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Mental Health-Related Beliefs as a Barrier to Service Use for Military Personnel and Veterans: A Review
Open accessAbstract
OBJECTIVE: Although military personnel are at high risk of mental health problems, research findings indicate that many military personnel and veterans do not seek needed mental health care. Thus it is critical to identify factors that interfere with the use of mental health services for this population, and where possible, intervene to reduce barriers to care. The overarching goal of this review was to examine what is known with regard to concerns about public stigma and personal beliefs about mental illness and mental health treatment as potential barriers to service use in military and veteran populations and to provide recommendations for future research on this topic. METHODS: Fifteen empirical articles on mental health beliefs and service use were identified via a review of the military and veteran literature included in PsycINFO and PubMed databases. RESULTS: Although results suggest that mental health beliefs may be an important predictor of service use for this population, several gaps were identified in the current literature. Limitations include a lack of attention to the association between mental health beliefs and service use, a limited focus on personal beliefs about mental illness and mental health treatment, and the application of measures of mental health beliefs with questionable or undocumented psychometric properties. CONCLUSIONS: Studies that attend to these important issues and that examine mental health beliefs in the broader context within which decisions about seeking health care are made can be used to best target resources to engage military personnel and veterans in health care.
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“In addition, mHealth apps may fill a gap for those who require mental health treatment but are faced with barriers, such as stigma to visible help-seeking, long waiting times, a high mobility of their jobs, and geographic restrictions [8,30,33,34], all of which have been noted as problematic for the MMs, PSP, and veteran populations.”
From Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation (2022) · cites this paper as [34]
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“These concerns can be a consequence of self-generated stigma and can also be an internalization of negative beliefs, behaviors, and myths about mental health that arise within military organizations (Britt et al., 2008; Greene-Shortridge et al., 2007; Vogt, 2011).”
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Ghafoori, B., Barragan, B., & Palinkas, L. A. (2014) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000108 · Cited by 40
“A growing body of research indicates low mental health service use relative to need among trauma survivors (Gavrilovic et al., 2005; Sayer et al., 2009; Vogt, 2011).”
Stecker, T. A., McHugo, G. J., Xie, H., Whyman, K., & Jones, M. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300433 · Cited by 40
Campbell, D. G., Bonner, L. M., Bolkan, C. R., Lanto, A. B., Zivin, K., Waltz, T. J., Klap, R. S., Rubenstein, L. V., & Chaney, E. F. (2016) · Annals of Behavioral Medicine · doi:10.1007/s12160-016-9780-1 · Cited by 38
“Stigma related to mental health concerns clearly exists in these populations even though, as presented earlier, the evidence is mixed regarding stigma's function as a treatment barrier (28-32,35,38,40,41).”
BackgroundPatient-Centered Mental Health Care for Female Veterans
Kimerling, R. E., Bastian, L. A., Bean‐Mayberry, B., Bucossi, M. M., Carney, D. V., Goldstein, K. M., Phibbs, C. S., Pomernacki, A., Sadler, A. G., Yano, E. M., et al. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300551 · Cited by 39
“Veterans who are underrepresented in gender, race, or sexual orientation in the health care system may differ from the majority in beliefs about belongingness, stigma, or therapist-client match (40,41) and may perceive TABLE 1.”
BackgroundE-mental health preferences of Veterans with and without probable posttraumatic stress disorder
Whealin, J. M., Seibert, L. A., Howell, J. W., & Tsai, J. (2015) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2014.04.0113 · Cited by 44
“[6,10,48,54–56].”
BackgroundMethodClary, K. L., Pena, S., & Smith, D. C. (2021) · Current Psychology · doi:10.1007/s12144-021-01768-7 · Cited by 39
“In addition, stigma regarding mental health issues is persuaded by the Warrior Ethos (Ben-Zeev et al., 2012; Hoerster et al., 2012; Vogt, 2011; Westphal & Convoy, 2015).”
