may modify the role of intimate partner problems in suicide. Methods: Participants included 6255 men who died by suicide at 18 years of age and older and who actively, previously, or never served in the military. Reports of intimate partner problems prior to suicide were documented by the Virginia Department of Health. Results: Unmarried active service members, above middle age, were more likely than veterans and individuals without prior military service to have associated reports of intimate partner problems. Conclusion: Life stages and relationship context may influence the role of intimate partner problems as a risk factor for suicide.
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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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Booth LC, Schwalb ME, Kim PY, Adler AB. Health-Promoting Leadership During an Infectious Disease Outbreak: A Cross-Sectional Study of US Soldiers Deployed to Liberia. J Nerv Ment Dis 2021; 209:362-369. [PMID: 33835954 DOI: 10.1097/nmd.0000000000001305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Infectious disease outbreaks are uniquely stressful for essential employees. One way to support workers is for supervisors to engage in behaviors promoting employees' well-being and attitudes toward preventive medicine practices. We examined whether health-promoting leadership contributes to these outcomes in a population of active-duty soldiers (N = 173) deployed to provide nonmedical support in Liberia during the 2014 Ebola epidemic using data reported in Sipos, Kim, Thomas, and Adler (Mil Med 183[3-4]:e171-e178, 2018). Soldiers completed surveys assessing posttraumatic stress disorder (PTSD), depression, anxiety, sleep problems, burnout, morale, and attitudes and rated their leaders on health-promoting behaviors. Using mixed-effects logistic regression, health-promoting leadership focused on psychological health was associated with decreased odds of PTSD, depression, anxiety, and burnout, and increased odds of high morale and avoiding unnecessary risk. Health-promoting leadership focused on preventive medicine was associated with decreased odds of depression and anxiety, and increased odds of high morale, positive attitudes, and avoiding unnecessary risk. Findings suggest health-promoting leadership could be valuable for workers responding to epidemics.
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Affiliation(s)
- Laurel C Booth
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
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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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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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Reed-Fitzke K, Lucier-Greer M. The Buffering Effect of Relationships on Combat Exposure, Military Performance, and Mental Health of U.S. Military Soldiers: A Vantage Point for CFTs. JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:321-336. [PMID: 31436335 DOI: 10.1111/jmft.12402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examined the role of cumulative combat experiences with regard to military performance and conduct and mental health among a sample of young soldiers from the Army STARRS dataset (N = 5,283). Higher levels of cumulative combat experiences were directly related to poorer performance and conduct and a greater likelihood of anxiety, depression, and post-traumatic stress disorder (PTSD). Military performance and conduct served as a linking mechanism between combat experiences and mental health. Using moderated mediation structural equation modeling, relationship disruptions were found to exacerbate the adverse effects of combat experiences; conversely, unit cohesion buffered the impact of combat experiences. Implications for military helping professionals include identifying leverage points for intervention, particularly strengthening the social connections of service members within and outside the military.
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16
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Jones N, Greenberg N, Phillips A, Simms A, Wessely S. British military women: combat exposure, deployment and mental health. Occup Med (Lond) 2019; 69:549-558. [PMID: 31404463 DOI: 10.1093/occmed/kqz103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Internationally, women are about to undertake combat duties alongside their male colleagues. The psychological effect of this policy change is largely unknown. AIMS To explore the mental health impact of combat exposure among military women. METHODS Self-report, between-subjects survey data were collected in Iraq and Afghanistan on four occasions between 2009 and 2014 (n = 4139). Differences in mental health, stigmatization, deployment experiences, intimate relationship impact, perception of family support levels, unit cohesion, leadership and help-seeking were compared between deployed men and women. Comparisons were repeated with the study sample stratified by level of combat exposure. Outcomes were examined using logistic regression adjusted for socio-demographic, mental health and military factors. RESULTS Overall, 4.1% of women and 4.3% of men reported post-traumatic stress disorder (PTSD) (odds ratio (OR) 1.31, 95% confidence interval (95% CI) 0.70-2.46); 22% of women and 16% of men reported symptoms of common mental disorder (CMD) (OR 1.52, 95% CI 1.11-2.08). Women were less likely to report mental health-related stigmatization (OR 0.68, 95% CI 0.53-0.87), negative relationship impact from deployment (OR 0.69, 95% CI 0.49-0.98) and subjective unit cohesion (OR 0.69, 95% CI 0.53-0.90). Help-seeking for emotional problems was similar by gender (OR 1.22, 95% CI 0.84-1.77). Overall, outcomes were minimally impacted by level of combat exposure. CONCLUSIONS Although women experienced more CMD symptoms, PTSD symptoms were similar by gender. Subject to confirmation of the study findings, women may not require enhanced mental healthcare during deployment for exposure-based conditions such as PTSD when undertaking the ground close combat role.
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Affiliation(s)
- N Jones
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK.,King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
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Williamson V, Greenberg N, Stevelink SAM. Perceived stigma and barriers to care in UK Armed Forces personnel and veterans with and without probable mental disorders. BMC Psychol 2019; 7:75. [PMID: 31775853 PMCID: PMC6881983 DOI: 10.1186/s40359-019-0351-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/11/2019] [Indexed: 12/04/2022] Open
Abstract
Background Previous studies have found that perceptions of mental health related stigma can negatively impact help-seeking, particularly in military samples. Moreover, perceptions of stigma and barriers to care can vary between individuals with different psychiatric disorders. The aim of this study was to examine whether perceptions of stigma and barriers to care differed in a UK military sample between those with and without a current likely mental health diagnosis. Method Structured telephone interviews were carried out with 1432 service personnel and veterans who reported recent subjective mental ill health in the last 3 years. Participants completed self-reported measures relating to perceived stigma, barriers to care and psychological wellbeing. Results Those meeting criteria for probable common mental disorders (CMD) and PTSD were significantly more likely to report concerns relating to perceived and internalised stigma and barriers to care compared to participants without a likely mental disorder. Compared to individuals with likely CMD and alcohol misuse, those with probable PTSD reported higher levels of stigma-related concerns and barriers to care – although this difference was not significantly different. Conclusions These results indicate that perceptions of stigma continue to exist in UK serving personnel and military veterans with current probable mental disorders. Efforts to address particular concerns (e.g. being seen as weak; difficulty accessing appointments) may be worthwhile and, ultimately, lead to improvements in military personnel and veteran wellbeing.
