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

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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.

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          Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

          Charles W Hoge, Carl A. Castro, Stephen C. Messer … (2004)
          The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. Copyright 2004 Massachusetts Medical Society
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            Lessons from social psychology on discrediting psychiatric stigma.

            P Corrigan, D. L. Penn (1999)
            Advocacy, government, and public-service groups rely on a variety of strategies to diminish the impact of stigma on persons with severe mental illness. These strategies include protest, education, and promoting contact between the general public and persons with these disorders. The authors argue that social psychological research on ethnic minority and other group stereotypes should be considered when implementing these strategies. Such research indicates that (a) attempts to suppress stereotypes through protest can result in a rebound effect; (b) education programs may be limited because many stereotypes are resilient to change; and (c) contact is enhanced by a variety of factors, including equal status, cooperative interaction, and institutional support. Future directions for research and practice to reduce stigma toward persons with severe mental illness are discussed.
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              Assessing depression in primary care with the PHQ-9: can it be carried out over the telephone?

              Alejandra Pinto-Meza, Antoni Serrano-Blanco, Maria T Peñarrubia … (2005)
              Telephone assessment of depression for research purposes is increasingly being used. The Patient Health Questionnaire 9-item depression module (PHQ-9) is a well-validated, brief, self-reported, diagnostic, and severity measure of depression designed for use in primary care (PC). To our knowledge, there are no available data regarding its validity when administered over the telephone. The aims of the present study were to evaluate agreement between self-administered and telephone-administered PHQ-9, to investigate possible systematic bias, and to evaluate the internal consistency of the telephone-administered PHQ-9. Three hundred and forty-six participants from two PC centers were assessed twice with the PHQ-9. Participants were divided into 4 groups according to administration procedure order and administration procedure of the PHQ-9: Self-administered/Telephone-administered; Telephone-administered/Self-administered; Telephone-administered/Telephone-administered; and Self-administered/Self-administered. The first 2 groups served for analyzing the procedural validity of telephone-administered PHQ-9. The last 2 allowed a test-retest reliability analysis of both self- and telephone-administered PHQ-9. Intraclass correlation coefficient (ICC) and weighted kappa (for each item) were calculated as measures of concordance. Additionally, Pearson's correlation coefficient, Student's t-test, and Cronbach's alpha were analyzed. Intraclass correlation coefficient and weighted kappa between both administration procedures were excellent, revealing a strong concordance between telephone- and self-administered PHQ-9. A small and clinically nonsignificant tendency was observed toward lower scores for the telephone-administered PHQ-9. The internal consistency of the telephone-administered PHQ-9 was high and close to the self-administered one. Telephone and in-person assessments by means of the PHQ-9 yield similar results. Thus, telephone administration of the PHQ-9 seems to be a reliable procedure for assessing depression in PC.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMC Health Serv Res
                Title: BMC Health Services Research
                Publisher: BioMed Central
                ISSN (Electronic): 1472-6963
                Publication date Collection: 2011
                Publication date (Electronic): 10 February 2011
                Volume: 11
                Page: 31
                Affiliations
                [1 ]King's Centre for Military Health Research, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK
                [2 ]Academic Centre for Defence Mental Health, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK
                [3 ]Health Service and Population Research Department, King's College London, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK
                Article
                Publisher ID: 1472-6963-11-31
                DOI: 10.1186/1472-6963-11-31
                PMC ID: 3048487
                PubMed ID: 21310027
                SO-VID: 5576c189-bbe3-4151-89c1-ec736d821575
                Copyright © Copyright ©2011 Iversen et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 July 2010
                Date accepted : 10 February 2011
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Health & Social care
                Data availability:
                ScienceOpen disciplines: Health & Social care

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