Stigma, Barriers to Care, and Use of Mental Health Services Among Active Duty and National Guard Soldiers After Combat

Mental Health Issues of Women Deployed to Iraq and Afghanistan

This prospective study examined whether combat deployment differentially affected physical health–related functioning in U.S. Army National Guard (NG) versus Active Duty (AD) soldiers. Data collected in person at pre- and postdeployment assessments of 615 U.S. Army AD (n = 517) and NG (n = 98) male participants from infantry-type units deployed to the Iraq War were analyzed via linear mixed effects models. NG soldiers demonstrated significantly more adverse changes in physical health–related functioning than did AD soldiers. The adjusted Veterans RAND 12-Item Health Survey Physical Component Summary (PCS) score decreased 5% for NG versus 1% for AD from pre- to postdeployment. Adjustment for post-traumatic stress symptom severity did not alter these results.

To compare differences in disease nonbattle injury data between cohorts of deployed active duty (AD) and National Guard (NG) soldiers. This study compared AD and NG soldiers presenting for medical visits to a level I clinic in Iraq. Retrospective data were collected from the Department of Defense (DOD) electronic records system, on soldiers in two AD and two NG companies with populations of 391 and 425, respectively, regarding number of visits, age, gender, diagnosis, and evacuation for laboratory tests or X-rays (level II care) or for hospitalization or subspecialty services (level III care). Visits occurred during the 11-month period of October 1, 2006 through August 30, 2007. In the AD group, 180 of 391 (46%) soldiers presented for 594 visits (1.5 visits per soldier). In the NG units, 300 of 425 (71%) soldiers made 1,294 visits (3.1 visits per soldier). There were 67 AD evacuations, 54 sent for level II care and 13 for level III care as compared to 151 NG evacuations, 116 to level II and 35 to level III. The leading diagnoses for visits in both groups were musculoskeletal and dermatologic and the leading cause for evacuation was genitourinary. Gender utilization rates were 3.4 and 7.4 visits per AD and NG female compared to 1.2 and 2.8 visit per group matched male. NG soldiers presented for care and required evacuation twice as frequently as AD soldiers. NG patients were typically older. Female soldiers in both groups had higher utilization and evacuation rates than males.

Military unit support, postdeployment social support, and PTSD symptoms among active duty and National Guard soldiers deployed to Iraq

Employment Among Persons With Past and Current Mood and Anxiety Disorders in the Israel National Health Survey

Research into social determinants of mental and emotional health problems highlighted the need to understand the cultural factors. Mental health of immigrants is influenced by a variety of cultural, psychological, social, and economic factors. There is some evidence to suggest that South Asian people have higher rates of mental and emotional health problems than the rest of the Canadian population. Limited research also suggests that psycho-social factors are highly likely to be responsible for these high rates of mental health problems. These psychosocial factors may be impeding access and engagement with the services. These socially determined emotional and mental health problems are more likely to respond to psychosocial interventions than biological treatments. Evidence-based psychosocial interventions such as Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT) might offer the way forward. CBT can be offered in a low-cost, low intensity format in a variety of settings, thus addressing the attached stigma. However, these interventions need to be culturally adapted, as these are underpinned by a Western value system. CBT has been culturally adapted and found to be effective in this group elsewhere. This opinion paper describes the need to enhance research on psychosocial determinants of the mental and emotional health problems, status, and the psychosocial determinants of health amongst South Asians in Canada to inform our understanding of the cultural specificity of psychosocial interventions.

Loneliness has been shown to predict mental health problems and suicide in active duty soldiers. In the present study, we examined distal (e.g., demographic & socioeconomic characteristics) to proximal factors (e.g., platoon relations, relationship quality) that were associated with loneliness in active duty soldiers in the U.S. Army. Results revealed a set of factors that were associated with loneliness in active duty soldiers, including age, frequency of contact with friends and family by phone, childhood trauma, self-reported overall emotional health, intra-platoon harassment, perceived stress, perceived platoon cohesion and support, organizational citizenship behavior, relationship satisfaction with friends, and relationship satisfaction with platoon members. The association between loneliness and both perceived stress and relationship satisfaction with platoon members reached a moderate effect size in the multivariate models. Although some of predictors overlap with those identified in studies of civilians, most were unique to soldiers. Implications are discussed for understanding loneliness in an organization like the military and for the early identification of and intervention with active duty soldiers who may be at risk for mental and behavioral problems.

