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Goodman TM, Martinez RN, Giarrusso NL, Thompson C, Hoffman WR. Factors That Influence Health care-Seeking Behavior and Health Information Disclosure Among U.S. Air Force Pilots. Mil Med 2024:usae310. [PMID: 38870075 DOI: 10.1093/milmed/usae310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/24/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION The reality of pilot health care avoidance behavior is often common knowledge to both pilots and aeromedical physicians, but the underlying factors leading to this behavior are less understood. In the current study, we conducted a qualitative assessment of a sample of U.S. Air Force (USAF) pilots to gather firsthand perceptions of the factors that encourage and discourage disclosure during aeromedical screening and use of mental and physical health care services, as well as recommendations to improve the USAF aeromedical health care system. MATERIALS AND METHODS We conducted interviews with 21 USAF pilots on their perceptions of seeking medical care to identify factors that uniquely discourage or encourage disclosure and health care utilization to understand factors that aid the aeromedical provider/aviator relationship and to elicit interventions that could be prospectively researched. This work was reviewed by the Air Force Research Laboratory Institutional Review Board at Wright-Patterson Air Force Base and designated as exempt research, FWR20220103E. RESULTS The most reported factors that discourage military pilot health care disclosure and health care utilization overall were medical revocation, stigma, and lack of trust in providers. Unit-embedded services, ease of access, and severity of condition were the most reported factors encouraging disclosure and utilization. Factor descriptions and exemplary quotes from pilots and pilot recommendations to encourage health care utilization and disclosure are provided. CONCLUSIONS Results from firsthand interviews with pilots provide valuable information for flight surgeons to focus on building trust with their pilots to reduce health care avoidance.
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Affiliation(s)
- Tanya M Goodman
- LLC, NeuroStat Analytical Solutions, Great Falls, VA 22066, USA
| | - Rachael N Martinez
- Aerospace Medicine Department, U.S. Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, OH 45433-7913, USA
| | | | - Christopher Thompson
- Aerospace Medicine Department, U.S. Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, OH 45433-7913, USA
| | - William R Hoffman
- Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
- Department of Aviation, University of North Dakota, Grand Forks, ND 58202, USA
- Department of Neurology, Neurological Institute of New York, Columbia University Medical Center, New York, NY 10033, USA
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Sondhi A, Maguire L, Leidi A, Weston C. Exploring Reasons for Non-Engagement From a Peer-Led Diversionary Intervention for Veterans in Police Custody. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024:306624X231219992. [PMID: 38178544 DOI: 10.1177/0306624x231219992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
UK veterans with complex needs arrested in police custody can access support through pre-charge diversion into treatment and ancillary services. We consider why veterans in police custody disengaged from a peer-led criminal justice diversionary support service in one UK region that adopted a continuous case management approach. Seven hundred and fifty-seven veterans were assessed to have high levels of comorbid health needs and socio-economic harms, with one-quarter (26.7%, n = 202) subsequently disengaging from the service. A logistic regression model using Multivariate Imputation by Chained Equations identified that veterans of a younger age, no-fixed-abode, a history of incarceration, and those from a Royal Navy background were likelier to disengage from the intervention. We conclude that this peer-based diversionary model has some efficacy in maintaining the engagement of a highly complex, comorbid segment of criminally-justice-exposed UK military veterans. The perceived benefits of an integrated peer-based model predicated on continuous case-management techniques are discussed.
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Affiliation(s)
- Arun Sondhi
- Therapeutic Solutions (Addictions), London, UK
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Carreno-Davidson JT, Faller TN, Richardson MD, Roy TC. Behavioral Health-related Reasons for Permanent Duty Limitation Profiles in the U.S. Army: Population-Based Data from 2017 to 2019. Mil Med 2023; 188:444-449. [PMID: 37948224 DOI: 10.1093/milmed/usad183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/20/2023] [Accepted: 05/10/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION When warfighters are unable to fight, they are formally removed from battle through temporary or permanent duty limitation profiles. This study uses a population-based data repository to characterize permanent behavioral health (BH)-related profiles across the army for an identified 2-year period. The absolute risk of a permanent duty limitation for specific BH categories was also examined. MATERIALS AND METHODS This study utilized a retrospective population-based design to identify all new BH diagnoses across the U.S. Army. Service members identified as having a new BH diagnosis were tracked for 12 months following the diagnosis to determine the recommendation of a permanent duty limitation profile. RESULTS From 2017 to 2018, 16% (n = 102,440) of service members received a "new" BH diagnosis. Less than 10% (9.5%; n = 9,752) of soldiers diagnosed with a BH disorder were issued a permanent BH-related duty profile within 12 months of the initial diagnosis. The absolute risk of a permanent profile was highest for soldiers diagnosed with a psychotic or delusional disorder (42%; n = 324) followed by dissociative or somatoform disorders (26%; n = 178) and eating disorders (23%; n = 108). CONCLUSIONS Military regulations dictating medical readiness and retention standards reflect both the standards required for mission readiness and a layer of medical protection for the service member. This study provides important information on the relationship between a new BH diagnosis and the likelihood that a service member will be referred for a retirement evaluation.
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Affiliation(s)
- Jamie T Carreno-Davidson
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Theresa N Faller
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Department of Mental Health, John Hopkins University, Baltimore, MD 21205, USA
| | - Melissa D Richardson
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Tanja C Roy
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Operational Health Services, Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
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Kohl F, Angerer P, Weber J. Determinants of the intention to seek psychotherapeutic consultation at work - a cross-sectional study in Germany. BMC Public Health 2023; 23:1945. [PMID: 37805517 PMCID: PMC10559521 DOI: 10.1186/s12889-023-16852-9] [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: 05/02/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Psychotherapeutic consultation at work (PT-A) provides employees with mental illnesses or subclinical symptoms a short-term and low-threshold access to psychotherapeutic care. However, practical experience shows that the utilisation rate seems low compared to expected demand. Therefore, this study aimed to identify determinants of utilisation by exploring associations between sociodemographic characteristics, psychological well-being, stigma-related barriers and psychosocial safety climate and the intention to seek PT-A. METHODS Within a cross-sectional study, 658 participants were recruited via various social media channels in Germany. Participants answered an online questionnaire on potential determinants of (1) intention to seek PT-A in general and of intention to seek PT-A to specifically discuss (2) occupational burden and (3) private burden. Multiple ordinal regression analyses were conducted for the whole study sample and for the subgroups of participants screened positive and negative for current depression. RESULTS Lower stigma-related barriers were associated with higher general intention to seek PT-A among all study groups. Lower psychological well-being was associated with higher general intention to seek PT-A and with higher intention to seek PT-A to discuss occupational and private burden, but only so in the subgroup of employees who were screened negative for current depression. Treatment experience was associated with higher intention to seek PT-A for occupational burden among participants screened negative but not among participants screened positive for current depression. No associations were found between age, gender, education or psychosocial safety climate and any variable of intention to seek PT-A. CONCLUSION Those results give an overview on potential determinants for the intention to seek PT-A, but future research with longitudinal designs is needed to confirm that those factors also determine actual utilisation of PT-A. Based on the results, practical implications might include antistigma campaigns and promotion of PT-A adapted to the aims of the consultation.
