Abstract
Self-stigma can generate significant public health costs because of its implications concerning underutilization of treatment. Veterans are particularly vulnerable to the effects of self-stigma because of the military’s value of self-reliance, which may compound negative feelings toward receiving treatment. Few intervention studies to reduce veteran self-stigma apply the Corrigan and Watson (2002) model of self-stigma to the veteran experience. Doing so may yield additional insight into factors driving self-stigma. Therefore, the purpose of this article is to apply this model to veterans from recent generations of war. The authors conducted a constant-comparative method between the Corrigan and Watson self-stigma model and a variation of a stigma model among military personnel with mental illness to identify similarities, differences, and any unaccounted factors. Contextual factors, such as identify development, military cultural values, and family concerns, that have been noted in recent research as factors impacting stigma, were not accounted for in the Corrigan and Watson model. The proposed model encompasses those nuanced contextual factors. The newly proposed model and underlying reasons for behaviors differed from the Corrigan and Watson self-stigma framework regarding the following components: 1) resistance; 2) differentiate; and 3) protect. The model is meant to disseminate novel issues that compound the effects of veteran self-stigma. Future research needs to assess the adequacy of this model, and if it is consistent with the lived experience of veterans, develop interventions that target the corresponding issues within each component.
Highlights
Prior studies have found that 50%-82% of the recent generation of veterans (Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn) with mental health concerns do not access healthcare because of stigma (Kulesza et al, 2015; Nelson et al, 2014)
The authors propose the following components and underlying reasons for behaviors to explicate the self-stigma process among veterans
Veterans may believe that their situation and contextual factors vary from those of a civilian with mental illness
Summary
Prior studies have found that 50%-82% of the recent generation of veterans (Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn) with mental health concerns do not access healthcare because of stigma (Kulesza et al, 2015; Nelson et al, 2014). Heightened suicide rates are commonly associated with stigma, which among veterans, continues to be higher than that of any other group, holding steadily at 21 suicides per day (www.va.gov, 2018). Individuals in society are taught at an early age not to embrace feelings of differentness, but veterans may have a heightened sense of disregarding feelings of differentness (Kranke, Weiss, and Brown, 2017). Difference can accentuate feelings of exclusion and dissonance among veterans and civilians, since relationships are commonly based on feelings of similarity. There are approximately 22 million veterans in the US, 1.2 million of whom receive mental health treatment (www.va.gov, 2018). A report by the National Council for Behavioral Health (2012) showed that the incurred cost of Post-9/11 veterans with mental illnesses who do not seek treatment, is almost four-fold the cost for veterans who do seek psychiatric treatment; non-
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