BackgroundPTSD Risk and Mental Health Care Engagement in a Multi-War Era Community Sample of Women Veterans
Washington, D. L., Davis, T. D., Der‐Martirosian, C., & Yano, E. M. (2013) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2303-2 · Cited by 38
Angel, C. M., Smith, B. P., Pinter, J. M., Young, B. B., Armstrong, N. J., Quinn, J. P., Brostek, D. F., Goodrich, D. E., Hoerster, K. D., & Erwin, M. S. (2018) · Translational Behavioral Medicine · doi:10.1093/tbm/iby050 · Cited by 47
“For example, OEF/OIF veterans with mental health problems infrequently receive an adequate dose of mental health treatment [40] possibly due to stigma or instrumental barriers to care [42, 43].”
BackgroundVoth, M., Chisholm, S., Sollid, H., Jones, C., Smith-MacDonald, L., & Brémault-Phillips, S. (2022) · JMIR mHealth and uHealth · doi:10.2196/26453 · Cited by 35
“…gap for those who require mental health treatment but are faced with barriers, such as stigma to visible help-seeking, long waiting times, a high mobility of their jobs, and geographic restrictions [8,30,33,34], all of which have been noted as problematic for the MMs, PSP, and veteran populations.”
Bonar, E. E., Bohnert, K. M., Walters, H., Ganoczy, D. A., & Valenstein, M. M. (2014) · Journal of American College Health · doi:10.1080/07448481.2014.975718 · Cited by 37
Resilience-based intervention for UK military recruits: a randomised controlled trial
Jones, N., Whelan, C., Harden, L., Macfarlane, A., Burdett, H. J., & Greenberg, N. L. (2018) · Occupational and Environmental Medicine · doi:10.1136/oemed-2018-105503 · Cited by 39
B, M. D. W., & W, P. E. B. (2015) · International Journal of Emergency Mental Health and Human Resilience · doi:10.4172/1522-4821.1000250 · Cited by 35
“The relationship of stigma in the Armed Forces is complicated by the military culture that places an emphasis on psychological resilience (Rona et al., 2004; Vogt, 2011).”
BackgroundValenstein-Mah, H. R., Kehle‐Forbes, S., Nelson, D. B., Danan, E. R., Vogt, D. S., & Spoont, M. R. (2019) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000428 · Cited by 35
“Male veterans may be more vulnerable to traditionally masculine messages of self-reliance (Vogt, 2011), which in turn, may make them less likely to fully engage in psychotherapy.”
BackgroundSelf-citationNichter, B., Hill, M. L., Norman, S. B., Haller, M. M., & Pietrzak, R. H. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.07.004 · Cited by 35
Mohatt, N. V., Boeckmann, R., Winkel, N., Mohatt, D. F., & Shore, J. (2017) · Military Medicine · doi:10.7205/milmed-d-16-00033 · Cited by 32
Advances in PTSD Treatment Delivery: the Role of Digital Technology in PTSD Treatment
Kuhn, E., & Owen, J. E. (2020) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-020-00207-x · Cited by 34
Turchik, J. A., Bucossi, M. M., & Kimerling, R. E. (2014) · Military Behavioral Health · doi:10.1080/21635781.2014.892410 · Cited by 34
“…in other studies of mental health help seeking among veterans more generally, particularly the stigma-related barriers (e.g., Ouimette et al., 2011; Vogt, 2011), whereas others appear to be specifically related to the sexual trauma and were consistent with concerns commonly identified by sexual…”
ResultUK military doctors; stigma, mental health and help-seeking: a comparative cohort study
Jones, N., Whybrow, D., & Coetzee, R. H. (2018) · Journal of the Royal Army Medical Corps · doi:10.1136/jramc-2018-000928 · Cited by 34
Access to VA Services for Returning Veterans With PTSD
Shiner, B. R., Drake, R. E., Watts, B. V., Desai, R. A., & Schnurr, P. P. (2012) · Military Medicine · doi:10.7205/milmed-d-12-00009 · Cited by 35
Chapman, P. L., Elnitsky, C., Pitts, B. L., Figley, C. R., Thurman, R. M., & Unwin, B. (2014) · Military Medicine · doi:10.7205/milmed-d-12-00367 · Cited by 34
Social Support and Mental Health Outcomes Among U.S. Army Special Operations Personnel
Russell, D. W., Benedek, D. M., Naifeh, J. A., Fullerton, C. S., Benevides, N., Ursano, R. J., Russell, C. A., Forsten, R. D., & Cacciopo, J. T. (2016) · Military Psychology · doi:10.1037/mil0000114 · Cited by 34
“…contexts (Hoge & Castro, 2012); therefore, building an organizational culture that encourages more informal social support could prove extremely important, especially when considering that service members are neither seeking nor fully utilizing the more formal forms of social support (Vogt, 2011).”