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Affiliation(s)
- Fiona Kohl
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jeannette Weber
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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Piro L, Luo H, Jones K, Lazorick S, Cummings DM, Saeed SA. Racial and Ethnic Differences Among Active-Duty Service Members in Use of Mental Health Care and Perceived Mental Health Stigma: Results From the 2018 Health Related Behaviors Survey. Prev Chronic Dis 2023; 20:E85. [PMID: 37769249 PMCID: PMC10557975 DOI: 10.5888/pcd20.220419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION The prevalence of mental health disorders is rising among US service members; however, research is limited on their use of mental health care. The objective of our study was to determine whether racial and ethnic disparities exist in the use of mental health care and perceived mental health stigma among active-duty service members. METHODS We obtained data from a sample of 17,166 active-duty service members who participated in the 2018 Department of Defense Health Related Behavior Survey (HRBS). Racial and ethnic groups included Black, Hispanic, White, and other. Yes-no questions about use of mental health care and perceived mental health stigma were our outcome variables. We used multiple logistic regression to assess racial and ethnic differences in mental health care use and perceived mental health stigma by service members. Significance was set at P <.05. RESULTS In 2018, approximately 25.5% of service members self-reported using mental health services, and 34.2% self-reported perceived mental health stigma. Hispanic service members (AOR = 0.78) and service members in the "other" racial and ethnic group (AOR = 0.81) were less likely than their White counterparts to have used mental health care. Black (AOR = 0.68) and Hispanic (AOR = 0.86) service members were less likely than their White counterparts to self-report perceived mental health stigma. CONCLUSION The 2018 HRBS showed racial and ethnic differences in mental health care use and perceived stigma among US active-duty service members. Perceived stigma was a barrier to use of mental health care among service members with a mental health condition. Culture-sensitive programs customized for different racial and ethnic groups are needed to promote mental health care and reduce perceptions of stigma associated with its use.
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Affiliation(s)
- Lauren Piro
- Healthcare Administrator, Navy Medicine Readiness and Training Command, New England, Newport, Rhode Island
| | - Huabin Luo
- Department of Public Health, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC 27834
| | - Katherine Jones
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Suzanne Lazorick
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Doyle M Cummings
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Sy Atezaz Saeed
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Grimm CJ, de Terte I, Hodgetts D, Kearney S. Narratives of holistic mental health recovery in New Zealand Defence Force personnel. MILITARY PSYCHOLOGY 2023:1-11. [PMID: 37643328 DOI: 10.1080/08995605.2023.2250708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
Research on military mental health recovery has tended to focus on therapy outcomes while backgrounding the role of diverse healing influences. The New Zealand Defence Force (NZDF) is a bicultural military integrated with Māori customs and cultural perspectives on holistic health and wellbeing. This study used narrative analysis to examine the semi-structured interviews of 21 active duty NZDF personnel who had accessed mental healthcare to understand what factors contributed to their return to wellness. Narratives described an orientation toward recovery as a process, where many interrelated wellbeing and social factors together supported the return to health. Culturally available Māori wellbeing metaphors were adopted as heuristics by service members in their storying of growth and healing. Findings are considered in terms of how wellbeing and recovery are conceptualized and promoted within militaries with diverse cultures. Discussion focuses on how narratives within military institutions can promote resilience and support service member recovery from mental distress.
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Affiliation(s)
- Carsten James Grimm
- Directorate of Health, New Zealand Defence Force, Wellington, New Zealand
- School of Psychology, Manawatu Campus, Massey University, Palmerston North, New Zealand
| | - Ian de Terte
- School of Psychology, Wellington Campus, Massey University, Wellington, New Zealand
| | - Darrin Hodgetts
- School of Psychology, Albany Campus, Massey University, Auckland, New Zealand
| | - Stephen Kearney
- Directorate of Health, New Zealand Defence Force, Wellington, New Zealand
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Carreno-Davidson JT, Faller TN, Richardson M, Roy TC. Diagnosed Behavioral Health Disorders, Related Duty Limitations, and Return to Duty Time in the U.S. Army: Population-based Data, from 2017 to 2019. Mil Med 2023; 188:e3167-e3172. [PMID: 37158993 DOI: 10.1093/milmed/usad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/05/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Less than half of service members with a behavioral health (BH) problem seek care. Soldiers may avoid seeking needed care because of concerns related to being placed on a duty-limiting profile and the related medical disclosures that follow. MATERIALS AND METHODS This study used a retrospective population-based design to identify all new BH diagnoses across the U.S. Army. The relationship between diagnostic category, risk of being issued a duty limitation (profile), and time until return to full duty was also examined. Data were collected from a comprehensive data repository that includes medical and administrative records. Soldiers with a new BH diagnosis were identified from 2017 to 2018. All duty limitation profiles within 12 months of initial diagnosis were identified. RESULTS Records for 614,107 unique service members were reviewed. This cohort was mostly male, enlisted, unmarried, and White. The mean age was 27.13 years (SD = 8.05). Soldiers with a new BH diagnosis accounted for 16.7% (n = 102,440) of the population. The most common diagnostic category was adjustment disorder (55.7%). About a quarter (23.6%) of soldiers with a new diagnosis were issued a related profile. The mean length of these profiles was 98.55 days (SD = 56.91). Of those with a new diagnosis, sex and race failed to have an effect on the odds of being placed on a profile. Overall, enlisted, unmarried, or younger soldiers had greater odds of being placed on a profile. CONCLUSION These data provide relevant information for both the service member who seeks care and command teams seeking readiness projections.
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Affiliation(s)
- Jamie T Carreno-Davidson
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Theresa N Faller
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- The department of mental health, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Melissa Richardson
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Tanja C Roy
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Operational Health Services, Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
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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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Hoffman WR, Aden JK, Barbera D, Tvaryanas A. Self-Reported Health Care Avoidance Behavior in U.S. Military Pilots Related to Fear for Loss of Flying Status. Mil Med 2023; 188:e446-e450. [PMID: 36242520 DOI: 10.1093/milmed/usac311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/29/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION U.S. military pilots are required to meet certain medical standards in order to maintain an active flying status. Military pilots face potential temporary or permanent loss of flying privileges in the setting of a new condition or symptom that does not meet required standards, which could result in negative social and occupational repercussions for the pilot. For this reason, it has been proposed that U.S. military pilots participate in health care avoidance behavior, but little evidence exists to characterize such a trend in this population. MATERIALS AND METHODS We conducted a non-probabilistic Internet survey of the general population of U.S. pilots from November 1, 2019 through August 1, 2021. The current study is a sub-analysis of military pilots. RESULTS A total of 4,320 pilots answered the informed consent question, and 264 selected one military pilot type and were included in this sub-analysis. There were 72% of military pilots who reported a history of health care avoidance behavior (n = 190), and no statistical difference was found between age groups, gender, and military pilot types. There were 55.5% of pilots who reported a history of seeking informal medical care (n = 147), 33.7% of pilots who have flown despite a new symptom they felt required medical evaluation, 42.5% of pilots who reported withholding information on aeromedical screening (n = 111), and 11.4% of pilots who reported a history of undisclosed prescription medication use (n = 30). CONCLUSIONS U.S. military pilots may participate in health care avoidance behavior because of fear for loss of flying status.
