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BMC Health Services Research
Published in: BMC Health Services Research 1/2011

Open Access 01-12-2011 | Research article

The stigma of mental health problems and other barriers to care in the UK Armed Forces

Authors: Amy C Iversen, Lauren van Staden, Jamie Hacker Hughes, Neil Greenberg, Matthew Hotopf, Roberto J Rona, Graham Thornicroft, Simon Wessely, Nicola T Fear

Published in: BMC Health Services Research | Issue 1/2011

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Abstract

Background

As with the general population, a proportion of military personnel with mental health problems do not seek help. As the military is a profession at high risk of occupational psychiatric injury, understanding barriers to help-seeking is a priority.

Method

Participants were drawn from a large UK military health study. Participants undertook a telephone interview including the Patient Health Questionnaire (PHQ); a short measure of PTSD (Primary Care PTSD, PC-PTSD); a series of questions about service utilisation; and barriers to care. The response rate was 76% (821 participants).

Results

The most common barriers to care reported are those relating to the anticipated public stigma associated with consulting for a mental health problem. In addition, participants reported barriers in the practicalities of consulting such as scheduling an appointment and having time off for treatment. Barriers to care did not appear to be diminished after people leave the Armed Forces. Veterans report additional barriers to care of not knowing where to find help and a concern that their employer would blame them for their problems. Those with mental health problems, such as PTSD, report significantly more barriers to care than those who do not have a diagnosis of a mental disorder.