The Link Between Homeless Women's Mental Health and Service System Use

Impact of Intimate Partner Violence on Unmet Need for Mental Health Care: Results From the NSDUH

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

U.S. Army Soldiers undergo annual audiometric surveillance to facilitate prevention of auditory injury. Soldiers are screened for bothersome tinnitus and subsequently referred for a clinical audiological evaluation as warranted. Presumably, most Soldiers seen in the clinic for bothersome tinnitus receive a tinnitus diagnosis. The incidence of self-reported bothersome tinnitus at the time of annual audiometric surveillance and subsequent diagnosis of tinnitus in the medical record has not been examined to date. This study estimated the incidence of tinnitus diagnosis in a population of Soldiers who reported new onset bothersome tinnitus and explored trends associated with tinnitus diagnosis to refine hearing health education. A subset of hearing conservation records retrieved for a previous study were selected based on change in self-reporting of bothersome tinnitus. Corresponding medical records were retrieved for this sample of Active Duty (AD) Soldiers. The data were retrospectively examined, and analyses were conducted to identify statistically significant differences between Soldiers with and Soldiers without a tinnitus diagnosis. In addition, trend patterns of bothersome tinnitus and significant threshold shift (STS) were examined. Of the sample of 730,350 AD Soldiers, 16.7% self-reported new onset bothersome tinnitus and 7.1% of those recorded as having bothersome tinnitus had a diagnosis of tinnitus in their medical record. Soldiers with a tinnitus diagnosis were older and had higher pure-tone averages than Soldiers without a tinnitus diagnosis. Counterintuitively, overall trend percentages of bothersome tinnitus increased per calendar year, while the percentages of STS decreased throughout the study period. The rate of tinnitus diagnosis in the medical record is vastly lower than the prevalence of bothersome tinnitus recorded in the annual surveillance system. Steps should be taken to screen, refer, and diagnose tinnitus more consistently. Based on the outcome of the study analysis, we recommend that screening for bothersome tinnitus more closely follows procedure recommendations from the Department of Veterans Affairs and Department of Defense (VA/DOD) Tinnitus Working Group, which may reduce the rate at which Soldiers report bothersome tinnitus.

Purpose – The purpose of this paper is to assess changes in rates of mental health problems and service utilisation for Australian regular injecting drug users (IDUs) from 2006 to 2012. Design/methodology/approach – Data were taken from Illicit Drug Reporting System national surveys with 914 regular IDUs in 2006 and 883 in 2012. Changes in rates of self-reported mental health problems and service use were assessed. Findings – Rates of self-reported mental health problems increased from 38.3 per cent in 2006 to 43.7 per cent in 2012 – mainly due to increases in anxiety rates. Conversely, there was a decrease in mental health service use from 70.2 to 58.4 per cent by 2012. However, there was a proportional increase in the use of psychologists. These trends remained after controlling for socio-demographic and medical differences between the 2006/2012 samples. K10 scores for 2012 participants validated the use of the self-report measures. Practical implications – Reductions in stigma, improvements in mental health literacy, and modest increases in anxiety may explain increases in self-report of mental health problems. Stagnant service utilisation rates in an expanding population willing to self-report may explain decreasing service use. The introduction of key mental health reforms also may have contributed, particularly with the increase in psychologist access. This paper highlights the need for improved population monitoring of mental health in disadvantaged groups such as IDUs. Originality/value – This paper is the first to assess changes in mental health outcomes over time in Australian IDUs. This examination covered a critical era in the mental health landscape, with significant increases in public awareness campaigns and major mental health reforms.

Active duty United States soldiers encounter unimaginable stressors and challenges throughout their military career. Many of these soldiers are also simultaneously working to achieve a long-term goal of obtaining post-secondary education, yet they face unique challenges due to the demands of military service that traditional students do not. Active duty soldiers are referred to by Molina and Morse (2015) as military-connected students, defined as "National Guard members, reservists, active duty personnel, and veterans" from the United States Army, Navy, Marine Corps, and Air Force" (p. 1). Military students present uncommon challenges to institutions of higher education due to the demands of military service such as frequent deployments and duty assignments that may cause lack of access to their online courses for an extended amount of time (Brown & Gross, 2011). Due to challenges such as these, active duty soldiers have been shown to exhibit more risk factors of non-completion in higher education than other military-connected students; yet, it is unknown if there are additional risk factors that affect their academic perseverance in online learning programs (Molina & Morse, 2015). The purpose of this phenomenological case study was to identify the factors that affect the academic perseverance of active duty soldiers stationed at a large military installation in the southeast region of the United States to determine what relationships, if any, existed between factors related to active duty military service, personal factors, and grit in a sample of military-connected students who were enrolled in or had recently completed an online learning program. The central research question addressed in the study was as follows: What are the factors that affect the academic perseverance of military-connected students in online learning programs? Three sub-questions were addressed within the central research question. Applying the social constructivist stance, the researcher conducted data collection through semi-structured individual face-to-face interviews and administered the Short Grit Scale to eight active duty soldiers at a large military installation located in the southeast region of the United States. Data analysis followed Moustakas' (1994) modified version of the Van Kaam method of phenomenological analysis. Quantitative results from the Short Grit Scale were scored in accordance with the guidance in Duckworth and Quinn (2009). Five themes emerged from participants' shared experiences during eight semi-structured interviews as follows: (1) military-connected students may experience inter-role conflicts between work (military service), family, and school that could affect their academic perseverance in online learning programs; (2) military resources and incentives for higher education reported may positively affect military-connected students' academic perseverance in online learning programs; (3) military service obligations reported may negatively affect military-connected students' academic perseverance in online learning programs; (4) educational experiences in childhood and personal factors in adulthood may affect military-connected students' academic perseverance in online learning programs; (5) grit impact factors may influence military-connected students' work ethic and level of achievement in online learning programs. Results from the study will be used to better understand factors that affect the academic perseverance of military-connected students and to provide recommendations for supporting this population in institutions of higher education.