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Affiliation(s)
- William R Hoffman
- Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, TX 78204, USA
| | - James K Aden
- Department of Graduate Medical Education, Brooke Army Medical Center, Fort Sam Houston, TX 78204, USA
| | - Daniel Barbera
- Department of Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78204, USA
| | - Anthony Tvaryanas
- Civil Aerospace Medical Institute (CAMI), Federal Aviation Administration (FAA), Oklahoma City, OK 73125, USA
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Kohl F, Angerer P, Weber J. Employees' preferences on organisational aspects of psychotherapeutic consultation at work by occupational area, company size, requirement levels and supervisor function - a cross-sectional study in Germany. BMC Public Health 2023; 23:347. [PMID: 36797723 PMCID: PMC9932407 DOI: 10.1186/s12889-023-15255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Common mental disorders affect a significant proportion of the population worldwide at any given time. Psychotherapeutic consultation at work offers employees with mental distress short-term and low-threshold access to psychotherapeutic treatment. However, this offer is only accepted by one to two percent of the employees to whom it is offered. Taking into account employees ' preferences regarding organisational aspects might increase the use of psychotherapeutic consultation at work. This study therefore aimed to identify preferences on organisational aspects of psychotherapeutic consultation at work among employees of diverse occupational areas, company sizes, supervisor functions and job requirement levels. METHODS A total of 755 employees were recruited via advertisements on social media (Instagram, Facebook and LinkedIn). Participants rated on a 5-point Likert scale their agreement to different implementation options of psychotherapeutic consultation at work: type (in-person/video/telephone), location (on/outside company premises), time (within/outside working hours), scope (diagnostic/diagnostic + treatment) and purpose (private/occupational). Additionally, the maximum accepted distance to the location of consultation was assessed. Various analyses of variances (ANOVA) were conducted to determine differences in agreement to implementation options within each organisational aspect and to analyse differences between occupational areas, company sizes, requirement levels and between employees with and without supervisor function. RESULTS Participants indicated a preference for in-person psychotherapeutic consultation that takes places outside company premises and outside working hours. Furthermore, they preferred offers including diagnostic and treatment sessions compared to offers including diagnostic sessions only. Even though participants agreed that consultation should be offered for all purposes, agreement for occupational issues was stronger than for private issues. For some implementation options, the level of agreement varied according to occupational field, company size, supervisor function and level of requirement. However, these differences did not affect the key findings mentioned above. CONCLUSION Those findings give practical indications on the organisational design of psychotherapeutic consultation at work. The results suggest that in-person consultation outside company premises and working hours combining diagnostic and treatment sessions will be accepted by employees regardless of their occupational area, company size, supervisor function and requirement level.
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Affiliation(s)
- Fiona Kohl
- grid.411327.20000 0001 2176 9917Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Peter Angerer
- grid.411327.20000 0001 2176 9917Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Jeannette Weber
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
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Schneider M, Werner S, Yavnai N, Ben Yehuda A, Shelef L. Israeli soldiers' intentions and actions toward seeking mental health help: Barriers and facilitators. J Clin Psychol 2023; 79:449-465. [PMID: 35988124 PMCID: PMC10087119 DOI: 10.1002/jclp.23431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 07/16/2022] [Accepted: 08/03/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND While military settings may increase psychological distress, soldiers frequently avoid seeking professional help. This study aimed to examine barriers and facilitators associated with intentions to seek help and actually seeking help from a mental health officer (MHO) and how these differ among soldiers who had sought help in the past and those who had not. METHOD This cross-sectional study included 263 combat and noncombat soldiers. The Health Belief Model and the Help-Seeking Model were the theoretical framework used to map the potential variables associated with soldiers' decision to seek help. RESULTS Stigma and administrative barriers were found to be significant barriers to both the intention to seek help and actually consulting an MHO. These findings were more definitive among combat soldiers. The belief in the effectiveness of mental health treatment was positively associated with the intention to seek help. Positive associations were found between well-being, perceived seriousness of one's condition, and belief in the effectiveness of mental health care and intention to seek MHO help. Distress and self-concealment were positively associated with actual consultation with an MHO. Public stigma about seeking help was associated with both the intention to seek mental health assistance and actually consulting an MHO. CONCLUSION Military commanders should make an effort to make soldiers feel safe to seek mental health assistance by creating a supportive organizational atmosphere to reduce the stigma associated with mental health care.
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Affiliation(s)
- Maayan Schneider
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shirli Werner
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nirit Yavnai
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan, Israel
| | - Ariel Ben Yehuda
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan, Israel
| | - Leah Shelef
- Department of Health and Well-Being, IDF's Medical Corps, Israel Defense Forces, Ramat Gan, Israel.,Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Hoffman WR, Aden J, Barbera RD, Mayes R, Willis A, Patel P, Tvaryanas A. Healthcare Avoidance in Aircraft Pilots Due to Concern for Aeromedical Certificate Loss: A Survey of 3765 Pilots. J Occup Environ Med 2022; 64:e245-e248. [PMID: 35166258 DOI: 10.1097/jom.0000000000002519] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study healthcare avoidance behavior in pilots related to fear of aeromedical certificate loss. METHODS Voluntary participation in an anonymous survey distributed to U.S. pilots. RESULTS A total of 3765 pilots were included in the analysis. There were 56.1% of pilots (n = 2111) who reported a history of healthcare avoidance behavior due fear for losing their aeromedical certificate. There were 45.7% who sought informal medical care (n = 1721) and 26.8% who misrepresented/withheld information on a written healthcare questionnaire for fear of aeromedical certificate loss (n = 994). CONCLUSIONS Aircraft pilots may participate in healthcare avoidance behavior related to fear of losing their aeromedical certificate. Further work is necessary to address pilot healthcare avoidance.
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Affiliation(s)
- William R Hoffman
- Department of Neurology, Brooke Army Medical Center, Ft. Sam Houston, Texas (Dr Hoffman and Dr Willis); Department of Graduate Medical Education, Brooke Army Medical Center, Ft. Sam Houston, Texas (Dr Aden); Department of Flight Medicine, Hulbert Field Medical Center, U.S. Air Force, Hulbert Field, Florida (Dr Barbera); School of Aerospace Medicine, U.S. Air Force, Wright Patterson Air Force Base, Ohio (Dr Mayes); University of Alberta, Edmonton, Alberta, Canada (Mr Patel); Civil Aerospace Medical Institute, U.S. Federal Aviation Administration, Oklahoma City, Oklahoma (Dr Tvaryanas)
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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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14
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Keller EM, Owens GP. Understanding help-seeking in rural counties: A serial mediation analysis. J Clin Psychol 2021; 78:857-876. [PMID: 34614200 DOI: 10.1002/jclp.23260] [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: 03/09/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Rural areas in the Southern United States are characterized by certain cultural values that may delay or prevent mental health service utilization. The present study examined a four-stage chain of serial mediation where higher levels of general self-reliance would be related to greater levels of public stigma, which would in turn be related to higher levels of self-stigma, followed by greater self-reliance about managing mental health problems, and finally, more negative attitudes toward seeking help from psychologists. METHOD Community members who lived in rural counties in the Southern United States (N = 783) completed measures of these constructs online. RESULTS Mediation analyses supported a direct association between general self-reliance and attitudes toward help-seeking that was explained in serial by higher levels of public stigma, self-stigma, and mental health self-reliance. CONCLUSIONS Clinical implications for rural practitioners are suggested including instilling policy changes, increasing provider visibility, and addressing barriers in therapy.
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Affiliation(s)
- Emily M Keller
- University of Tennessee, Department of the Psychology, Knoxville, Tennessee, USA
| | - Gina P Owens
- University of Tennessee, Department of the Psychology, Knoxville, Tennessee, USA
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15
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James D. Hardiness and attitudes toward professional healthcare services: Implications for healthcare service utilization among Black American adults. Health Psychol Open 2021; 8:20551029211029157. [PMID: 34377525 PMCID: PMC8323433 DOI: 10.1177/20551029211029157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This study (N = 780) examines the indirect effects of
hardiness—health locus of control (HLOC), health competence (HC), health value
(HV)—on past-year healthcare provider visit via attitudes toward seeking and
receiving professional healthcare services (ATSRPHS). Across four health domains
(dental, general health, mental, vision), ATSRPHS mediated the indirect effect
of (1) HV and (2) internal HLoC on past-year healthcare provider visit. ATSRPHS
also mediated the indirect effect of external HLoC on past-year visit to
healthcare provider visit for general medical, mental, and vision health.
ATSRPHS did not mediate any indirect effect of HC on past-year healthcare
provider visit. This research contributes to understanding determinants of
healthcare service utilization among Black American adults.
