Abstract
A common barrier to healthcare for psychiatric conditions is the stigma associated with these disorders. Perceived stigma prevents many from reporting their symptoms. Stigma is a particularly pervasive problem among military service members, preventing them from reporting symptoms of combat-related conditions like posttraumatic stress disorder (PTSD). However, research shows increased reporting by service members when anonymous assessments are used. For example, service members report more symptoms of PTSD when they anonymously answer the Post-Deployment Health Assessment (PDHA) symptom checklist compared to the official PDHA, which is identifiable and linked to their military records. To investigate the factors that influence reporting of psychological symptoms by service members, we used a transformative technology: automated virtual humans that interview people about their symptoms. Such virtual human interviewers allow simultaneous use of two techniques for eliciting disclosure that would otherwise be incompatible; they afford anonymity while also building rapport. We examined whether virtual human interviewers could increase disclosure of mental health symptoms among active-duty service members that just returned from a year-long deployment in Afghanistan. Service members reported more symptoms during a conversation with a virtual human interviewer than on the official PDHA. They also reported more to a virtual human interviewer than on an anonymized PDHA. A second, larger sample of active-duty and former service members found a similar effect that approached statistical significance. Because respondents in both studies shared more with virtual human interviewers than an anonymized PDHA -even though both conditions control for stigma and ramifications for service members’ military records- virtual human interviewers that build rapport may provide a superior option to encourage reporting.
Highlights
People are reluctant to disclose information that could be potentially stigmatizing
There are pragmatic military career implications for having been screened positive for mental health conditions. To address this reluctance to disclose posttraumatic stress disorder (PTSD) symptoms on the Post-Deployment Health Assessment (PDHA), we examine whether a new technology, namely virtual human-interviewers, can be used to increase willingness of service members to report PTSD symptoms compared to the PDHA
Participants reported more PTSD symptoms when asked by a virtual human interviewer
Summary
People are reluctant to disclose information that could be potentially stigmatizing. One area where this failure to disclose honest information has large consequences is mental health. They may try to deal with stigma using coping methods that are more or less effective (Isaksson et al, 2017); if they cannot successfully cope, stigma and the resultant unwillingness to report symptoms end up preventing people from accessing or receiving treatment, leaving the disorder unresolved These barriers to care pose a large problem for society since mental health problems are costly, both in terms of money and social capital (Insel, 2008) and unresolved mental health problems continue to accrue increasing costs (World Health Organization, 2004; Insel, 2008; National Institute of Mental Health, 2010; World Economic Forum, 2011). There are pragmatic military career implications (such as the perception of possible future restrictions from certain job placements and from obtaining future security clearances) for having been screened positive for mental health conditions To address this reluctance to disclose PTSD symptoms on the PDHA, we examine whether a new technology, namely virtual human-interviewers, can be used to increase willingness of service members to report PTSD symptoms compared to the PDHA. Health symptoms that might otherwise be withheld when using traditional self-report checklists (such as the PDHA)
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