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Dunbar MS, Breslau J, Collins R, Beckman R, Engel CC. Heterogeneity in Unmet Treatment Need and Barriers to Accessing Mental Health Services Among U.S. Military Service Members with Serious Psychological Distress. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01289-4. [PMID: 37596460 DOI: 10.1007/s10488-023-01289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/20/2023]
Abstract
The goal of the current study is to examine heterogeneity in mental health treatment utilization, perceived unmet treatment need, and barriers to accessing care among U.S. military members with probable need for treatment. Using data from the 2018 Department of Defense Health Related Behavior Survey, we examined a subsample of 2,336 respondents with serious psychological distress (SPD; past-year K6 score ≥ 13) and defined four mutually exclusive groups based on past-year mental health treatment (treated, untreated) and self-perceived unmet treatment need (recognized, unrecognized). We used chi-square tests and adjusted regression models to compare groups on sociodemographic factors, impairment (K6 score; lost work days), and endorsement of treatment barriers. Approximately 43% of respondents with SPD reported past-year treatment and no unmet need (Needs Met). The remainder (57%) met criteria for unmet need: 18% endorsed treatment and recognized unmet need (Treated/Additional Need); 7% reported no treatment and recognized unmet need (Untreated/Recognized Need); and 32% reported no treatment and no unmet need (Untreated/Unrecognized Need). Compared to other groups, those with Untreated/Unrecognized Need tended to be younger (ages 18-24; p = 0.0002) and never married (p = 0.003). The Treated/Additional Need and Untreated/Recognized Need groups showed similar patterns of treatment barrier endorsement, whereas the Untreated/Unrecognized Need group endorsed nearly all barriers at lower rates. Different strategies may be needed to increase appropriate mental health service use among different subgroups of service members with unmet treatment need, particularly those who may not self-perceive need for treatment.
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Affiliation(s)
- Michael S Dunbar
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213-2665, USA.
| | - Joshua Breslau
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213-2665, USA
| | - Rebecca Collins
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Robin Beckman
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Charles C Engel
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Health Services Research & Development Center for Innovation, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
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Born J, Frank C. Direct and indirect barriers to hypothetical access to care among Canadian forces health services personnel. RESEARCH IN HEALTH SERVICES & REGIONS 2023; 2:11. [PMID: 39177892 PMCID: PMC11281741 DOI: 10.1007/s43999-023-00026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/13/2023] [Indexed: 08/24/2024]
Abstract
BACKGROUND Though research among Canadian Forces Health Services (CFHS) personnel is limited, the literature suggests formal healthcare is underused. Though much research has been conducted on particular barriers (e.g., stigma), examining a breadth of barriers could better inform behavioral interventions. Furthermore, work has yet to examine the indirect effects of barriers through their impact on intentions to access care. METHODS CFHS participants were randomly assigned to complete either a mental health (N = 503) or physical health (N = 530) version of the survey. The survey included questions on the perceived impact of barriers, health-related information (e.g., past access to care), intention to seek care, and two hypothetical scenarios (i.e., pneumonia and back injury or post-traumatic stress disorder and depression) as a proxy of access to care. Multiple regressions using Hayes PROCESS macro were conducted to assess the direct and indirect effects (through intentions) of the barriers on hypothetical access to care. RESULTS Results show conflict with career goals barriers were indirectly linked to all health outcomes, and directly linked to mental health outcomes. Treatment preference barriers were directly and indirectly linked to care seeking only for mental health, while resource barriers were directly linked to care seeking only for physical health. Knowledge and ability to access care barriers were directly linked to care seeking for depression and pneumonia. IMPLICATIONS Interventions to improve treatment-seeking should be developed only after the behavioural antecedents are understood, and should focus on combining evidence-based techniques to simultaneously target multiple aspects of the behaviour.
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Affiliation(s)
- Jennifer Born
- Department of National Defence and the Canadian Armed Forces, Director General Military Personnel Research and Analysis, Ottawa, Ontario, Canada.
