Barriers and facilitators for treatment-seeking for mental health conditions and substance misuse: multi-perspective focus group study within the military

Military culture and collaborative decision-making in mental healthcare: cultural, communication and policy considerations

Military culture relies on hierarchy and obedience, which contradict the implementation and use of collaborative care models. In this commentary, a team of lived experience, clinical and research experts discuss, for the first time, cultural, communication and policy considerations for implementing collaborative care models in military mental healthcare settings.

Feasibility of delivering a virtual 1-day acceptance and commitment therapy workshop to rural veterans through community partnerships

Background

This single-arm, open pilot study examined the feasibility and initial efficacy of a 1-day virtual Acceptance and Commitment Therapy (ACT) group workshop for distressed veterans.

Methods

We collaborated with veteran-serving community-based organizations to enhance outreach to veterans, especially those in rural areas. Veterans completed a baseline assessment and two follow-up assessments (1 month, 3 months) after workshop participation. Feasibility outcomes included reach (workshop recruitment and completion rates; veteran characteristics) and acceptability (open-ended survey question about satisfaction). Clinical outcomes included psychological distress (Outcome Questionnaire-45), stressor-related distress (PTSD Checklist-5), community reintegration (Military to Civilian Questionnaire), and meaning and purpose (PROMIS Short Form). Psychological flexibility (Action and Acceptance Questionnaire-II) - the proposed change mechanism underlying ACT - was also measured.

Results

Sixty-four veterans (50% rural, 39% self-identified as female) participated in a virtual workshop (97.1% completion rate). Overall, veterans liked the format and interactive nature of workshops. Convenience was noted as a benefit, while connectivity issues were highlighted as a drawback. Veterans showed improvements in psychological distress (F(2,109) = 3.30; p = 0.041), stressor-related distress (F(2,110) = 9.50; p = 0.0002), community reintegration (F(2,108) = 4.34; p = 0.015), and meaning and purpose (F(2,100) = 4.06; p = 0.020) over time. No between-group differences were detected, based on rurality or gender.

Conclusion

Pilot findings were promising and warrant a larger randomized trial to assess the efficacy of the 1-day virtual ACT workshop. Integrating community-engaged and participatory-research designs can enhance the external validity of these future studies and promote greater health equity.

Dutch workers' attitudes towards having a coworker with mental health issues or illness: a latent class analysis

Introduction

Workplace mental health stigma is a major problem as it can lead to adverse occupational outcomes and reduced well-being. Although workplace climate is largely determined by managers and co-workers, the role of co-workers in workplace stigma is understudied. Therefore, the aims are: (1) to examine knowledge and attitudes towards having a coworker with Mental Health Issues or Illness (MHI), especially concerning the desire for social distance, (2) to identify distinct subgroups of workers based on their potential concerns towards having a coworker with MHI, and (3) to characterize these subgroups in terms of knowledge, attitudes, and background characteristics.

Materials and methods

A cross-sectional survey was conducted among a nationally representative internet panel of 1,224 Dutch workers who had paid jobs and did not hold management positions. Descriptive statistics and a three-step approach Latent Class Analysis (LCA) were used to address the research aims.

Results

Concerning the desire for social distance, 41.9% of Dutch workers indicated they did not want to have a close colleague with MHI, and 64.1% did not want to work for a higher-ranking manager who had MHI. In contrast however, most workers did not have negative experiences with interacting with coworkers with MHI (92.6%). Next, five distinct subgroups (SG) of workers were identified: two subgroups with few concerns towards having a coworker with MHI (SG1 and SG2; 51.8% of the respondents), one subgroup with average concerns (SG3; 22.7% of the respondents), and two subgroups with more concerns (SG4 and SG5; 25.6% of the respondents). Four out of five subgroups showed a high tendency towards the desire for social distance. Nevertheless, even in the subgroups with more concerns, (almost) half of the respondents were willing to learn more about how to best deal with coworkers with MHI. No significant differences were found between the subgroups on background characteristics.