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16
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McCreary DR, Oliffe JL, Black N, Flannigan R, Rachert J, Goldenberg SL. Canadian men's health stigma, masculine role norms and lifestyle behaviors. Health Promot Int 2021; 35:535-543. [PMID: 31132103 DOI: 10.1093/heapro/daz049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Men are at high risk for both morbidity and premature mortality from several of the most common serious diseases. Although numerous factors have been identified to explain men's risk, this study focused on the relationship between lifestyle behaviors, health-related self-stigma and masculine role norms. An age and location stratified sample of 2000 Canadian men completed measures assessing five lifestyle behaviors (smoking, alcohol use, sleep, diet and exercise), a screen for depression, and measures of self-stigma and masculine role norms. The results showed that elements of both health-related self-stigma and masculine role norms were associated with increased risk for being above the clinical threshold for four of the lifestyle behaviors and depression. The most frequent and largest relationships were associated with exercise and depression. The total number of lifestyle behaviors for which participants were above the clinical cut-points was also associated with self-stigma and masculine role norms. These findings demonstrate the importance of health-related self-stigma and masculine role norms as potential barriers to men's health and well-being.
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Affiliation(s)
- Donald R McCreary
- DRM Scientific Consulting, British Columbia, Canada.,Brock University, St. Catharines, Ontario, Canada
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Black
- Intensions Consulting, Vancouver, British Columbia, Canada
| | - Ryan Flannigan
- Weill Cornell Medicine, Department of Urology, Male Reproduction & Microsurgery, New York, NY, USA.,Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Men's Health Foundation, Vancouver, British Columbia, Canada
| | - Joe Rachert
- Canadian Men's Health Foundation, Vancouver, British Columbia, Canada
| | - S Larry Goldenberg
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Men's Health Foundation, Vancouver, British Columbia, Canada
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17
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Johnson EM, Possemato K. Problem recognition and treatment beliefs relate to mental health utilization among veteran primary care patients. Psychol Serv 2021; 18:11-22. [PMID: 30869974 PMCID: PMC6745017 DOI: 10.1037/ser0000341] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mental health concerns are prevalent among primary care patients, but many do not utilize services for these conditions. This study aims to conduct a comprehensive assessment of barriers and facilitators to mental health care utilization among veteran primary care patients with common mental health concerns. We hypothesized that beliefs and knowledge about mental illness and mental health care would be more strongly associated with recent mental health care utilization than stigma, help-seeking behaviors, or logistical barriers. Veterans (n = 116) enrolled in primary care with current symptoms of depression (58%), posttraumatic stress disorder (37%), and/or hazardous alcohol use (50%) who either recently used mental health services (47%) or had no recent mental health treatment utilization (53%) completed a telephone-based screening, medical records review, and mail survey of 10 measures of barriers and facilitators to mental health treatment utilization. Recognition of problems as a cause for concern, odds ratio = 5.95, 95% confidence interval [2.36, 15.01], and beliefs about psychotherapy, odds ratio = 2.53, 95% confidence interval [1.39, 4.60], emerged as stronger correlates of recent mental health care utilization than stigma, self-efficacy, and external barriers to treatment. Results suggest the use of specific theories, measures, and interventions that focus on patient recognition of problems and beliefs about treatment over those that focus on other treatment barriers and facilitators. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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18
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Hastuti R, Timming AR. An inter-disciplinary review of the literature on mental illness disclosure in the workplace: implications for human resource management. INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT 2021. [DOI: 10.1080/09585192.2021.1875494] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Rina Hastuti
- School of Management, RMIT University, Melbourne, VIC, Australia
- Faculty of Islamic Business and Economics, IAIN, Surakarta, Central Java, Indonesia
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19
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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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20
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Shakespeare-Finch J, Alichniewicz KK, Strodl E, Brown K, Quinn C, Hides L, White A, Gossage G, Poerio L, Batras D, Jackson S, Styles J, Kavanagh D. Experiences of Serving and Ex-Serving Members With the PTSD Coach Australia App: Mixed Methods Study. J Med Internet Res 2020; 22:e18447. [PMID: 33030438 PMCID: PMC7582151 DOI: 10.2196/18447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/25/2020] [Accepted: 07/26/2020] [Indexed: 01/30/2023] Open
Abstract
Background PTSD Coach Australia is an app for serving and ex-serving defense members and was adapted for the Australian context in 2013 from PTSD Coach, which was created in the United States. Objective This study aimed to provide a user-centered evaluation of the app from the perspective of serving and ex-serving members of the Australian Defence Force. Methods Qualitative data were collected in response to questions to participants in 1 of 5 workshops (n=29) or in telephone interviews (n=24). Quantitative data were collected using the user version of Mobile Apps Rating Scale (uMARS). Results Analysis of the qualitative data demonstrated mixed support for the app. While some people found it extremely useful, especially as an adjunct to therapy, others pointed out limitations and cautioned against the app potentially triggering symptoms in people with PTSD. This perceived risk was usually found to stem from frustration with the app’s functionality rather than its content. Participants spoke about the helpful and unhelpful aspects of the app and barriers to its use and made suggestions for improvement. Many participants encouraged its continued use and highlighted the need for it to be promoted more broadly, as many were not aware of it until they were invited to participate in this research. Conclusions PTSD Coach Australia was seen in a positive light by some participants, but others thought it had too much text and the potential to trigger a traumatic response in users with PTSD. A need to update the app was also a common comment as was the need to increase awareness of the app’s existence.
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Affiliation(s)
| | | | - Esben Strodl
- Queensland University of Technology, Brisbane, Australia
| | - Kelly Brown
- Queensland University of Technology, Brisbane, Australia.,Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia
| | | | | | - Angela White
- Royal Brisbane and Womens Hospital, Brisbane, Australia
| | | | | | | | - Samantha Jackson
- Mental Health Strategy & Research, Joint Health Command, Canberra, Australia
| | - Jess Styles
- Mental Health Strategy & Research, Joint Health Command, Canberra, Australia
| | - David Kavanagh
- Queensland University of Technology, Brisbane, Australia
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21
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Keeling M, Barr N, Atuel H, Castro CA. Symptom Severity, Self-efficacy and Treatment-Seeking for Mental Health Among US Iraq/Afghanistan Military Veterans. Community Ment Health J 2020; 56:1239-1247. [PMID: 32064566 PMCID: PMC7434717 DOI: 10.1007/s10597-020-00578-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/11/2020] [Indexed: 12/04/2022]
Abstract
Military veterans have high rates of mental health problems, yet the majority do not seek treatment. Understanding treatment-seeking in this population is important. This study investigated if symptom severity and self-efficacy are associated with treatment-seeking among US Iraq/Afghanistan veterans. Survey data from 525 veterans meeting clinical criteria for PTSD and depression were included of which, 54.4% had sought treatment in the past 12 months. Multivariate logistic regression analysis indicated that high symptom severity was associated with treatment seeking, whereas high self-efficacy was associated with a decreased likelihood to seek treatment. Self-efficacy could be an underlying mechanism of treatment seeking decisions.