| | - Christine Frank
- Department of National Defence and the Canadian Armed Forces, Director General Military Personnel Research and Analysis, Ottawa, Ontario, Canada
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Bessey AF, Black KJ, Britt TW. A bidirectional examination of mental health symptoms and perceptions of leader support: Which comes first? MILITARY PSYCHOLOGY 2023; 35:119-131. [PMID: 37133493 PMCID: PMC10013486 DOI: 10.1080/08995605.2022.2085957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/20/2022] [Indexed: 10/17/2022]
Abstract
Leader support for psychological health (LSPH) has been identified as an important factor in the prediction of mental health symptoms among warfighters. Although research has examined the relationship between LSPH and mental health symptoms, the extent to which this relationship is bidirectional has been underexplored. Consequently, the present study examined the longitudinal relationships between perceived LSPH and mental health symptoms (depression and PTSD) among military personnel over a 5-month period. We found that perceived LSPH at Time 1 (T1) was associated with fewer mental health symptoms at Time 2 (T2); however, mental health symptoms at T1 were also associated with lower perceptions of LSPH at T2. The results differed slightly based on the type of symptoms experienced, but the relationships between perceived LSPH and symptoms did not vary based on whether soldiers had been exposed to combat. However, it is important to note that the overall sample had low combat experience. Despite this, these findings may suggest that the assumption that leader support can enhance soldier mental health may fail to consider that the symptoms themselves may also affect how leaders are perceived. Therefore, organizations such as the military should consider both directions to optimally understand the relationship between leaders and subordinate mental health.
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Affiliation(s)
- Alexxa F. Bessey
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Kristen Jennings Black
- Department of Psychology, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | - Thomas W. Britt
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
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Fikretoglu D, Sharp ML, Adler AB, Bélanger S, Benassi H, Bennett C, Bryant R, Busuttil W, Cramm H, Fear N, Greenberg N, Heber A, Hosseiny F, Hoge CW, Jetly R, McFarlane A, Morganstein J, Murphy D, O'Donnell M, Phelps A, Richardson DJ, Sadler N, Schnurr PP, Smith P, Ursano R, Hooff MV, Wessely S, Forbes D, Pedlar D. Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective. Clin Psychol Rev 2021; 91:102100. [PMID: 34871868 DOI: 10.1016/j.cpr.2021.102100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022]
Abstract
Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the past six years to update and broaden the discussion on pathways to mental healthcare in military populations. We find that at a broad population level, there is improvement in several indicators of mental health care access, with greater gains in initial engagement, time to first treatment contact, and subjective satisfaction with care, and smaller gains in objective indicators of adequacy of care. Among individual-level barriers to care-seeking, there is progress in improving recognition of need for care and reducing stigma concerns. Among organizational-level barriers, there are advances in availability of services and cultural acceptance of care-seeking. Other barriers, such as concerns around confidentiality, career impact, and deployability persist, however, and may account for some remaining unmet need. To address these barriers, new initiatives that are more evidence-based, theoretically-driven, and culturally-sensitive, are therefore needed, and must be rigorously evaluated to ensure they bring about additional improvements in pathways to care.
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Affiliation(s)
- Deniz Fikretoglu
- Defence Research and Development Canada, 1133 Sheppard Ave. West, Toronto, ON, Canada.
| | | | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | | | | | | | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | | | | | | | - Fardous Hosseiny
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rakesh Jetly
- Department of National Defence, Ottawa, ON, Canada
| | | | | | - Dominic Murphy
- Combat Stress, Leatherhead, Surrey, UK; King's College London, London, UK
| | - Meaghan O'Donnell
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Andrea Phelps
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Don J Richardson
- Parkwood Institute- St. Joseph's Health Care London, London, ON, Canada
| | - Nicole Sadler
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | | | - Patrick Smith
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | | | - Miranda Van Hooff
- Military and Emergency Services Health Australia (MESHA), Woodville, SA, Australia
| | | | - David Forbes
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - David Pedlar
- Canadian Institute for Military and Veteran Health Research, Queen's University, Kingston, ON, Canada
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Mohr CD, Hammer LB, Brady JM, Perry ML, Bodner T. Can supervisor support improve daily employee well‐being? Evidence of supervisor training effectiveness in a study of veteran employee emotions. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2021. [DOI: 10.1111/joop.12342] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Leslie B. Hammer
- Portland State University Oregon USA
- Oregon Health and Science University PortlandOregon USA
| | - Jacquelyn M. Brady
- Oregon Health and Science University PortlandOregon USA
- San José State University California USA
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Does Help Seeking Behavior Change Over Time Following a Workplace Mental Health Intervention in the Coal Mining Industry? J Occup Environ Med 2020; 61:e282-e290. [PMID: 30985617 DOI: 10.1097/jom.0000000000001605] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate help seeking behavior and attitudes to mental health in mining employees. METHODS A pre-post survey study of employees from two Australian coal mines. Data were collected prior to, at baseline, at 6 and 18 months following delivery of the MATES in mining (MIM) peer support mental health intervention. RESULTS Help seeking behaviors increased, with participants' sex, age, relationship status, shift type, and psychological distress significantly associated with likelihood of seeking help (P <0.05). In relation to stigma, significantly more participants' disagreed that they would be treated differently by friends or colleagues following disclosure of mental illness (P < 0.01). CONCLUSIONS Results provide an understanding of help seeking behaviors of mining employees; support the MATES in Mining peer support program in the men dominated industry and provide information to guide mental health workplace program development more broadly.
