Exploring positive pathways to care for members of the UK Armed Forces receiving treatment for PTSD: a qualitative study

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Abstract

Objective

To examine the factors which facilitate UK military personnel with post-traumatic stress disorder (PTSD) to engage in help-seeking behaviours.

Methods

The study recruited active service personnel who were attending mental health services, employed a qualitative design, used semi-structured interview schedules to collect data, and explored these data using interpretative phenomenological analysis (IPA).

Results

Five themes emerged about how participants were able to access help; having to reach a crisis point before accepting the need for help, overcoming feelings of shame, the importance of having an internal locus of control, finding a psychological explanation for their symptoms and having strong social support.

Conclusions

This study reported that for military personnel who accessed mental health services, there were a number of factors that supported them to do so. In particular, factors that combated internal stigma, such as being supported to develop an internal locus of control, appeared to be critical in supporting military personnel to engage in help-seeking behaviour.

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Most cited references 24

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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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The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America?

R. Michael Bagby, Jian Yang, Shuqiao Yao … (2008)

The expectation that Chinese people present distress somatically is a central prediction of cultural psychopathology and has been the subject of considerable theoretical speculation. At the same time, empirical studies have been infrequent and have yielded mixed results. The authors examined symptom presentation in Chinese (n=175) and Euro-Canadian (n=107) outpatients, using spontaneous problem report, structured clinical interview, and symptom questionnaire methods. All 3 methods yielded cross-culturally equivalent somatic and psychological symptom subscales. Chinese outpatients reported more somatic symptoms on spontaneous problem report and structured clinical interview compared with Euro-Canadians, who in turn reported more psychological symptoms on all 3 methods. The relation between culture and somatic symptom presentation was mediated by a tendency toward externally oriented thinking. Difficulties with identifying emotions or describing them to others did not differ significantly across cultures, supporting a nonpathological interpretation of observed differences. Psychological symptom effects were larger and more consistent than somatic symptom effects; because other studies have confirmed the ubiquity of somatic presentations worldwide, these results suggest that Western psychologization may be more culturally specific than is Chinese somatization.

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New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study.

Tyler C Smith, Margaret A K Ryan, Deborah L. Wingard … (2008)

To describe new onset and persistence of self reported post-traumatic stress disorder symptoms in a large population based military cohort, many of whom were deployed in support of the wars in Iraq and Afghanistan. Prospective cohort analysis. Survey enrolment data from the millennium cohort (July 2001 to June 2003) obtained before the wars in Iraq and Afghanistan. Follow-up (June 2004 to February 2006) data on health outcomes collected from 50 184 participants. Self reported post-traumatic stress disorder as measured by the posttraumatic stress disorder checklist-civilian version using Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. More than 40% of the cohort were deployed between 2001 and 2006; between baseline and follow-up, 24% deployed for the first time in support of the wars in Iraq and Afghanistan. New incidence rates of 10-13 cases of post-traumatic stress disorder per 1000 person years occurred in the millennium cohort. New onset self reported post-traumatic stress disorder symptoms or diagnosis were identified in 7.6-8.7% of deployers who reported combat exposures, 1.4-2.1% of deployers who did not report combat exposures, and 2.3-3.0% of non-deployers. Among those with self reported symptoms of post-traumatic stress disorder at baseline, deployment did not affect persistence of symptoms. After adjustment for baseline characteristics, these prospective data indicate a threefold increase in new onset self reported post-traumatic stress disorder symptoms or diagnosis among deployed military personnel who reported combat exposures. The findings define the importance of post-traumatic stress disorder in this population and emphasise that specific combat exposures, rather than deployment itself, significantly affect the onset of symptoms of post-traumatic stress disorder after deployment.

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Author and article information

Journal

Journal ID (nlm-ta): Eur J Psychotraumatol

Journal ID (iso-abbrev): Eur J Psychotraumatol

Journal ID (publisher-id): EJPT

Title: European Journal of Psychotraumatology

Publisher: Co-Action Publishing

ISSN (Print): 2000-8198

ISSN (Electronic): 2000-8066

Publication date (Electronic): 17 February 2014

Publication date Collection: 2014

Volume: 5

Electronic Location Identifier: 10.3402/ejpt.v5.21759

Affiliations

[1 ]King’s Centre for Military Health Research, King’s College London, London, UK

[2 ]Department of Clinical Psychology, Royal Holloway University, London, UK

Author notes

[* ]Correspondence to: Dominic Murphy, KCMHR, Weston Education Centre, Cutcombe Road, SE5 9PR London, UK, Email: dominicmurphy100@ 123456gmail.com

Article

Publisher ID: 21759

DOI: 10.3402/ejpt.v5.21759

PMC ID: 3929076

SO-VID: e419109d-6a0f-4031-bbb8-65894ae49e38

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 17 June 2013

Date revision received : 04 October 2013

Date accepted : 20 November 2013

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Exploring positive pathways to care for members of the UK Armed Forces receiving treatment for PTSD: a qualitative study

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Abstract

Objective

Methods

Results

Conclusions

Related collections

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Most cited references 24

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

The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America?

New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study.

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Cited by 14

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