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Affiliation(s)
- Mary Keeling
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Frenchey Campus, Coldharbour Road, Bristol, BS16 1QY, UK.
| | - Nicholas Barr
- Center for Innovation and Research on Veterans & Military Families, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1400, Los Angeles, CA, 90015, USA
| | - Hazel Atuel
- Center for Innovation and Research on Veterans & Military Families, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1400, Los Angeles, CA, 90015, USA
| | - Carl A Castro
- Center for Innovation and Research on Veterans & Military Families, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1400, Los Angeles, CA, 90015, USA
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22
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Aikins DE, Pietrzak RH, Geraci JC, Benham T, Morrissey P, Southwick SM. Beyond stigma: Understanding the "inclined abstainers" in military behavioral health-care utilization. MILITARY PSYCHOLOGY 2020; 32:419-427. [PMID: 38536308 PMCID: PMC10013392 DOI: 10.1080/08995605.2020.1784822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
Low treatment utilization in Soldiers with combat-related Posttraumatic Stress Disorder (PTSD) is an ongoing issue. The critical concern is to better understand factors which prohibit a Soldier with PTSD who wants help from seeking treatment (an "inclined abstainer"). A total of 537 Active Duty Soldiers on a US Army post completed a brief survey comprising psychometrically validated measures of stigma, behavioral health treatment beliefs, resilience, PTSD symptoms, and treatment intentions. Health-care records were prospectively tracked for 12 months to determine the relation between survey answers and treatment utilization. Sixty-three percent of those who acknowledged having a mental health-related problem did not seek help within a one-year period. Greater severity of PTSD symptoms was associated with an increased likelihood of behavioral health engagement. Soldiers that were classified as "inclined abstainers" were also more likely to endorse negative beliefs about psychotherapy and report higher levels of resilience as compared to "inclined actors." These results suggest that a treatment model of PTSD emphasizing self-efficacy and self-reliance, while addressing negative beliefs about psychotherapy, may help promote engagement of behavioral health services among Active Duty Soldiers.
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Affiliation(s)
- Deane E. Aikins
- Department of Psychiatry, VA Detroit Healthcare System, Detroit, Michigan
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, Wayne
| | - Robert H. Pietrzak
- National Center for PTSD Behavioral Neuroscience Division, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Joseph C. Geraci
- Behavioral Health MEDDAC, United States Army
- Resilience Center for Veterans & Families, Teachers College, Columbia University, New York
| | - Todd Benham
- Behavioral Health MEDDAC, United States Army
| | | | - Steven M. Southwick
- National Center for PTSD Behavioral Neuroscience Division, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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23
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Mental Health Care Utilization and Psychiatric Diagnoses in a Sample of Military Suicide Decedents and Living Matched Controls. J Nerv Ment Dis 2020; 208:646-653. [PMID: 32502074 PMCID: PMC7483990 DOI: 10.1097/nmd.0000000000001192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article examines mental health care utilization and psychiatric diagnoses among US military personnel who died by suicide. We employed an existing electronic health record dataset including 800 US military suicide decedents and 800 matched controls. Suicide decedents were more likely to have received outpatient and inpatient mental health care and to have been diagnosed with depression, bipolar, and nonaffective psychotic disorders. Younger decedents and those in the US Marine Corps were less likely to receive MH care before suicide. Given that approximately half of the suicide decedents in our sample had no mental health care visits before their death, our study suggests the need for programs to increase treatment engagement by at-risk individuals. Such programs could address barriers to care such as stigma regarding mental illness and concerns that seeking mental health care would damage a service member's career.
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24
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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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25
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Nugent KL, Riviere LA, Sipos ML, Wilk JE. Mental Health Service Utilization and Perceived Barriers to Receiving Care in Deployed Soldiers. Mil Med 2020; 185:e625-e631. [PMID: 32175578 DOI: 10.1093/milmed/usaa019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Scant research has examined mental health treatment utilization and barriers to care in deployed U.S. soldiers. This study aims to assess mental health treatment utilization in deployed soldiers, including providers used and barriers to care. MATERIALS AND METHODS U.S. Army soldiers (n = 2,412) in a combat environment were surveyed on psychiatric symptoms, mental health help received, sources of care, and perceived barriers to care by Mental Health Advisory teams from 2009 to 2013. RESULTS Of the 25% of soldiers at mental health risk, 37% received mental health help, with 18% receiving help from a provider. Nonprovider sources of care were utilized significantly more frequently than providers. Soldiers at mental health risk reported significantly greater anticipated career-related stigma, organizational barriers to care, self-reliance views, and negative attitudes toward care, yet these constructs did not differ between who did or did not receive help. Soldiers who received help from providers exclusively reported significantly more anticipated career-related stigma and fewer organizational barriers to care than those that received no help. Soldiers who spent no time living outside the forward operating base and soldiers with six or more types of combat exposures were more likely to receive help. CONCLUSIONS Prevalence of common psychopathology and receipt of care in a combat environment was similar to previous reports from postdeployment settings. Nonprovider sources of care were more frequently utilized as compared to an in-Garrison report. Findings suggest important differences exist in sources of help and barriers to care in deployed vs. postdeployment environments. The hypothesized barriers to care did not preclude receiving any help, however, less than one-half of soldiers at mental health risk received help. Thus, future research should identify factors that have the greatest influence on help seeking behavior in both deployed and Garrison settings.
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Affiliation(s)
- Katie L Nugent
- TechWerks, 2001 Clarendon Blvd, Suite 705, Arlington, VA 22201.,Military Psychiatry Branch, Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20906
| | - Lyndon A Riviere
- Military Psychiatry Branch, Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20906
| | - Maurice L Sipos
- Command and Leadership Studies, Department of Command, Leadership and Management, US Army War College, 122 Forbes Ave, Carlisle, PA 17013
| | - Joshua E Wilk
- Military Psychiatry Branch, Center for Military Psychiatry and Neurosciences, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20906
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26
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Start AR, Amiya RM, Dixon AC, Britt TW, Toblin RL, Adler AB. LINKS Training and Unit Support for Mental Health: a Group-randomized Effectiveness Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:784-794. [PMID: 32242289 DOI: 10.1007/s11121-020-01106-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The LINKS curriculum, adapted from Britt et al. (2018a), was designed to improve unit climate, knowledge, and attitudes about mental health treatment seeking in military personnel. The present study extends this research by examining implementation options, comparing the effectiveness of LINKS to an active control condition with training delivered by non-experts and comparing modules that varied in training length. Eight Army platoons were randomly assigned to one of four conditions: (1) 1-h Active Control, (2) 2-h Active Control, (3) 1-h LINKS, or (4) 2-h LINKS. Two platoons were assigned to each condition. Surveys were administered at pre-training (T1), post-training (T2), and 3 months later (T3). Eighty-four participants completed all study phases. Regardless of training content, participants receiving the 2-h modules reported greater training acceptability than those receiving the 1-h modules. At T3, participants in the LINKS conditions reported more mental health knowledge than participants in the Active Control conditions. Sustained effects were also observed on a number of treatment barriers and facilitators, with the LINKS conditions generally leading to better outcomes. At T3, 2-h LINKS condition participants reported receiving more mental health treatment relative to the other conditions. Findings suggest that LINKS can be effectively delivered by non-expert trainers, is a viable intervention for targeting mental health treatment-seeking, and is optimally packaged in a 2-h module. The training might benefit from additional leadership training efforts.
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Affiliation(s)
- Amanda R Start
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Rachel M Amiya
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Alexis C Dixon
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Thomas W Britt
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA.,Department of Psychology, Clemson University, Clemson, SC, USA
| | - Robin L Toblin
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA.
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Krill Williston S, Roemer L, Vogt DS. Cultural and service factors related to mental health beliefs among post-9/11 veterans. Int J Soc Psychiatry 2019; 65:313-321. [PMID: 30995148 DOI: 10.1177/0020764019842327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The primary purpose of this study was to examine cultural and demographic predictors of dimensions of anticipated stigma and negative mental health beliefs, known barriers to mental health care utilization, among post-9/11 veterans. METHODS A cross-sectional survey methodology was used to assess 132 post-9/11 veterans. Bivariate correlations were used to examine associations between military cultural values (self-reliance and emotional control), demographic variables (gender and service characteristics) and dimensions of anticipated stigma and negative beliefs about mental health. Descriptive statistics were used to examine item-level agreement on scales of stigma, mental health beliefs and cultural values to more fully describe these beliefs in this population. RESULTS Descriptive findings revealed that the most highly endorsed dimension of stigma was anticipated stigma from coworkers. Correlational findings indicated that only exaggerated self-reliance, not emotional control, was positively associated with higher negative beliefs about treatment and treatment-seeking, and not other dimensions of negative beliefs about mental health. Active duty service members and those who deployed reported higher negative beliefs about treatment-seeking, emotional control and self-reliance. In addition, men reported higher negative beliefs about treatments, treatment-seeking and self-reliance than women. CONCLUSION These results highlight the importance of addressing concerns about self-reliance and mental health treatment in stigma-reduction interventions especially among male, deployed, and active duty service members to reduce stigma and stigma-related barriers to care.