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Affiliation(s)
- Victoria Williamson
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK.
| | - Neil Greenberg
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK.,Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 16 DeCrespigny Park, London, SE5 8AF, UK
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18
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Russell DW, Russell CA. The evolution of mental health outcomes across a combat deployment cycle: A longitudinal study of the Guam Army National Guard. PLoS One 2019; 14:e0223855. [PMID: 31665175 PMCID: PMC6821079 DOI: 10.1371/journal.pone.0223855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/30/2019] [Indexed: 02/02/2023] Open
Abstract
In the United States, National Guard soldiers have been called upon at unprecedented rates since 2001 to supplement active duty military forces. Frequent military deployments generate many occupational and environmental stressors for these citizen-soldiers, from serving in a dangerous zone to being away from family and home for long periods of time. Whereas there is a substantial amount of research focused on deployment-related health outcomes in relation to active duty (i.e., full-time) military populations, reserve forces are less understood. This study focuses on a United States Army National Guard combat unit deployed to Afghanistan. This prospective longitudinal study was conducted over the course an operational deployment cycle (i.e., before, during, and after) to document the evolution of salient mental health outcomes (i.e., post-traumatic stress, depression, general anxiety, and aggression). The findings show that both combat (e.g., killing others) and non-combat (e.g., boredom) stressors negatively affect mental health outcomes, and the severity of these outcomes increases over the course of a deployment cycle. Of special note, the study reveals key gender differences in the evolution of post-traumatic stress (PTS), depression, and anxiety across a deployment cycle: females report increased PTS, depression, and anxiety 6 months post-deployment, whereas the levels reported by males stabilize at their mid-deployment levels. The findings offer insights for medical providers and policymakers in developing more targeted health promotion campaigns and interventions, especially at the post-deployment phase.
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Affiliation(s)
- Dale W. Russell
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- * E-mail:
| | - Cristel Antonia Russell
- Pepperdine University, Graziadio Business School, Malibu, California, United States of America
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19
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Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members. Behav Res Ther 2019; 118:7-17. [DOI: 10.1016/j.brat.2019.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/12/2019] [Accepted: 03/04/2019] [Indexed: 11/18/2022]
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20
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Jones N, Whelan C, Harden L, Macfarlane A, Burdett H, Greenberg N. Resilience-based intervention for UK military recruits: a randomised controlled trial. Occup Environ Med 2018; 76:90-96. [DOI: 10.1136/oemed-2018-105503] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/06/2018] [Accepted: 11/13/2018] [Indexed: 11/04/2022]
Abstract
ObjectivesWe evaluated a military resilience intervention which aimed to help UK military recruits to manage their personal health and well-being more effectively.MethodsTrainers within six pre-existing training teams were randomly allocated by team to deliver a resilience-based intervention (SPEAR) or usual training (control) during recruit training. 23 trainers delivered SPEAR; 18 delivered the control training. 707 recruits participated (n=358 SPEAR and n=349 controls). Outcome measures were obtained before and after recruit training and 3 months later. Measures of post-traumatic stress disorder (PTSD), common mental disorder (CMD) symptoms, alcohol use, homesickness and mental health stigmatisation were obtained at baseline. Repeat baseline scales plus measures of help-seeking, cohesion, leadership and training impact were obtained at the two follow-up points.ResultsResponse rates were 91.7% (baseline), 98.1% (post) and 73.6% (follow-up). Following adjustment for potential confounders, levels of PTSD, CMD symptoms, alcohol misuse, help-seeking and homesickness were not significantly different between groups at any measurement point. Stigmatisation was significantly lower among SPEAR recipients at baseline but was not significantly different at the two follow-up points. Following adjustment for mental health confounders, there were no significant between-group differences in perceptions of leadership and cohesion and in ratings of six training outcomes at the two follow-up points.ConclusionsWe found no evidence that resilience-based training had any specific benefit to the health and well-being of UK military recruits.