Conclusions

Despite recent efforts to de-stigmatise mental disorders in the military, anticipated stigma and practical barriers to consulting stand in the way of access to care for some Service personnel. Further interventions to reduce stigma and ensuring that Service personnel have access to high quality confidential assessment and treatment remain priorities for the UK Armed Forces.
Literature
1.
Sareen J, Cox BJ, Afifi TO, Stein MB, Belik SL, Meadows G, Asmundson GJ: Combat and peacekeeping operations in relation to prevalence of mental disorders and perceived need for mental health care: findings from a large representative sample of military personnel. Arch Gen Psychiatry. 2007, 64 (7): 843-852. 10.1001/archpsyc.64.7.843.CrossRefPubMed
2.
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL: Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004, 351 (1): 13-22. 10.1056/NEJMoa040603.CrossRefPubMed
3.
Iversen A, Dyson C, Smith N, Greenberg N, Walwyn R, Unwin C, Hull L, Hotopf M, Dandeker C, Ross J, et al: 'Goodbye and good luck': the mental health needs and treatment experiences of British ex-service personnel. Br J Psychiatry. 2005, 186: 480-486. 10.1192/bjp.186.6.480.CrossRefPubMed
4.
Hoge CW, Auchterlonie JL, Milliken CS: Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA. 2006, 295 (9): 1023-1032. 10.1001/jama.295.9.1023.CrossRefPubMed
5.
Hoge CW, Lesikar SE, Guevara R, Lange J, Brundage JF, Engel CC, Messer SC, Orman DT: Mental disorders among U.S. military personnel in the 1990s: association with high levels of health care utilization and early military attrition. Am J Psychiatry. 2002, 159 (9): 1576-1583. 10.1176/appi.ajp.159.9.1576.CrossRefPubMed
6.
Corrigan PW, Watson AC: The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice. 2002, 9: 35-53. 10.1093/clipsy/9.1.35.
7.
Britt TW: The Stigma of Psychological Problems in Work Environment: Evidence from the Screening of Service Members Returning from Bosnia. Journal of Applied Social Psychology. 2000, 30 (8): 1599-1618. 10.1111/j.1559-1816.2000.tb02457.x.CrossRef
8.
French C, Rona RJ, Jones M, Wessely S: Screening for physical and psychological illness in the British Armed Forces: II: Barriers to screening--learning from the opinions of Service personnel. J Med Screen. 2004, 11 (3): 153-157. 10.1258/0969141041732247.CrossRefPubMed
9.
Greene-Shortridge TM, Britt TW, Castro CA: The stigma of mental health problems in the military. Mil Med. 2007, 172 (2): 157-161.CrossRefPubMed
10.
Cepeda-Benito A, Short P: Self-concealment, avoidance of psychological services, and perceived likelihood of seeking professional help. Journal of Counseling Psychology. 1998, 45: 1-7. 10.1037/0022-0167.45.1.58.CrossRef
11.
Hotopf M, Hull L, Fear NT, Browne T, Horn O, Iversen A, Jones M, Murphy D, Bland D, Earnshaw M, et al: The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet. 2006, 367 (9524): 1731-1741. 10.1016/S0140-6736(06)68662-5.CrossRefPubMed
12.
Iversen AC, van Staden L, Hughes JH, Browne T, Hull L, Hall J, Greenberg N, Rona RJ, Hotopf M, Wessely S, et al: The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study. BMC Psychiatry. 2009, 9: 68-10.1186/1471-244X-9-68.CrossRefPubMedPubMedCentral
13.
14.
Fear NT, Iversen A, Meltzer H, Workman L, Hull L, Greenberg N, Barker C, Browne T, Earnshaw M, Horn O, et al: Patterns of drinking in the UK Armed Forces. Addiction. 2007, 102 (11): 1749-1759. 10.1111/j.1360-0443.2007.01978.x.CrossRefPubMed
15.
Goldberg D: The detection of psychiatric illness by questionnaire. 1972, London: OUP
16.
Spitzer RL, Kroenke K, Williams JB: Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999, 282 (18): 1737-1744. 10.1001/jama.282.18.1737.CrossRefPubMed
17.
Prins A, Kimerling R, Cameron R, Oumiette PC, Shaw J, Thrailkill A, Sheikh J, Gusman F: The Primary Care PTSD Screen (PC-PTSD). 15th annual meeting of the International Society for Traumatic Stress Studies. Miami, FL. 1999
18.
Chisholm D, Knapp MR, Knudsen HC, Amaddeo F, Gaite L, van Wijngaarden B: Client Socio-Demographic and Service Receipt Inventory--European Version: development of an instrument for international research. EPSILON Study 5. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs. Br J Psychiatry Suppl. 2000, 39: s28-33. 10.1192/bjp.177.39.s28.CrossRefPubMed
19.
Pinto-Meza A, Serrano-Blanco A, Penarrubia MT, Blanco E, Haro JM: Assessing depression in primary care with the PHQ-9: can it be carried out over the telephone?. J Gen Intern Med. 2005, 20 (8): 738-742. 10.1111/j.1525-1497.2005.0144.x.CrossRefPubMedPubMedCentral
20.
Milliken CS, Auchterlonie JL, Hoge CW: Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007, 298 (18): 2141-2148. 10.1001/jama.298.18.2141.CrossRefPubMed
21.
Kessler R, Somnnega A, Bromet E, Nelson C, Hughes M, Nelson C: Post-traumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry. 1995, 52: 1048-1060.CrossRefPubMed
22.
STATA 10: StataCorp LP,4905 Lakeway Drive, College Station, Texas 77845, USA. 2007
23.
Kent RA: Data construction and data analysis for survey research. 2001, New York: Palgrave Macmillan
24.
Corrigan PW: How stigma interferes with mental health care. American Psychologist. 2004, 59 (7): 614-625. 10.1037/0003-066X.59.7.614.CrossRefPubMed
25.
Tanielian T, Jaycox LH: Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery. 2008, Santa Monica, USA: RAND Centre for Military Health Policy Research
26.
Fikretoglu D, Guay S, Pedlar D, Brunet A: Twelve month use of mental health services in a nationally representative, active military sample. Med Care. 2008, 46 (2): 217-223. 10.1097/MLR.0b013e31815b979a.CrossRefPubMed
27.
Porter TL, Johnson WB: Psychiatric stigma in the military. Mil Med. 1994, 159 (9): 602-605.PubMed
28.
Warner CH, Appenzeller GN, Mullen K, Warner CM, Grieger T: Soldier attitudes toward mental health screening and seeking care upon return from combat. Mil Med. 2008, 173 (6): 563-569.CrossRefPubMed
29.
Browne T, Hull L, Horn O, Jones M, Murphy D, Fear NT, Greenberg N, French C, Rona RJ, Wessely S, et al: Explanations for the increase in mental health problems in UK reserve forces who have served in Iraq. Br J Psychiatry. 2007, 190: 484-489. 10.1192/bjp.bp.106.030544.CrossRefPubMed
30.
Eversden-French C, Dandeker C, Greenberg N, Hatch S, Riley P, van Staden L, Wessely S: Laying down their rifles: The changing influences on the retention of Volunteer British Army Reservists returning from Iraq: 2003-2007. Armed Forces & Society. 2010, 36 (2): 264-289.CrossRef
31.
32.
Thornicroft G: Shunned: Discrimination against people with mental illness. 2006, Oxford: Oxford University Press
33.
34.
Adler AB, Bliese PD, McGurk D, Hoge CW, Castro CA: Battlemind debriefing and battlemind training as early interventions with soldiers returning from iraq: Randomization by platoon. J Consult Clin Psychol. 2009, 77 (5): 928-940. 10.1037/a0016877.CrossRefPubMed
35.
36.
Corrigan PW, Penn DL: Lessons from social psychology on discrediting psychiatric stigma. Am Psychol. 1999, 54 (9): 765-776. 10.1037/0003-066X.54.9.765.CrossRefPubMed
37.
Adler AB, Cawkill P, van den Berg C, Arvers P, Puente J, Cuvelier Y: International military leaders' survey on operational stress. Mil Med. 2008, 173 (1): 10-16.CrossRefPubMed
38.
Wright K, Cabrera OA, Adler A, Bliese PD, Hoge CW: Stigma and barriers to care in soldier postcombat. Psychological Services. 2009, 6 (2): 108-116. 10.1037/a0012620.CrossRef
39.
Rowan AB, Campise RL: A multisite study of Air Force outpatient behavioral health treatment-seeking patterns and career impact. Mil Med. 2006, 171 (11): 1123-1127.CrossRefPubMed
40.
Greenberg N, Langston V, Jones N: Trauma risk management (TRiM) in the UK Armed Forces. J R Army Med Corps. 2008, 154 (2): 124-127.CrossRefPubMed
Metadata
Title
The stigma of mental health problems and other barriers to care in the UK Armed Forces
Authors
Amy C Iversen
Lauren van Staden
Jamie Hacker Hughes
Neil Greenberg
Matthew Hotopf
Roberto J Rona
Graham Thornicroft
Simon Wessely
Nicola T Fear
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2011
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-11-31

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