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Schomerus G, Stolzenburg S, Freitag S, Speerforck S, Janowitz D, Evans-Lacko S, Muehlan H, Schmidt S. Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness. Eur Arch Psychiatry Clin Neurosci 2019; 269:469-479. [PMID: 29679153 DOI: 10.1007/s00406-018-0896-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/17/2018] [Indexed: 12/20/2022]
Abstract
It is unclear to what extent failure to recognize symptoms as potential sign of a mental illness is impeding service use, and how stigmatizing attitudes interfere with this process. In a prospective study, we followed a community sample of 188 currently untreated persons with mental illness (predominantly depression) over 6 months. We examined how lack of knowledge, prejudice and discrimination impacted on self-identification as having a mental illness, perceived need, intention to seek help, and help-seeking, both with respect to primary care (visiting a general practitioner, GP) and specialist care (seeing a mental health professional, MHP). 67% sought professional help within 6 months. Fully saturated path models accounting for baseline depressive symptoms, previous treatment experience, age and gender showed that self-identification predicted need (beta 0.32, p < 0.001), and need predicted intention (GP: beta 0.45, p < 0.001; MHP: beta 0.38, p < 0.001). Intention predicted service use with a MHP after 6 months (beta 0.31, p < 0.01; GP: beta 0.17, p = 0.093). More knowledge was associated with more self-identification (beta 0.21, p < 0.01), while support for discrimination was associated with lower self-identification (beta - 0.14, p < 0.05). Blaming persons with mental illness for their problem was associated with lower perceived need (beta - 0.16, p < 0.05). Our models explained 37% of the variance of seeking help with a MHP, and 33% of help-seeking with a GP. Recognizing one's own mental illness and perceiving a need for help are impaired by lack of knowledge, prejudice, and discrimination. Self-identification is a relevant first step when seeking help for mental disorders.
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Affiliation(s)
- Georg Schomerus
- Department of Psychiatry, University Medicine Greifswald, Ellernholzstraße 2, 17475, Greifswald, Germany.
| | - Susanne Stolzenburg
- Department of Psychiatry, University Medicine Greifswald, Ellernholzstraße 2, 17475, Greifswald, Germany
| | - Simone Freitag
- Department Health and Prevention, University Greifswald, Greifswald, Germany
| | - Sven Speerforck
- Department of Psychiatry, University Medicine Greifswald, Ellernholzstraße 2, 17475, Greifswald, Germany
| | - Deborah Janowitz
- Department of Psychiatry, University Medicine Greifswald, Ellernholzstraße 2, 17475, Greifswald, Germany
| | - Sara Evans-Lacko
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Holger Muehlan
- Department Health and Prevention, University Greifswald, Greifswald, Germany
| | - Silke Schmidt
- Department Health and Prevention, University Greifswald, Greifswald, Germany
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29
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Zuromski KL, Dempsey CL, Ng THH, Riggs-Donovan CA, Brent DA, Heeringa SG, Kessler RC, Stein MB, Ursano RJ, Benedek D, Nock MK. Utilization of and barriers to treatment among suicide decedents: Results from the Army Study to Assess Risk and Resilience Among Servicemembers (Army STARRS). J Consult Clin Psychol 2019; 87:671-683. [PMID: 31008631 DOI: 10.1037/ccp0000400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine suicide decedents' use of mental health treatment and perceived barriers to initiating and maintaining treatment. METHOD We used a psychological autopsy study conducted as part of the Army Study to Assess Risk and Resilience Among Servicemembers (Army STARRS) that compared suicide decedents (n = 135) to soldiers in two control conditions: those propensity-score-matched on known sociodemographic and Army history variables (n = 137) and those with a history of suicidal thoughts in the past 12 months (n = 118). Informants were next of kin and Army supervisors. RESULTS Results revealed that suicide decedents were significantly more likely to be referred to services and to use more intensive treatments (e.g., medication, overnight stay in hospital) than propensity-matched controls. However, decedents also were more likely to perceive significant barriers to treatment-seeking. All differences observed in the current study were between propensity-matched controls and decedents, with no observed differences between suicide ideators and decedents. CONCLUSIONS Many suicide decedents used some form of mental health care at some point in their lives; however, they also were more likely than propensity-matched controls to perceive barriers that may have prevented service use. The lack of differences between suicide ideators and decedents suggests that more information is needed, beyond knowledge of treatment utilization or perceived barriers, to identify and intervene on those at highest risk for suicide. These findings underscore the importance of reducing attitudinal barriers that may deter suicidal soldiers from seeking treatment, and also improving risk detection among those who are attending treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Catherine L Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - Tsz Hin Hinz Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - Charlotte A Riggs-Donovan
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | - Murray B Stein
- Department of Psychiatry and Family Medicine & Public Health, University of California, San Diego
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - David Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
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30
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Forbes D, Pedlar D, Adler AB, Bennett C, Bryant R, Busuttil W, Cooper J, Creamer MC, Fear NT, Greenberg N, Heber A, Hinton M, Hopwood M, Jetly R, Lawrence-Wood E, McFarlane A, Metcalf O, O'Donnell M, Phelps A, Richardson JD, Sadler N, Schnurr PP, Sharp ML, Thompson JM, Ursano RJ, Hooff MV, Wade D, Wessely S. Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward. Int Rev Psychiatry 2019; 31:95-110. [PMID: 31043106 DOI: 10.1080/09540261.2019.1595545] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health.