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21
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Affiliation(s)
- Alexa A. Lopez
- United States Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Tacoma, Washington
| | - Amy B. Adler
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Oscar A. Cabrera
- United States Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Tacoma, Washington
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22
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Ricciardelli R, Carleton RN, Mooney T, Cramm H. "Playing the system": Structural factors potentiating mental health stigma, challenging awareness, and creating barriers to care for Canadian public safety personnel. Health (London) 2018; 24:259-278. [PMID: 32283964 DOI: 10.1177/1363459318800167] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are growing concerns about the impact of public safety work on the mental health of public safety personnel; as such, we explored systemic and individual factors that might dissuade public safety personnel from seeking care. Public safety personnel barriers to care-seeking include the stigma associated with mental disorders and frequent reports of insufficient access to care. To better understand barriers to care-seeking, we thematically analyzed the optional open-ended final comments provided by over 828 Canadian public safety personnel as part of a larger online survey designed to assess the prevalence of mental disorders among public safety personnel. Our results indicated that systematic processes may have (1) shaped public safety personnel decisions for care-seeking, (2) influenced how care-seekers were viewed by their colleagues, and (3) encouraged under-awareness of personal mental health needs. We described how public safety personnel who do seek care may be viewed by others; in particular, we identified widespread participant suspicion that coworkers who took the time to address their mental health needs were "abusing the system." We explored what constitutes "abusing the system" and how organizational structures-systematic processes within different public safety organizations-might facilitate such notions of abuse. We found that understaffing may increase scrutiny of injured public safety personnel by those left to manage the additional burden; in addition, cynicism and unacknowledged structural stigma may emerge, preventing the other public safety personnel from identifying their mental health needs and seeking help. Finally, we discuss how system-level stigma can be potentiated by fiscal constraints when public safety personnel take any leave of absence, inadvertently contributing to an organizational culture wherein help-seeking for employment-related mental health concerns becomes unacceptable. Implications for public safety personnel training and future research needs are discussed.
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23
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Morgan NR, Davis KD, Richardson C, Perkins DF. Common components analysis: An adapted approach for evaluating programs. EVALUATION AND PROGRAM PLANNING 2018; 67:1-9. [PMID: 29132065 DOI: 10.1016/j.evalprogplan.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
Common Components Analysis (CCA) summarizes the results of program evaluations that utilize randomized control trials and have demonstrated effectiveness in improving their intended outcome(s) into their key elements. This area of research has integrated and modified the existing CCA approach to provide a means of evaluating components of programs without a solid evidence-base, across a variety of target outcomes. This adapted CCA approach (a) captures a variety of similar program characteristics to increase the quality of the comparison within components; (b) identifies components from four primary areas (i.e., content, process, barrier reduction, and sustainability) within specific programming domains (e.g., vocation, social); and (c) proposes future directions to test the extent to which the common components are associated with changes in intended program outcomes (e.g., employment, job retention). The purpose of this paper is to discuss the feasibility of this adapted CCA approach. To illustrate the utility of this technique, researchers used CCA with two popular employment programs that target successful Veteran reintegration but have limited program evaluation - Hire Heroes USA and Hire Our Heroes. This adapted CCA could be applied to longitudinal research designs to identify all utilized programs and the most promising components of these programs as they relate to changes in outcomes.
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Affiliation(s)
- Nicole R Morgan
- Clearinghouse for Military Family Readiness, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA.
| | - Kelly D Davis
- School of Social and Behavioral Health Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR 97330, USA.
| | - Cameron Richardson
- Clearinghouse for Military Family Readiness, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA.
| | - Daniel F Perkins
- Clearinghouse for Military Family Readiness, The Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA; Department of Agricultural Economics, Sociology and Education, The Pennsylvania State University, 107 Ferguson Bldg, University Park, PA 16802, USA.
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24
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Britt TW, Black KJ, Cheung JH, Pury CLS, Zinzow HM. Unit training to increase support for military personnel with mental health problems. WORK AND STRESS 2018. [DOI: 10.1080/02678373.2018.1445671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Thomas W. Britt
- Department of Psychology, Clemson University, Clemson, SC, USA
| | | | | | | | - Heidi M. Zinzow
- Department of Psychology, Clemson University, Clemson, SC, USA
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25
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Sipos ML, Wood MD, Riviere LA, Adler AB. Behavioral Health Adjustment in Reserve Component Soldiers During a Noncombat Deployment to Africa. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Maurice L. Sipos
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Michael D. Wood
- U.S. Army Medical Research Unit–Europe, Walter Reed Army Institute of Research, Sembach, Germany
| | - Lyndon A. Riviere
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Amy B. Adler
- U.S. Army Medical Research Unit–Europe, Walter Reed Army Institute of Research, Sembach, Germany
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26
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Eckford RD, Barnett DL. Comparing Paper-and-Pencil and Internet Survey Methods Conducted in a Combat-Deployed Environment. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rachel D. Eckford
- United States Army Medical Research Unit-Europe, Walter Reed Army Institute of Research, Sembach, Germany
| | - Donell L. Barnett
- 528th Medical Detachment, United States Army 44th Medical Brigade, Fort Bragg, North Carolina
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27
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Zinzow HM, Britt TW, Pury CLS, Raymond MA, McFadden AC, Burnette CM. Barriers and Facilitators of Mental Health Treatment Seeking Among Active-Duty Army Personnel. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000015] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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28
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Mallick LM, Mitchell MM, Millikan-Bell A, Gallaway MS. Small Unit Leader Perceptions of Managing Soldier Behavioral Health and Associated Factors. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lindsay M. Mallick
- Behavioral and Social Health Outcomes Program (BSHOP), U.S. Army Institute of Public Health, U.S. Army Public Health Command, Aberdeen Proving Ground, Maryland
| | - Mary M. Mitchell
- Behavioral and Social Health Outcomes Program (BSHOP), U.S. Army Institute of Public Health, U.S. Army Public Health Command, Aberdeen Proving Ground, Maryland
| | - Amy Millikan-Bell
- Behavioral and Social Health Outcomes Program (BSHOP), U.S. Army Institute of Public Health, U.S. Army Public Health Command, Aberdeen Proving Ground, Maryland
| | - M. Shayne Gallaway
- Behavioral and Social Health Outcomes Program (BSHOP), U.S. Army Institute of Public Health, U.S. Army Public Health Command, Aberdeen Proving Ground, Maryland
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29
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Coleman SJ, Stevelink SAM, Hatch SL, Denny JA, Greenberg N. Stigma-related barriers and facilitators to help seeking for mental health issues in the armed forces: a systematic review and thematic synthesis of qualitative literature. Psychol Med 2017; 47:1880-1892. [PMID: 28290262 DOI: 10.1017/s0033291717000356] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A recent quantitative review in the area of stigma and help seeking in the armed forces has questioned the association between these factors (Sharp et al. 2015). To date, the contribution of qualitative literature in this area has largely been ignored, despite the value this research brings to the understanding of complex social constructs such as stigma. The aim of the current systematic review of qualitative studies was to identify appropriate literature, assess the quality and synthesize findings across studies regarding evidence of stigma-related barriers and facilitators to help seeking for mental health issues within the armed forces. A multi-database text word search incorporating searches of PsycINFO, MEDLINE, Social Policy and Practice, Social Work Abstracts, EMBASE, ERIC and EBM Review databases between 1980 and April 2015 was conducted. Literature was quality assessed using the Critical Appraisal Skills Programme tool. Thematic synthesis was conducted across the literature. The review identified eight studies with 1012 participants meeting the inclusion criteria. Five overarching themes were identified across the literature: (1) non-disclosure; (2) individual beliefs about mental health; (3) anticipated and personal experience of stigma; (4) career concerns; and (5) factors influencing stigma. The findings from the current systematic review found that unlike inconsistent findings in the quantitative literature, there was substantial evidence of a negative relationship between stigma and help seeking for mental health difficulties within the armed forces. The study advocates for refinement of measures to accurately capture the complexity of stigma and help seeking in future quantitative studies.
