Download perceptions of stigma and other barriers to seeking mental health

PERCEPTIONS OF STIGMA AND OTHER BARRIERS TO SEEKING
MENTAL HEALTH SERVICES AMONG VETERANS
Ashley J. Nichols, Ruveanna A. Hambrick, Lauren M. Sparks, & Michelle B.
Hill, PhD. University of North Georgia, Dahlonega, GA.
Introduction
Methodology
The results for this presentation are a subset of a larger study that will
examine the prevalence and manifestation of Post Traumatic Stress
Disorder (PTSD) among a group of combat veterans. It examines
whether elevated rates of externalizing behaviors following
deployment could be explained by combat exposure and internalizing
symptoms, such as PTSD symptoms, guilt, and moral injury. This
study also examines the health of the social environment. The culture
of the military values self-reliance and strength, and seeking mental
health services stigmatizes one as weak (Bush et. al, 2011).
According to Britt, stigma in the military is defined as the belief “that
seeking treatment would be embarrassing, cause harm to their
career, and/or cause their fellow unit members to have less
confidence in them,” (2004). Consequently, a significant proportion of
the veteran population who are in need of mental health care are
choosing not to seek treatment at all. In addition, financial barriers
and lack of knowledge of where to seek help prevents some veterans
from doing so. Many combat veterans hold negative perceptions of
mental health professionals and the delivery of mental health care
(Ouimette et. al, 2011). Some combat veterans may also express
concern about the potential effects a diagnosed mental disorder may
have on their careers in the military (Britt 2012). A 2004 study found
that those veterans whose self-report data were indicative of a mental
health disorder were twice as likely to report concern about
stigmatization and other barriers to seeking mental health care (Hoge
et. al, 2004). A study conducted in 2009 found that veterans who
rated their leaders more highly and had a more positive perception of
unit cohesion were less likely to perceive barriers to care and express
concern regarding the stigmatization of seeking mental health care
(Wright et. al). # This study examines the in-country diagnosis of
Combat Related Stress (CRS) and the perceived reaction of the
veteran’s unit leadership to the CRS diagnosis at their forward
operating base. Although the military provides a strict code of conduct
in how one’s unit leadership should respond to CRS, current research
has shown significant differences in veteran’s in-country experience
from supportive to unaccommodating. Some soldiers are told to that
such reactions to combat are signs of weakness. The effects of this
dynamic in relation to the general stigmas perceived by veterans
regarding the seeking of mental health services were analyzed in
relation to the barriers that veterans have when attempting to seek
mental health services. In the current research, beyond stigma,
significant barriers have been related mostly to available services and
understanding of combat by mental health providers. By researching
these issues associated with seeking mental health care, we can
better access why veterans do not seek help when experiencing
symptoms of PTSD.
Participants (n=21) were all veterans of the OIF, OEF, OND, or Desert
Storm conflicts. There were 19 males and 2 females, and participants
ranged in age from 23-49. The sample was representative of all
ethnicities, marital status, educational levels, and SES. Date of last
deployment ranged from 2004-2012.
Demographic survey: The 12-item survey is used to gather data for
participant characteristics with regards to age, gender, SES, marital
status, branch of service
and deployment.
Internalized Symptomology. The Mississippi Scale for Combat-Related
PTSD or M-PTSD is a 35-item self-report measure that assesses
combat-related PTSD in veteran
populations. Items sample DSM IV symptoms of PTSD and frequently
observed associated features (substance abuse, suicidality, and
depression). Respondents are asked to rate how they feel about each
item using 5-point, Likert-style response categories. Ten positively
framed items are reversed scored and then responses are summed to
provide an index of PTSD symptom severity that can range from 35175. Cutoff scores for a probable PTSD diagnosis have been validated
for some populations, but may not generalize to other populations
(Keane, Caddell, & Taylor, 1988).