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Affiliation(s)
- David Forbes
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - David Pedlar
- b Canadian Institute for Military and Veteran Health Research , Kingston , ON, Canada
| | - Amy B Adler
- c Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research , Silver Spring , MD , USA
| | - Clare Bennett
- d New Zealand Defence Force , Wellington , New Zealand
| | - Richard Bryant
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.,e School of Psychology , University of New South Wales , Sydney , Australia
| | | | - John Cooper
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Mark C Creamer
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Nicola T Fear
- g King's Centre for Military Health Research, King's College London , London , UK.,h Academic Centre for Military Mental Health Research , London , UK
| | - Neil Greenberg
- g King's Centre for Military Health Research, King's College London , London , UK
| | - Alexandra Heber
- i Veterans Affairs Canada , Charlottetown , Canada.,j Department of Psychiatry , University of Ottawa , Ottawa , Canada
| | - Mark Hinton
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Mal Hopwood
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Rakesh Jetly
- k Directorate of Mental Health , Canadian Armed Forces , Ottawa , Canada
| | - Ellie Lawrence-Wood
- l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Alexander McFarlane
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.,l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Olivia Metcalf
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Meaghan O'Donnell
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Andrea Phelps
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - J Don Richardson
- m Department of Psychiatry , Western University , London , Canada.,n McDonald/Franklin OSI Research Centre , London , Canada
| | - Nicole Sadler
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Paula P Schnurr
- o National Center for PTSD , White River Junction , VT , USA.,p Department of Psychiatry , Geisel School of Medicine , Hanover , NH , USA
| | - Marie-Louise Sharp
- g King's Centre for Military Health Research, King's College London , London , UK
| | - James M Thompson
- i Veterans Affairs Canada , Charlottetown , Canada.,q Department of Public Health Sciences , Queen's University , Kingston , ON , Canada
| | - Robert J Ursano
- r Center for the Study of Traumatic Stress, Department of Psychiatry , Uniformed Services University School of Medicine , Bethesda , MD , USA
| | - Miranda Van Hooff
- l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Darryl Wade
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Simon Wessely
- g King's Centre for Military Health Research, King's College London , London , UK
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Bein L, Grau PP, Saunders SM, deRoon-Cassini TA. Military Mental Health: Problem Recognition, Treatment-Seeking, and Barriers. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/21635781.2018.1526147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Laura Bein
- Advocate Health Care, Marquette University, Milwaukee, Wisconsin
| | - Peter P. Grau
- Department of Counseling Psychology, Marquette University, Milwaukee, Wisconsin
| | | | - Terri A. deRoon-Cassini
- Department of Surgery, Division of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
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32
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Seidman AJ, Wade NG, Vogel DL, Armistead-Jehle P. The impact of stigma on behavioral health care utilization among active duty service members. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1522927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - David L. Vogel
- Department of Psychology, Iowa State University, Ames, Iowa
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33
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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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34
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Blais RK. Preliminary Evidence of Differences Between Stigma Source Versus Type With Individual Functioning Variables in National Guard/Reserve Troops. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000119] [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)
- R. K. Blais
- Department of Psychology, University of Utah
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35
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Haugen PT, McCrillis AM, Smid GE, Nijdam MJ. Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis. J Psychiatr Res 2017; 94:218-229. [PMID: 28800529 DOI: 10.1016/j.jpsychires.2017.08.001] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/11/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE It is unclear how many first responders experience barriers to care and stigma regarding mental health care, and how this influences their help-seeking. A systematic review and meta-analysis was conducted on barriers to care and mental health stigma in first responders and their empirical relationship with psychosocial and psychiatric variables. METHODS The databases Medline, Embase PsycINFO, CINAHL, PILOTS, LILACS, Sociological Abstracts, SocINDEX, and Social Citation Index were searched to identify relevant studies. A quality assessment and meta-analysis was performed. RESULTS Fourteen articles met inclusion criteria, from which data from 12 samples were extracted for meta-analyses. All studies measured stigma regarding mental health care and 33.1% of first responders (95% CI 26.7-40.1; 12 individual samples) endorsed stigma items. The systematic review revealed that the most frequently endorsed items were fears regarding confidentiality and negative career impact. Five of 14 studies measured barriers to mental health care and 9.3% of first responders (95% CI 7.0-12.3; 4 individual samples) endorsed barriers to care items. The most frequently endorsed barriers were scheduling concerns and not knowing where to get help. Indications were found for more stigma and barriers in individuals with mental health problems. CONCLUSIONS Stigma and barriers to care are experienced by a significant proportion of firs responders, which can potentially lead to delayed presentation in mental health care and therefore, increased risk of chronicity of post-trauma psychopathology for these groups. The current systematic review draws attention to the paucity of research in this area, particularly in non-Western samples.
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Affiliation(s)
- Peter T Haugen
- NYU School of Medicine, NYU School of Medicine WTC Health Program Clinical Center of Excellence, 530 First Avenue, New York, NY, 10016, USA.
| | - Aileen M McCrillis
- NYU School of Medicine, Medical Library, 577 First Ave, New York, NY, 10016, USA
| | - Geert E Smid
- Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands
| | - Mirjam J Nijdam
- Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands; Center for Psychological Trauma, Academic Medical Center at the University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
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36
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Graziano R, Elbogen EB. Improving Mental Health Treatment Utilization in Military Veterans: Examining the Effects of Perceived Need for Care and Social Support. MILITARY PSYCHOLOGY 2017; 29:359-369. [PMID: 29335663 PMCID: PMC5766283 DOI: 10.1037/mil0000169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Many veterans with mental health problems do not adequately utilize needed care. Research has focused on identifying barriers to mental health care in veterans. METHOD The current study adds to existing literature by examining whether perceived need for treatment and social support affect treatment utilization in a national longitudinal survey of Iraq and Afghanistan veterans (n = 1090). RESULTS The Health Beliefs Model (HBM) postulates that a key reason why patients fail to obtain needed care is their belief "it's up to me to handle my own problems." This view was endorsed by 42% in the current national sample of veterans and was found in multivariate analysis to predict less treatment seeking in the next year. Mediation analysis revealed that veterans with higher ratings of social support were less likely to believe they needed to solve mental health problems on their own, indirectly equating to higher odds of treatment use. Simultaneously, findings indicated that posttraumatic stress disorder (PTSD) had a direct effect on more mental health visits but was also associated with higher endorsement that one needed to handle one's own problems and thus had an indirect effect of reducing mental health visits. CONCLUSION Both social support and PTSD affected veterans' perceptions of needing to solve one's own problems, significantly predicted follow-up with mental health care. As a result, the findings indicate that clinicians' should explore veterans' belief systems about perceived treatment need as well as investigate the role of social support to improve mental health treatment utilization.
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Affiliation(s)
| | - Eric B Elbogen
- University of North Carolina at Chapel Hill. Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
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37
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Hernandez SHA, Morgan BJ, Parshall MB. A Concept Analysis of Stigma Perceived by Military Service Members Who Seek Mental Health Services. Nurs Forum 2017; 52:188-195. [PMID: 27958653 DOI: 10.1111/nuf.12187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/26/2016] [Accepted: 06/27/2016] [Indexed: 06/06/2023]
Abstract
PROBLEM The aim of this concept analysis is to clarify military service members' stigma associated with seeking mental health services (MHS). Since 2001, over 2 million military service members have been deployed for or assigned to support military operations. Many service members develop a mental health concern during or after a deployment. Although researchers have assessed perceptions of stigma associated with accessing MHS, defining stigma is difficult, and conceptual clarity regarding stigma is lagging behind studies focused on its effects. METHODS Stigma was explored using Walker and Avant's method of concept analysis. Thirty articles were found in the PsycARTICLES, PsycINFO, and PubMed databases and selected for inclusion and synthesis. FINDINGS Military service member stigma is a set of beliefs, based on the member's military and prior civilian enculturation, that seeking MHS would be discrediting or embarrassing, cause harm to career progression, or cause peers or superiors to have decreased confidence in the member's ability to perform assigned duties. CONCLUSIONS Nurses are ideally suited and situated to play an important role in decreasing stigma inhibiting service members from seeking MHS. Healthcare providers and civilian and uniformed leaders must communicate the value of seeking MHS to ensure service members' health, unit readiness, and overall force preparedness.