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Affiliation(s)
- S J Coleman
- King's College London, Clinical Psychology, Institute of Psychology, Psychiatry and Neuroscience,Addiction Sciences Building,4 Windsor Walk,London SE5 8AF,UK
| | - S A M Stevelink
- King's Centre for Military Health Research, King's College London, Weston Education Centre,Cutcombe Road,London SE5 9RJ,UK
| | - S L Hatch
- King's College London, Psychological Medicine, Institute of Psychiatry,10 Cutcombe Road,London SE5 9RJ,UK
| | - J A Denny
- Queen's University Belfast,University Road,Belfast BT7 1NN,UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, Weston Education Centre,Cutcombe Road,London SE5 9RJ,UK
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30
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Siegel S, Rau H, Dors S, Brants L, Börner M, Mahnke M, Zimmermann PL, Willmund G, Ströhle A. [Barriers to treatment-seeking among German veterans: expert interviews]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 125:30-37. [PMID: 28711419 DOI: 10.1016/j.zefq.2017.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 05/30/2017] [Accepted: 06/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The number of service members of the German armed forces suffering from deployment-related mental health problems is increasing. However, less than 50 % seek professional help, and there is little knowledge about the barriers to treatment-seeking. METHODS The article presents data gathered by the Delphi technique combined with focus groups from 55 health service experts regarding the evaluated barriers to treatment-seeking among German veterans. FINDINGS According to the interviewed experts, major contextual barriers to treatment-seeking include: 1) intimidating processes and structures, 2) actual stigmatization and discrimination, and 3) health service deficits. Major individual barriers to treatment were: 4) health beliefs, self-perception and fear of stigmatization, and 5) avoidance behavior related to psychopathology. In addition, there is another both contextual and individual barrier, i.e., 6) information deficits. INTERPRETATION Individual internal factors like the soldiers' self-perception and their fear of being stigmatized were considered important barriers to treatment-seeking. The experts' opinion about avoidance behavior related to psychopathology and deficits in health services and information coincides with international findings. Compared to research in other countries, actual stigmatization and discrimination were regarded to be an important barrier in itself. According to our findings daunting/intimidating processes and structures like time-consuming and complex expert medical reports rather seem to be a German phenomenon.
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Affiliation(s)
- Stefan Siegel
- Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte.
| | - Heinrich Rau
- Psychotraumazentrum der Bundeswehr, Bundeswehrkrankenhaus Berlin, Berlin
| | - Simone Dors
- Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte
| | - Loni Brants
- Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte
| | - Michaela Börner
- Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte
| | - Manuel Mahnke
- Psychotraumazentrum der Bundeswehr, Bundeswehrkrankenhaus Berlin, Berlin
| | - Peter L Zimmermann
- Psychotraumazentrum der Bundeswehr, Bundeswehrkrankenhaus Berlin, Berlin
| | - Gerd Willmund
- Psychotraumazentrum der Bundeswehr, Bundeswehrkrankenhaus Berlin, Berlin
| | - Andreas Ströhle
- Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte
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31
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Dillon KH, LoSavio ST, Resick PA. How should we treat post-traumatic stress disorder in active military personnel? Expert Rev Neurother 2017; 17:641-643. [DOI: 10.1080/14737175.2017.1325734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kirsten H. Dillon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Stefanie T. LoSavio
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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32
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Hom MA, Stanley IH, Schneider ME, Joiner TE. A systematic review of help-seeking and mental health service utilization among military service members. Clin Psychol Rev 2017; 53:59-78. [PMID: 28214634 DOI: 10.1016/j.cpr.2017.01.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 11/10/2016] [Accepted: 01/24/2017] [Indexed: 11/20/2022]
Abstract
Research has demonstrated that military service members are at elevated risk for a range of psychiatric problems, and mental health services use is a conduit to symptom reduction and remission. Nonetheless, there is a notable underutilization of mental health services in this population. This systematic review aimed to identify and critically examine: (1) rates of service use; (2) barriers and facilitators to care; and (3) programs and interventions designed to enhance willingness to seek care and increase help-seeking behaviors among current military personnel (e.g., active duty, National Guard, Reserve). Overall, 111 peer-reviewed articles were identified for inclusion. Across studies, the rate of past-year service use among service members with mental health problems during the same time frame was 29.3% based on weighted averages. Studies identified common barriers to care (e.g., concerns regarding stigma, career impact) and facilitators to care (e.g., positive attitudes toward treatment, family/friend support, military leadership support) among this population. Although programs (e.g., screening, gatekeeper training) have been developed to reduce these barriers, leverage facilitators, and encourage service use, further research is needed to empirically test the effectiveness of these interventions in increasing rates of service utilization. Critical areas for future research on treatment engagement among this high-risk population are discussed.