Discussion

The high tendency to the desire for social distance seems to contrast with the low number of respondents who personally had negative experiences with workers with MHI in the workplace. This suggests that the tendency to socially exclude this group was not based on their own experience. The finding that a large group of respondents indicated to want to learn more about how to deal with a co-worker with MHI is promising. Destigmatizing interventions in the workplace are needed in order to create more inclusive workplaces to improve sustained employment of people with MHI. These interventions should focus on increasing the knowledge of workers about how to best communicate and deal with coworkers with MHI, they do not need to differentiate in background variables of workers.

Social support and treatment utilization for posttraumatic stress disorder: Examining reciprocal relations among active duty service members

Evidence-based treatments for posttraumatic stress disorder (PTSD) are underutilized by active duty service members in the United States. Social support may help service members overcome avoidance and facilitate treatment utilization. In turn, treatment utilization may improve social support. To evaluate these possibilities, the aim of the current study was to examine potential reciprocal associations between social support and treatment utilization among service members. Secondary analyses were conducted on a randomized controlled trial of 161 U.S. military service members with PTSD. Participants completed assessments of perceived social support and attendance at individual therapy sessions at baseline and 3- and 6-month follow-ups. To determine reciprocal relations between social support and treatment utilization, a Bayesian approach was used to estimate a random-intercept cross-lagged panel model with a two-part variable for treatment utilization (i.e., any therapy, and if so, dose). There were no between-person associations between average social support and treatment utilization. One prospective cross-lagged within-person association emerged as significant: social support at 3 months was negatively associated with any therapy use at 6 months; the model explained 26.1% of the variance in this observed variable. The findings revealed that low social support promoted subsequent treatment utilization, but such treatment did not lead to changes in social support. This suggests service members with PTSD may have been motivated to attend individual therapy in pursuit of social connection and support. Future research is needed to determine if reciprocal associations between various forms of social support and therapy utilization differ by treatment modality.

Access to psychosocial support for church-going young people recovering from drug and substance abuse in Zimbabwe: a qualitative study

BACKGROUND

The church and other religious-affiliated organizations have promising yet underexplored potential to provide social support services for young people recovering from substance abuse in communities where drug and substance rehabilitation services are limited. This study aimed to establish the barriers and facilitators of accessing psychosocial support, the role of the church, and strategies to promote access to psychosocial support for youths recovering from drug and substance abuse.

METHODS

This was a qualitative cross-sectional study, and semi-structured interviews of 18 church-going youths and three youth pastors were conducted in eastern Zimbabwe. Data were collected using recorded telephone interviews. Data were transcribed and analyzed using the thematic network analysis technique of producing basic themes, which build into organizing themes. Organizing themes produces one overarching global theme. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for reporting on qualitative research were used in reporting the study findings.

RESULTS

The interviews produced the following basic themes under organizing theme barriers: stigma and discrimination, parental/guardian denial, radical religious beliefs, and negative role models. Under the organizing theme facilitators, the basic themes were acceptance, confidentiality, peer and parental support, and an organized support program. The church acted as the bridge between the barriers to access to services and support seeking through innovative, inclusive projects and activities, as well as a pillar of social support.

CONCLUSIONS

Acceptance of one's addiction problem is critical to initiate seeking psychosocial support. Confidentiality, support from trustworthy relationships, and the availability of a well-coordinated recovery program enable young people to seek support. We recommend formal training church-based counselors in the ethical aspects of psychotherapy to reduce the preconceived social stigma associated with drug and substance abuse.

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

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.

In What Ways Does Health Related Stigma Affect Sustainable Employment and Well-Being at Work? A Systematic Review

PURPOSE

Studies are increasingly showing that health related stigma is a barrier to employment, but it is not known how. The aim of this systematic review is to identify, appraise and analyse studies that have directly or indirectly addressed ways in which stigma affects sustainable employment and well-being at work of people with disabilities.

METHODS

Using a multiphase screening process, this review is based on a comprehensive literature search (2000-2019) carried out in six electronic databases: Embase, Web of Science, Medline Ovid, Cochrane CENTRAL, PsycINFO and Google Scholar.