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Lucier-Greer M, Quichocho D, Frye-Cox N, Sherman H, Burke B, Duncan JM. Coping and Mental Health Differences among Active Duty Service Members and Their Spouses with High and Low Levels of Marital Warmth. MILITARY PSYCHOLOGY 2020; 32:425-431. [PMID: 38536387 PMCID: PMC10187028 DOI: 10.1080/08995605.2020.1803724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 07/28/2020] [Indexed: 10/22/2022]
Abstract
This study examined the relationship between marital warmth (e.g., openly expressing affection, supportive behaviors) and assessments of coping (i.e., challenges coping with military life and self-efficacy in the context of stress) and mental health (i.e., depressive symptoms and anxiety symptoms) in a sample of active duty men and their spouses/romantic partners (N = 234 military couples). Results from a series of multivariate analysis of variance tests indicate that service members and spouses who reported higher levels of marital warmth also reported better coping skills and mental health compared to individuals in couple relationships that demonstrated lower levels of marital warmth. Intervention and prevention implications targeting social support and marital warmth are provided.
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Affiliation(s)
| | - Davina Quichocho
- Human Development and Family Studies, Auburn University, Auburn, Alabama
| | - Nicky Frye-Cox
- Human Development and Family Studies, Auburn University, Auburn, Alabama
| | - Haley Sherman
- Human Development and Family Studies, Auburn University, Auburn, Alabama
| | - Benjamin Burke
- Human Development and Family Studies, Auburn University, Auburn, Alabama
| | - James M. Duncan
- Human Development and Family Sciences, University of Arkansas, Fayetteville, Arkansas
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Britt TW, Sipos ML, Klinefelter Z, Adler AB. Determinants of mental and physical health treatment-seeking among military personnel. Br J Psychiatry 2020; 217:420-426. [PMID: 31258095 DOI: 10.1192/bjp.2019.155] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although research has documented factors influencing whether military personnel seek treatment for mental health problems, less research has focused on determinants of treatment-seeking for physical health problems. AIMS To explicitly compare the barriers and facilitators of treatment-seeking for mental and physical health problems. METHOD US soldiers (n = 2048) completed a survey with measures of barriers and facilitators of treatment-seeking for mental and physical health problems as well as measures of somatic symptoms and mental health. RESULTS The top barrier for both mental and physical health treatment-seeking was a preference for handling problems oneself. The top facilitators for both symptom types were related to treatment improving quality of life. Differential endorsement of barriers occurred for treatment of mental versus physical health symptoms. In contrast, facilitators were endorsed more for physical than for mental health treatment. While there were few gender differences, officers reported more barriers and facilitators than did enlisted personnel. Screening positive for mental or physical health problems was associated with greater endorsement of both barriers and facilitators for physical and mental health treatment, respectively. CONCLUSIONS The leading barriers and facilitators for seeking treatment for mental health and physical problems are relatively similar, suggesting that health education should consider decision-making in seeking both mental and physical healthcare. Interventions should be tailored to reduce barriers for officers and improve facilitators for junior enlisted personnel, and address barriers and facilitators for service members screening positive for a mental or physical health problem.
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Affiliation(s)
- Thomas W Britt
- Professor, Department of Psychology, Clemson University; and Research Psychologist, Center for Military Psychiatry and Neuroscience Research, Walter Reed Army Institute of Research, USA
| | | | - Zachary Klinefelter
- Graduate Research Assistant, Department of Psychology, Clemson University, USA
| | - Amy B Adler
- Clinical Research Psychologist, Center for Military Psychiatry and Neuroscience Research, Walter Reed Army Institute of Research, USA
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Hammer LB, Brady JM, Perry ML. Training supervisors to support veterans at work: Effects on supervisor attitudes and employee sleep and stress. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2019. [DOI: 10.1111/joop.12299] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Leslie B. Hammer
- Oregon Institute of Occupational Health Sciences Oregon Health & Science University Portland Oregon USA
- Department of Psychology Portland State University Oregon USA
| | - Jacquelyn M. Brady
- Oregon Institute of Occupational Health Sciences Oregon Health & Science University Portland Oregon USA
- Department of Psychology Portland State University Oregon USA
| | - MacKenna L. Perry
- Oregon Institute of Occupational Health Sciences Oregon Health & Science University Portland Oregon USA
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