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Affiliation(s)
- Melanie A Hom
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States.
| | - Ian H Stanley
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States
| | - Matthew E Schneider
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States
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Gorman LA, Sripada RK, Ganoczy D, Walters HM, Bohnert KM, Dalack GW, Valenstein M. Determinants of National Guard Mental Health Service Utilization in VA versus Non-VA Settings. Health Serv Res 2016; 51:1814-37. [PMID: 26840993 PMCID: PMC5034208 DOI: 10.1111/1475-6773.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine associations between need, enabling, and predisposing factors with mental health service use among National Guard soldiers in the first year following a combat deployment to Iraq or Afghanistan. DATA SOURCES/STUDY SETTING Primary data were collected between 2011 and 2013 from 1,426 Guard soldiers representing 36 units. STUDY DESIGN Associations between Guard soldier factors and any mental health service use were assessed using multivariable logistic regression models in a cross-sectional study. Further analysis among service users (N = 405) assessed VA treatment versus treatment in other settings. PRINCIPAL FINDINGS Fifty-six percent of Guard soldiers meeting cutoffs on symptom scales received mental health services with 81 percent of those reporting care from the VA. Mental health service use was associated with need (mental health screens and physical health) and residing in micropolitan communities. Among service users, predisposing factors (middle age range and female gender) and enabling factors (employment, income above $50,000, and private insurance) were associated with greater non-VA services use. CONCLUSION Overall service use was strongly associated with need, whereas sector of use (non-VA vs. VA) was insignificantly associated with need but strongly associated with enabling factors. These findings have implications for the recent extension of veteran health coverage to non-VA providers.
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Affiliation(s)
| | - Rebecca K Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Dara Ganoczy
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Heather M Walters
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Kipling M Bohnert
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Gregory W Dalack
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Marcia Valenstein
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
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Jones N, Campion B, Keeling M, Greenberg N. Cohesion, leadership, mental health stigmatisation and perceived barriers to care in UK military personnel. J Ment Health 2016; 27:10-18. [DOI: 10.3109/09638237.2016.1139063] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Norman Jones
- Academic Department of Military Mental Health, and
- Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK, and
| | - Ben Campion
- Academic Department of Military Mental Health, and
- Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK, and
| | - Mary Keeling
- Center for Innovation and Research on Veterans and Military Families (CIR), School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Neil Greenberg
- Academic Department of Military Mental Health, and
- Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK, and
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Fertout M, Jones N, Keeling M, Greenberg N. Mental health stigmatisation in deployed UK Armed Forces: a principal components analysis. J ROY ARMY MED CORPS 2015; 161 Suppl 1:i69-i76. [PMID: 26621815 DOI: 10.1136/jramc-2015-000587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION UK military research suggests that there is a significant link between current psychological symptoms, mental health stigmatisation and perceived barriers to care (stigma/BTC). Few studies have explored the construct of stigma/BTC in depth amongst deployed UK military personnel. METHOD Three survey datasets containing a stigma/BTC scale obtained during UK deployments to Iraq and Afghanistan were combined (n=3405 personnel). Principal component analysis was used to identify the key components of stigma/BTC. The relationship between psychological symptoms, the stigma/BTC components and help seeking were examined. RESULTS Two components were identified: 'potential loss of personal military credibility and trust' (stigma Component 1, five items, 49.4% total model variance) and 'negative perceptions of mental health services and barriers to help seeking' (Component 2, six items, 11.2% total model variance). Component 1 was endorsed by 37.8% and Component 2 by 9.4% of personnel. Component 1 was associated with both assessed and subjective mental health, medical appointments and admission to hospital. Stigma Component 2 was associated with subjective and assessed mental health but not with medical appointments. Neither component was associated with help-seeking for subjective psycho-social problems. CONCLUSIONS Potential loss of credibility and trust appeared to be associated with help-seeking for medical reasons but not for help-seeking for subjective psychosocial problems. Those experiencing psychological symptoms appeared to minimise the effects of stigma by seeking out a socially acceptable route into care, such as the medical consultation, whereas those who experienced a subjective mental health problem appeared willing to seek help from any source.