RESULTS

7.263 publications were identified; 96 studies were found eligible to be included in the review. 72% of the studies were conducted in North America or Europe. Few studies directly assessed how stigma affects the employment of people with disabilities. Most studies highlighted that attitudes and behaviour of employers formed a barrier to employment, as well as anticipated stigma and self-stigma in people with health problems. However, the findings also showed that the attitudes and behaviour of co-workers, health care professionals, reintegration professionals, customers, and family and friends could act as a barrier to employment although these influences are under-researched. Although many similarities were seen in the relevant findings of studies about both physical and mental disabilities, several nuances were found.

CONCLUSION

Stigma hampers sustainable employment and well-being in multiple ways. Whereas the number of publications on this topic is rapidly increasing, the roles of health care professionals, reintegration professionals, co-workers, customers, and family and friends particularly warrant more attention.

Associations between new health conditions and healthcare service utilizations among older adults in the United Kingdom: effects of COVID-19 risks, worse financial situation, and lowered income

Background

Health services are critically important for older adults, particularly during the Coronavirus disease-19 (COVID-19) pandemic. However, COVID-19 risks, worse financial situation, and lowered income may seriously impact health services by feasibility and accessibility. Therefore, the aim of the present study was empirically to explore how health-seeking behaviors are influenced by new health conditions through COVID-19 risks, worse financial situation, and lowered income.

Methods

Data were from ELSA COVID-19 waves 1 and 2 which included a sample of 6952 and 6710 older adults in the United Kingdom, respectively. The frequency distribution analyses were conducted by Chi-square analysis by gender groups. Zero-inflated Poisson regressions were used to examine how worse financial situation and lowered income were associated with COVID-19 risks and new health conditions. Logistic regressions were employed to examine the associations of COVID-19 risks, worse financial situation, and lowered income with treatment cancellation and accessible care. Cross-sectional mediation models, cross-sectional moderation models, longitudinal mediation models, and longitudinal moderation models were conducted based on Hayes model 6, Hayes model 29, Montoya model 1, and Montoya model 2, respectively.

Results

Most of the sample was >65 years old, females, located in urban place, and involved in long-standing condition. Regression analysis showed that COVID-19 risks, worse financial situation, and lowered income were associated with treatment cancellation and accessible care. In the longitudinal mediations, effect coefficients of ‘X’ → (treatment cancellation in wave 1 (Tcn1)- treatment cancellation in wave 2 (Tcn2))(β = −.0451, p < .0001, low limit confidence interval (LLCI) = −.0618, upper limit confidence interval (ULCI) = −.0284), ‘X’ → (COVID-19 risks in wave 1 (Csk1)- COVID-19 risks in wave 2 (Csk2)) (β = .0592, p < .0001, LLCI = .0361, ULCI = .0824), and ‘X’ → (lowered income in wave 1 (CIn1)- lowered income in wave 2 (CIn2)) (β = −.0351, p = .0001, LLCI = -.0523, ULCI = -.0179) were significant. Additionally, effect coefficients of ‘X’ → (accessible care in wave 1 (Acr1)- accessible care in wave 2 (Acr2)) (β = .3687, p < .0001, LLCI = .3350, ULCI = .4025),'X’ → (Csk1- Csk2) (β = .0676, p = .0005, LLCI = .0294, ULCI = .1058), and ‘X’ → (worse financial situation in wave 1- worse financial situation in wave 2) (β = −.0369, p = .0102, LLCI = -.0650, ULCI = -.0087) were significant.

Conclusions

There were longitudinal mediating effects of COVID-19 risks, worse financial situation, and lowered income on the relationship between new health conditions and treatment cancellation and relationship between new health conditions and accessible care. These findings suggest that worse financial situation, lowered income, and COVID-19 risks exerted an influence on the relationship between new health conditions and treatment cancellation and relationship between new health conditions and accessible care among older adults. Findings suggest that longitudinal mediations may be important components of interventions aiming to meet service needs. Long-term health policy implications indicate the need for reducing COVID-19 risks, improving financial situation, and increasing income among the targeted population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02995-8.

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

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.

Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military

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.