Health care utilization studies of mental disorders focus largely on the ICD-9 category 290-319, and do not generally include analysis of visits for mental health problems identified under V-code categories. Although active duty service members represent a large young adult employed population who use mental health services at similar rates as age-matched civilian populations, V-codes are used in a larger proportion of mental health visits in military mental health care settings than in civilian settings. However, the utilization of these diagnoses has not been systematically studied. The purpose of this study is to characterize outpatient behavioral health visits in military health care facilities prior to Operation Iraqi Freedom, including the use of diagnoses outside of the ICD-9 290-319 range, in order to evaluate the overall burden of mental health care. This study establishes baseline rates of mental health care utilization in military mental health clinics in 2000 and serves as a comparison for future studies of the mental health care burden of the current war. All active duty service members who received care in military outpatient clinics in 2000 (n = 1.35 million) were included. Primary diagnoses were grouped according to mental health relevance in the following categories: mental disorders (ICD-9 290-319), mental health V-code diagnoses (used primarily by behavioral health providers that were indicative of a potential mental health problem), and all other diagnoses. Rates of service utilization within behavioral health clinics were compared with rates in other outpatient clinics for each of the diagnostic groups, reported as individuals or visits per 1,000 person-years. Cox proportional hazard regression was used to produce hazard ratios as measures of association between each of the diagnostic groups and attrition from military service. Time to attrition in months was the difference between the date of military separation and the date of first clinic visit in 2000. Data were obtained from the Defense Medical Surveillance System. The total number of individuals who utilized behavioral health services in 2000 was just over 115 per 1,000 person-years, almost 12% of the military population. Out of every 1,000 person-years, 57.5 individuals received care from behavioral health providers involving an ICD-9 290-319 mental disorder diagnosis, and an additional 26.7 per 1,000 person-years received care in behavioral health clinics only for V-code diagnoses. Attrition from service was correlated with both categories of mental health-related diagnoses. After 1 year, approximately 38% of individuals who received a mental disorder diagnosis left the military, compared with 23% of those who received mental health V-code diagnoses and 14% of those who received health care for any other reason (which included well visits for routine physicals). This study establishes baseline rates of pre-war behavioral healthcare utilization among military service members, and the relationship of mental health care use and attrition from service. The research indicates that in the military population the burden of mental illness in outpatient clinics is significantly greater when V-code diagnoses are included along with conventional mental disorder diagnostic codes.

Despite significant mental health needs among sexual assault (SA) victims in the military, little is known about treatment-seeking patterns or factors associated with service use. This study examined service use behavior, barriers, and facilitators of mental health treatment-seeking in an active duty sample of 927 U.S. Army soldiers with mental health problems. SA victims (n = 113) did not differ from non-victims on barriers or facilitators after adjusting for demographic and mental health variables, with stigma rated as the largest barrier. Most SA victims (87.6%) had sought informal support and 59.3% had sought formal treatment. One third of treatment-seekers had dropped out of treatment. Multivariate logistic regression analyses identified several correlates of treatment-seeking among SA victims: Black race (OR = 7.57), SA during the military (OR = 4.34), positive treatment beliefs (OR = 2.22), social support for treatment (OR = 2.14), self-reliance (OR = 0.47), and stigma towards treatment seekers (OR = 0.43). Mental health symptoms were not associated with treatment seeking. Findings suggested that treatment-facilitating interventions should focus on improving recognition of mental health symptoms, altering perceptions related to self-reliance, and reducing stigma. Interventions should also enlist support for treatment-seeking from unit members, leaders, and significant others.