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Affiliation(s)
- Mohammed Fertout
- Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK
| | - N Jones
- Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK
| | - M Keeling
- Center for Innovation and Research on Veterans and Military Families (CIR), School of Social Work, University of Southern California, Los Angeles, California, USA
| | - N Greenberg
- Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK
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Wilks CR, Zieve GG, Lessing HK. Are Trials of Computerized Therapy Generalizable? A Multidimensional Meta-analysis. Telemed J E Health 2015; 22:450-7. [PMID: 26461235 DOI: 10.1089/tmj.2015.0129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Previous meta-analyses have established that computerized cognitive behavioral therapy (cCBT) is an effective, acceptable, and efficient method of delivering treatment for anxiety and depression. However, the potential generalizability of these conclusions to nonresearch settings has not yet been investigated. MATERIALS AND METHODS We conducted a multidimensional meta-analysis of randomized controlled trials of cCBT for anxiety and/or depressive disorders quantifying generalizability by examining the relationship between participant exclusion and treatment outcome. Thirty-six trials of cCBT were identified through systematic searches in six databases. The number of exclusion criteria and exclusion rate served as indices of participant exclusion. Outcome variables included between- and within-group effect sizes in addition to rates of clinically significant improvement. RESULTS Analyses were performed for all studies, depression studies (n = 11), and anxiety studies (n = 23). Pooling across all studies, we found a between-group effect size of 0.85 (95% confidence interval, 0.77-0.94). The mean number of exclusionary criteria was 12 (range, 2-24), and the mean exclusion rate was 0.49 (range, 0.08-0.92). Risk for suicide was the most common criterion for exclusion. Correlation analyses revealed a large relationship between number of exclusion criteria and proportion clinically changed in the treatment group for anxiety studies (r = 0.70). Results provide evidence for the limited effectiveness of cCBT for anxiety disorders in nonresearch samples. CONCLUSIONS As computerized therapy is developed to address barriers to dissemination, future trials should examine the effectiveness of cCBT for anxiety for patients with more complex clinical presentations.
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Affiliation(s)
- Chelsey R Wilks
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington , Seattle, Washington
| | - Garret G Zieve
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington , Seattle, Washington
| | - Hannah K Lessing
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington , Seattle, Washington
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Welsh JA, Olson J, Perkins DF, Travis WJ, Ormsby L. The Role of Natural Support Systems in the Post-deployment Adjustment of Active Duty Military Personnel. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2015; 56:69-78. [PMID: 26148977 DOI: 10.1007/s10464-015-9726-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examined the relations among three different types of naturally occurring social support (from romantic partners, friends and neighbors, and unit leaders) and three indices of service member well-being (self reports of depressive symptoms, satisfaction with military life, and perceptions of unit readiness) for service members who did and did not report negative experiences associated with military deployment. Data were drawn from the 2011 Community Assessment completed anonymously by more than 63,000 USAF personnel. Regression analyses revealed that higher levels of social support was associated with better outcomes regardless of negative deployment experiences. Evidence of moderation was also noted, with all forms of social support moderating the impact of negative deployment experiences on depressive symptoms and support from unit leaders moderating the impact of negative deployment experience on satisfaction with military life. No moderation was found for perceptions of unit readiness. Subgroup analyses revealed slightly different patterns for male and female service members, with support providing fewer moderation effects for women. These findings may have value for military leaders and mental health professionals working to harness the power of naturally occurring relationships to maximize the positive adjustment of service members and their families. Implications for practices related to re-integration of post-deployment military personnel are discussed.
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Affiliation(s)
- Janet A Welsh
- Bennett Pierce Prevention Research Center, The Pennsylvania State University, 320H Biobehavioral Health Building, University Park, PA, 16802, USA,
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Kulesza M, Pedersen E, Corrigan P, Marshall G. Help-Seeking Stigma and Mental Health Treatment Seeking Among Young Adult Veterans. ACTA ACUST UNITED AC 2015; 3:230-239. [PMID: 26664795 DOI: 10.1080/21635781.2015.1055866] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Veterans underutilize mental health services. We investigated the association between treatment seeking stigma and utilization of mental health services in a sample of 812 young adult veterans. Higher perceived public stigma of treatment seeking was significantly related to lower treatment utilization. Although many veterans were concerned about negative perceptions if they were to seek treatment, a much smaller number of them endorsed that they would judge a fellow veteran negatively in similar situation. Targeting perceived public stigma of treatment seeking, through perceived norms interventions, might help in narrowing the gap between the need and receipt of help among veterans.
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Affiliation(s)
- Magdalena Kulesza
- Associate Behavioral/Social Scientist, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407., , phone: 310-393-0411
| | - Eric Pedersen
- Behavioral/Social Scientist, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407., , phone: 310-393-0411
| | - Patrick Corrigan
- Distinguished Professor of Psychology, Illinois Institute of Technology, 3424 S. State Street, Chicago, IL 60616, , phone: 312-567-6751
| | - Grant Marshall
- Senior Behavioral Scientist, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407., , phone: 310-393-0411
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Bell KR, Brockway JA, Fann JR, Cole WR, De Lore JS, Bush N, Lang AJ, Hart T, Warren M, Dikmen S, Temkin N, Jain S, Raman R, Stein MB. Concussion treatment after combat trauma: Development of a telephone based, problem solving intervention for service members. Contemp Clin Trials 2015; 40:54-62. [DOI: 10.1016/j.cct.2014.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/31/2014] [Accepted: 11/01/2014] [Indexed: 11/24/2022]
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Bonar EE, Bohnert KM, Walters HM, Ganoczy D, Valenstein M. Student and Nonstudent National Guard Service Members/Veterans and Their Use of Services for Mental Health Symptoms. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2015; 63:437-46. [PMID: 25337770 PMCID: PMC4776315 DOI: 10.1080/07448481.2014.975718] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To compare mental health symptoms and service utilization among returning student and nonstudent service members/veterans (SM/Vs). PARTICIPANTS SM/Vs (N = 1,439) were predominately white (83%) men (92%), half were over age 30 (48%), and 24% were students. METHODS SM/Vs completed surveys 6 months post deployment (October 2011-July 2013). RESULTS Students and nonstudent SM/Vs did not differ in positive screens for depression, anxiety, hazardous drinking, or posttraumatic stress disorder. Students (n = 81) and nonstudents (n = 265) with mental health symptoms had low levels of mental health service use (eg, Department of Veterans Affairs [VA], civilian, or military facilities), at 47% and 57%. respectively. Fewer students used VA mental health services. Common barriers to treatment seeking included not wanting treatment on military records and embarrassment. CONCLUSIONS Like other returning SM/Vs, student SM/Vs have unmet mental health needs. The discrepancy between potential need and treatment seeking suggests that colleges might be helpful in further facilitating mental health service use for student SM/Vs.