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Affiliation(s)
| | - Brenda J Morgan
- Director, 59th Medical Wing Nursing Research Division, Lackland, TX
| | - Mark B Parshall
- Professor, College of Nursing, University of New Mexico, Albuquerque, NM
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38
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Rona RJ, Burdett H, Khondoker M, Chesnokov M, Green K, Pernet D, Jones N, Greenberg N, Wessely S, Fear NT. Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial. Lancet 2017; 389:1410-1423. [PMID: 28215661 DOI: 10.1016/s0140-6736(16)32398-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 09/06/2016] [Accepted: 09/20/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The effectiveness of post-deployment screening for mental disorders has not been assessed in a randomised controlled trial. We aimed to assess whether post-deployment screening for post-traumatic stress disorder (PTSD), depression, anxiety, or alcohol misuse was effective. We defined screening as the presumptive identification of a previously unrecognised disorder using tests to distinguish those who probably had the disorder from those who probably did not so that those people with a probable disorder could be referred appropriately, and assessed effectiveness and consequences for help-seeking by the odds ratio at follow-up between those receiving tailored help-seeking advice and those who received general mental health advice. METHODS We did a cluster randomised controlled trial among Royal Marines and Army personnel in the UK military after deployment to Afghanistan. Platoons were randomly assigned (1:1 initially, then 2:1) by stratified block randomisation with randomly varying block sizes of two and four to the screening group, which received tailored help-seeking advice, or the control group, which received general mental health advice. Initial assessment took place 6-12 weeks after deployment; follow-up assessments were done 10-24 months later. Follow-up measures were the PTSD Checklist-Civilian Version, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 scale, Alcohol Use Disorder Identification Test (AUDIT), and self-reported help-seeking from clinical and welfare providers comparing those receiving tailored advice and those receiving only general advice. All participants and all investigators other than the person who analysed the data were masked to allocation. The primary outcomes were PTSD, depression or generalised anxiety disorder, and alcohol misuse at follow-up. A key secondary outcome was assessment of whether post-deployment screening followed by tailored advice would modify help-seeking behaviour. Comparisons were made between screening and control groups, with primary analyses by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN19965528. FINDINGS Between Oct 24, 2011, and Oct 31, 2014, 434 platoons comprising 10 190 personnel were included: 274 (6350 personnel) in the screening group and 160 (3840 personnel) in the control group. 5577 (88%) of 6350 personnel received screening and 3996 (63%) completed follow-up, whereas 3149 (82%) of 3840 received the control questionnaire and 2369 (62%) completed follow-up. 1958 (35%) of 5577 personnel in the screening group declined to see the tailored advice, but those with PTSD (83%) or anxiety or depression (84%) were more likely than non-cases (64%) to view the advice (both p<0·0001). At follow-up, there were no significant differences in prevalence between groups for PTSD (adjusted odds ratio 0·92, 95% CI 0·75-1·14), depression or anxiety (0·91, 0·71-1·16), alcohol misuse (0·88, 0·73-1·06), or seeking support for mental disorders (0·92, 0·78-1·08). INTERPRETATION Post-deployment screening for mental disorders based on tailored advice was not effective at reducing prevalence of mental health disorders nor did it increase help-seeking. Countries that have implemented post-deployment screening programmes for mental disorders should consider monitoring the outcomes of their programmes. FUNDING The US Army Medical Research and Materiel Command-Military Operational Medicine Research Program (USAMRMC-MOMRP).
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Affiliation(s)
- Roberto J Rona
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK.
| | - Howard Burdett
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | | | - Melanie Chesnokov
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Kevin Green
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK; Navy Command Headquarter Operational Stress Management/Trauma Risk Management, West Battery, Whale Island, Portsmouth, UK
| | - David Pernet
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Norman Jones
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
| | - Neil Greenberg
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
| | - Simon Wessely
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Nicola T Fear
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
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39
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Adler AB, Gunia BC, Bliese PD, Kim PY, LoPresti ML. Using actigraphy feedback to improve sleep in soldiers: an exploratory trial. Sleep Health 2017; 3:126-131. [DOI: 10.1016/j.sleh.2017.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 12/24/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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40
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Schnyder N, Panczak R, Groth N, Schultze-Lutter F. Association between mental health-related stigma and active help-seeking: systematic review and meta-analysis. Br J Psychiatry 2017; 210:261-268. [PMID: 28153928 DOI: 10.1192/bjp.bp.116.189464] [Citation(s) in RCA: 309] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/22/2016] [Accepted: 09/06/2016] [Indexed: 11/23/2022]
Abstract
BackgroundMental disorders create high individual and societal costs and burden, partly because help-seeking is often delayed or completely avoided. Stigma related to mental disorders or mental health services is regarded as a main reason for insufficient help-seeking.AimsTo estimate the impact of four stigma types (help-seeking attitudes and personal, self and perceived public stigma) on active help-seeking in the general population.MethodA systematic review of three electronic databases was followed by random effect meta-analyses according to the stigma types.ResultsTwenty-seven studies fulfilled eligibility criteria. Participants' own negative attitudes towards mental health help-seeking (OR = 0.80, 95% CI 0.73-0.88) and their stigmatising attitudes towards people with a mental illness (OR = 0.82, 95% CI 0.69-0.98) were associated with less active help-seeking. Self-stigma showed insignificant association (OR = 0.88, 95% CI 0.76-1.03), whereas perceived public stigma was not associated.ConclusionsPersonal attitudes towards mental illness or help-seeking are associated with active help-seeking for mental problems. Campaigns promoting help-seeking by means of fighting mental illness-related stigma should target these personal attitudes rather than broad public opinions.
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Affiliation(s)
- Nina Schnyder
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Radoslaw Panczak
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Nicola Groth
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Frauke Schultze-Lutter
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
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Editorial. JOURNAL OF PUBLIC MENTAL HEALTH 2017. [DOI: 10.1108/jpmh-12-2016-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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: 93] [Impact Index Per Article: 13.3] [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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Sparrow K, Kwan J, Howard L, Fear N, MacManus D. Systematic review of mental health disorders and intimate partner violence victimisation among military populations. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1059-1080. [PMID: 28748307 PMCID: PMC5581819 DOI: 10.1007/s00127-017-1423-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/14/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE There is growing awareness of the problem of intimate partner violence (IPV) among military populations. IPV victimisation has been shown to be associated with mental disorder. A better understanding of the link between IPV and mental disorder is needed to inform service development to meet the needs of military families. We aimed to systematically review the literature on the association between IPV victimisation and mental health disorders among military personnel. METHODS Searches of four electronic databases (Embase, Medline, PsycINFO, and Web of Science) were supplemented by reference list screening. Heterogeneity among studies precluded a meta-analysis. RESULTS Thirteen studies were included. There was stronger evidence for an association between IPV and depression/alcohol problems than between IPV and PTSD. An association between IPV and mental health problems was more frequently found among veterans compared to active duty personnel. However, the link between IPV and alcohol misuse was more consistently found among active duty samples. Finally, among active duty personnel psychological IPV was more consistently associated with depression/alcohol problems than physical/sexual IPV. The review highlighted the lack of research on male IPV victimisation in the military. CONCLUSIONS There is evidence that the burden of mental health need may be significant among military personnel who are victims of IPV. The influence of attitudes towards gender in the military on research in this area is discussed. Further research is needed to inform development of services and policy to reduce IPV victimisation and the mental health consequences among military personnel.
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Affiliation(s)
- Katherine Sparrow
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry Psychology and Neuroscience, King’s College London, PO23, 16 De Crespigny Park, London, SE5 8AF UK
| | - Jamie Kwan
- Department of Psychological Medicine, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
| | - Louise Howard
- David Goldberg Centre, Institute of Psychiatry Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Nicola Fear
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
| | - Deirdre MacManus
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry Psychology and Neuroscience, King's College London, PO23, 16 De Crespigny Park, London, SE5 8AF, UK.
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Britt TW, Jennings KS, Cheung JH, Pury CL, Zinzow HM, Raymond MA, McFadden AC. Determinants of mental health treatment seeking among soldiers who recognize their problem: implications for high-risk occupations. WORK AND STRESS 2016. [DOI: 10.1080/02678373.2016.1246490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Michalopoulou LE, Welsh JA, Perkins DF, Ormsby L. Stigma and Mental Health Service Utilization in Military Personnel: A Review of the Literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/21635781.2016.1200504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lito E. Michalopoulou
- Clearinghouse for Military Family Readiness at Penn State, University Park, Pennsylvania
| | - Janet A. Welsh
- Clearinghouse for Military Family Readiness at Penn State, University Park, Pennsylvania
| | - Daniel F. Perkins
- Clearinghouse for Military Family Readiness at Penn State, University Park, Pennsylvania
| | - LaJuana Ormsby
- U.S. Air Force, Family Advocacy Program, San Antonio, Texas
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Goguen K, Britt TW, Jennings K, Sytine A, Jeffirs S, Peasley A, Zaremba B, Palmer J. Implicit and Explicit Attitudes Toward Mental Health Treatment. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2016. [DOI: 10.1521/jscp.2016.35.1.45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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