Social Environment: This part of the instrumentation packet asks 4items regarding Combat and Operational Stress Reactions (COSR)
and what the combat veterans experience was during deployment
because we hypothesize that this aspect of a soldiers social
experience called Combat Operation Stress Reaction (COSR) may
have an impact on their return and seeking services separate from
stigma. The 12-item survey of the Multidimensional Scale of Perceived
Social Support (MSPPS, Zimet et al., 1988) is on a 5-point scale and
assesses the soldier’s social environment after deployment and upon
reintegration. Three additional questions ask specific questions
regarding after deployment unit connection and use of the support of
mental health and significant relationship status since returning from
war. Included in externalizing behaviors is the 10-item Self-Stigma of
Seeking Help Scale (SSOSH) (Vogel, Wade, & Haake, 2006).
Hypothesis
It is expected that those with PTSD will be more likely to perceive that
a stigma exists within the military for those who seek mental health
care.
Results and Conclusions
Scores on the Mississippi scale for PTSD ranged from 36 to 125 (M
= 74.38, SD = 22.955). This potentially places 11 participants in the
category of psychological distress (within the range of 60-112) and
two potentially within the range of PTSD (112-148). In this sample, 8
responded that they experienced some form of battle distress. Only
one individual was correctly identified and sent to the forward
operating base. 5 believed they experienced COSR, but were never
sent to the FOB. Two individuals received care as outlined in the
military field manual, and three received none of the care outlined.
On a positive note, four felt that their unit leaders provided
reassurance and listened to them, although two reported that their
unit leaders ignored the problem and hoped it would just go away. A
correlation test was conducted to examine the relationship between
unit leaders’ reaction to distress or COSR and perceived threat to
self-confidence when seeking professional help. There was a
significant correlation (r(19) = -.526, p = .017). Any negative reaction
of unit leaders to the distress of soldiers within their unit correlates to
higher perceived threat of self-confidence if professional help was
sought (Figure 1). A one-way ANOVA was conducted to examine the
effect of unit leaders’ reaction to distress or COSR on perceived
stigma associated with seeking therapeutic assistance as
represented by beliefs regarding one’s potential to be promoted
within the military. A significant effect was found [F(1,18) = 6.05, p
=.024]. Any negative reaction of unit leaders to distress of the
soldiers within their unit was shown to predict negative perceptions
of promotional potential in the minds of veterans. A one-way ANOVA
was conducted to examine the effect of PTSD scores on perceived
threat to self confidence when seeking professional help. A
significant effect was found [F(1,19) = 5.31, p = .033]. Higher scores
on the Mississippi Scale for PTSD corresponds to a higher
perceived threat to self-confidence when seeking professional help.
Discussion
As of yet, our research is limited due to a small sample size.
In the future, we plan to gather more data from a greater number
of participants through non-random sampling. We will attempt to
develop a deeper understanding of COSR in relation to PTSD and
the ways in which the two differ in diagnostic criteria. It is our hope
that this and future research will contribute to the cultural
competency of mental health care providers so that they may
better provide the assistance that is needed in the veteran
population.
References
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toward receiving mental health treatment: A multilevel approach. Psychological Services, 9(1), 26-37.
doi:10.1037/a0026412
Bush, N. E., Bosmajian, C. P., Fairall, J. M., McCann, R. A., & Ciulla, R. P. (2011). afterdeployment.org:
A web-based multimedia wellness resource for the postdeployment military community. Professional
Psychology: Research And Practice, 42(6), 455-462. doi:10.1037/a0025038
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat
Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care. The New England Journal
Of Medicine, 351(1), 13-22. doi:10.1056/NEJMoa040603
Ouimette, P., Vogt, D., Wade, M., Tirone, V., Greenbaum, M. A., Kimerling, R., & ... Rosen, C. S. (2011).
Perceived barriers to care among veterans health administration patients with posttraumatic stress
disorder. Psychological Services, 8(3), 212-223. doi:10.1037/a0024360
Wright, K. M., Cabrera, O. A., Bliese, P. D., Adler, A. B., Hoge, C. W., & Castro, C. A. (2009). Stigma
and barriers to care in soldiers postcombat. Psychological Services, 6(2), 108-116.
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