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Affiliation(s)
- Erin E. Bonar
- Department of Psychiatry, Addiction Research Center, University of Michigan, Ann Arbor, Michigan
| | - Kipling M. Bohnert
- Department of Psychiatry, Addiction Research Center, University of Michigan, Ann Arbor, Michigan
- Department of Veterans Affairs, Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
| | - Heather M. Walters
- Department of Veterans Affairs, Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
| | - Dara Ganoczy
- Department of Veterans Affairs, Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
| | - Marcia Valenstein
- Department of Psychiatry, Addiction Research Center, University of Michigan, Ann Arbor, Michigan
- Department of Veterans Affairs, Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
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Nieuwsma JA, Jackson GL, DeKraai MB, Bulling DJ, Cantrell WC, Rhodes JE, Bates MJ, Ethridge K, Lane ME, Tenhula WN, Batten SV, Meador KG. Collaborating across the Departments of Veterans Affairs and Defense to integrate mental health and chaplaincy services. J Gen Intern Med 2014; 29 Suppl 4:885-94. [PMID: 25355089 PMCID: PMC4239284 DOI: 10.1007/s11606-014-3032-5] [Citation(s) in RCA: 17] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recognizing that clergy and spiritual care providers are a key part of mental health care systems, the Department of Veterans Affairs (VA) and Department of Defense (DoD) jointly examined chaplains' current and potential roles in caring for veterans and service members with mental health needs. OBJECTIVE Our aim was to evaluate the intersection of chaplain and mental health care practices in VA and DoD in order to determine if improvement is needed, and if so, to develop actionable recommendations as indicated by evaluation findings. DESIGN A 38-member multidisciplinary task group partnered with researchers in designing, implementing, and interpreting a mixed methods study that included: 1) a quantitative survey of VA and DoD chaplains; and 2) qualitative interviews with mental health providers and chaplains. PARTICIPANTS Quantitative: the survey included all full-time VA chaplains and all active duty military chaplains (n = 2,163 completed of 3,464 invited; 62 % response rate). Qualitative: a total of 291 interviews were conducted with mental health providers and chaplains during site visits to 33 VA and DoD facilities. MAIN MEASURES Quantitative: the online survey assessed intersections between chaplaincy and mental health care and took an average of 37 min to complete. Qualitative: the interviews assessed current integration of mental health and chaplain services and took an average of 1 h to complete. KEY RESULTS When included on interdisciplinary mental health care teams, chaplains feel understood and valued (82.8-100 % of chaplains indicated this, depending on the team). However, findings from the survey and site visits suggest that integration of services is often lacking and can be improved. CONCLUSIONS Closely coordinating with a multidisciplinary task group in conducting a mixed method evaluation of chaplain-mental health integration in VA and DoD helped to ensure that researchers assessed relevant domains and that findings could be rapidly translated into actionable recommendations.
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Affiliation(s)
- Jason A Nieuwsma
- Mental Health and Chaplaincy, Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA,
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Adler AB, Saboe KN, Anderson J, Sipos ML, Thomas JL. Behavioral health leadership: new directions in occupational mental health. Curr Psychiatry Rep 2014; 16:484. [PMID: 25160794 DOI: 10.1007/s11920-014-0484-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The impact of stress on mental health in high-risk occupations may be mitigated by organizational factors such as leadership. Studies have documented the impact of general leadership skills on employee performance and mental health. Other researchers have begun examining specific leadership domains that address relevant organizational outcomes, such as safety climate leadership. One emerging approach focuses on domain-specific leadership behaviors that may moderate the impact of combat deployment on mental health. In a recent study, US soldiers deployed to Afghanistan rated leaders on behaviors promoting management of combat operational stress. When soldiers rated their leaders high on these behaviors, soldiers also reported better mental health and feeling more comfortable with the idea of seeking mental health treatment. These associations held even after controlling for overall leadership ratings. Operational stress leader behaviors also moderated the relationship between combat exposure and soldier health. Domain-specific leadership offers an important step in identifying measures to moderate the impact of high-risk occupations on employee health.
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Affiliation(s)
- Amy B Adler
- US Army Medical Research Unit-Europe, Walter Reed Army Institute of Research, Sembach, Germany,
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Wright KM, Britt TW, Moore D. Impediments to mental health treatment as predictors of mental health symptoms following combat. J Trauma Stress 2014; 27:535-41. [PMID: 25322883 DOI: 10.1002/jts.21946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This longitudinal study examined whether impediments to mental health treatment would predict changes in mental health symptoms (posttraumatic stress disorder [PTSD] and depression) in the months following soldiers returning from combat. Three-hundred ten combat veterans completed measures of impediments to treatment and measures of PTSD and depression symptoms at 2, 3, and 4 months following a 15-month combat deployment. Structural equation modeling revealed that greater impediments (a latent variable indexed by stigma, practical barriers, and negative treatment attitudes) at 2 months predicted increased PTSD and depression symptoms from 2-3 months (β = .14) and greater impediments at 3 months predicted increased symptoms from 3-4 months (β = .26). In contrast, evidence was not obtained for the opposite causal direction of symptoms predicting higher levels of impediments at the different periods. Possible mechanisms for the predictive effects of impediments are discussed.
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Fragedakis TM, Toriello P. The Development and Experience of Combat-Related PTSD: A Demand for Neurofeedback as an Effective Form of Treatment. JOURNAL OF COUNSELING AND DEVELOPMENT 2014. [DOI: 10.1002/j.1556-6676.2014.00174.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tami Maes Fragedakis
- Department of Addictions and Rehabilitation Studies, East Carolina University at Greenville
- Now at Capital Biofeedback, Inc., Raleigh, North Carolina
| | - Paul Toriello
- Department of Addictions and Rehabilitation Studies, East Carolina University at Greenville
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Stanfill KE, Kinn J, Bush N. Soldiers' Preferences for Follow-Up Communications with Behavioral Health Providers. Telemed J E Health 2014; 20:742-3. [DOI: 10.1089/tmj.2013.0306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Julie Kinn
- National Center for Telehealth and Technology, Joint Base Lewis-McChord, Washington
| | - Nigel Bush
- National Center for Telehealth and Technology, Joint Base Lewis-McChord, Washington
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Valenstein M, Gorman L, Blow AJ, Ganoczy D, Walters H, Kees M, Pfeiffer PN, Kim HM, Lagrou R, Wadsworth SM, Rauch SAM, Dalack GW. Reported barriers to mental health care in three samples of U.S. Army National Guard soldiers at three time points. J Trauma Stress 2014; 27:406-14. [PMID: 25158634 DOI: 10.1002/jts.21942] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The military community and its partners have made vigorous efforts to address treatment barriers and increase appropriate mental health services use among returning National Guard soldiers. We assessed whether there were differences in reports of treatment barriers in 3 categories (stigma, logistics, or negative beliefs about treatment) in sequential cross-sectional samples of U.S. soldiers from a Midwestern Army National Guard Organization who were returning from overseas deployments. Data were collected during 3 time periods: September 2007-August 2008 (n = 333), March 2009-March 2010 (n = 884), and August 2011-August 2012 (n = 737). In analyses using discretized time periods and in trend analyses, the percentages of soldiers endorsing negative beliefs about treatment declined significantly across the 3 sequential samples (19.1%, 13.9%, and 11.1%). The percentages endorsing stigma barriers (37.8%, 35.2%, 31.8%) decreased significantly only in trend analyses. Within the stigma category, endorsement of individual barriers regarding negative reactions to a soldier seeking treatment declined, but barriers related to concerns about career advancement did not. Negative treatment beliefs were associated with reduced services use (OR = 0.57; 95% CI [0.33, 0.97]).
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Affiliation(s)
- Marcia Valenstein
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, Michigan, USA; University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
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Caring letters for suicide prevention: Implementation of a multi-site randomized clinical trial in the U.S. military and veteran affairs healthcare systems. Contemp Clin Trials 2014; 37:252-60. [DOI: 10.1016/j.cct.2014.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/17/2014] [Accepted: 01/20/2014] [Indexed: 11/20/2022]
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Jones N, Mitchell P, Clack J, Fertout M, Fear NT, Wessely S, Greenberg N. Mental health and psychological support in UK armed forces personnel deployed to Afghanistan in 2010 and 2011. Br J Psychiatry 2014; 204:157-62. [PMID: 24262819 DOI: 10.1192/bjp.bp.113.131433] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most accounts of deployment mental health in UK armed forces personnel rely on retrospective assessments. AIMS We present data relating to the burden of mental ill health and the effect of support measures including operational, family, welfare and medical support obtained on two occasions some 18 months apart. METHOD A total of 2794 personnel completed a survey while deployed to Afghanistan; 1363 in 2011 and 1431 in 2010. Their responses were compared and contrasted. RESULTS The prevalence of self-report mental health disorder was low and not significantly different between the surveys; the rates of probable post-traumatic stress disorder (PTSD) were 2.8% in 2010 and 1.8% in 2011; for common mental health disorders the rates were 17.0% and 16.0% respectively. Remembering receiving predeployment psychoeducation, perceptions of good leadership and good family support were all significantly associated with better mental health. Seeking support from non-medical sources and reporting sick for medical reasons were both significantly associated with poorer mental health. CONCLUSIONS Over a period of 18 months, deployment mental health symptoms in UK armed forces personnel were fewer than those obtained from a military population sample despite continuing deployment in a high-threat context and were associated with perceptions of support.
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Affiliation(s)
- Norman Jones
- Norman Jones, MSc, Paul Mitchell, MSc, John Clack, MSc, Mohammed Fertout, MSc, Nicola T. Fear, DPhil(Oxon), Simon Wessely, FMedSci, Neil Greenberg, MD, King's Centre for Military Health and Academic Centre for Defence Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, London, UK
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Exploring Indices of Disordered Eating Literacy in Male and Female Athletes: Knowledge Gaps and Lay Beliefs as Predictors of Attitudes Toward Help-Seeking. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2013. [DOI: 10.1123/jcsp.7.4.275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this pilot study was to explore disordered eating (DE) literacy in male and female athletes and to examine whether any gender differences were present. A related aim was to examine the moderating effect of gender on the relationship between indices of DE literacy and attitudes toward help-seeking for DE. A nonclinical sample of 133 (37% male) athletes from a variety of sports and competitive levels were recruited to complete an online questionnaire addressing a range of topics linked to DE literacy. Chi-square analysis indicated no significant gender differences on indicators of DE literacy. Findings from the survey revealed a number of beliefs conducive to low or inappropriate help-seeking for DE. The results highlight the importance of exploring DE literacy in athletes to develop more targeted interventions for this specific population.
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