BackgroundWhealin, J. M., King, L., Shore, P., & Spira, J. L. (2017) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217417703291 · Cited by 34
The Importance of US Military Cultural Competence
Meyer, E. G., & Wynn, G. H. (2018) · Springer eBooks · doi:10.1007/978-1-4939-7438-2_2 · Cited by 34
Osório, C., Jones, N., Fertout, M., & Greenberg, N. L. (2013) · Military Medicine · doi:10.7205/milmed-d-13-00079 · Cited by 33
Blais, R. K., & Renshaw, K. D. (2014) · Military Psychology · doi:10.1037/mil0000036 · Cited by 33
“Stigma for seeking treatment is identified as a possible barrier to care, but the majority of studies examining stigma in military service members do not link the experience of stigma to seeking mental health care (Vogt, 2011).”
BackgroundKumar, A. M., Azevedo, K. J., Factor, A., Hailu, E., Ramirez, J. C., Lindley, S. E., & Jain, S. (2018) · Psychological Services · doi:10.1037/ser0000269 · Cited by 32
Blais, R. K., Hoerster, K. D., Malte, C. A., Hunt, S. C., & Jakupcak, M. (2014) · Journal of Traumatic Stress · doi:10.1002/jts.21898 · Cited by 35
Koenig, C. J., Maguen, S., Daley, A., Cohen, G. H., & Seal, K. H. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2167-5 · Cited by 32
Allan, N. P., Conner, K. R., Pigeon, W. R., Grös, D. F., Salami, T. K., & Stecker, T. A. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.03.009 · Cited by 32
“Among active duty and former military personnel, those that do not use the Department of Veterans Affairs (VA) healthcare services (Veterans Health Administration [VHA]) are a vulnerable and understudied population (Vogt, 2011).”
Barriers to care for women veterans with posttraumatic stress disorder and depressive symptoms.
Lehavot, K., Der‐Martirosian, C., Simpson, T. L., Sadler, A. G., & Washington, D. L. (2013) · Psychological Services · doi:10.1037/a0031596 · Cited by 30
Arbisi, P. A., Rusch, L. C., Polusny, M. A., THURAS, P. D., & Erbes, C. R. (2013) · Psychological Assessment · doi:10.1037/a0032225 · Cited by 34
Momen, N., Strychacz, C. P., & Viirre, E. (2012) · Military Medicine · doi:10.7205/milmed-d-11-00286 · Cited by 29
Metadata
- Authors
- Vogt, D.
- Affiliations
- Boston University (US)
- Corresponding author
- Vogt, Dawne
- ORCID
- Vogt, Dawne
- Venue
- Psychiatric Services
- Published
- 2011-02
- Volume
- 62
- Issue
- 2
- Pages
- 135-142
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W2135921044
- Cited by
- 371
- References
- 67
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 12 · 2023: 19 · 2022: 17 · 2021: 22 · 2020: 29 · 2019: 36 · 2018: 28 · 2017: 34 · 2016: 31 · 2015: 35 · 2014: 37 · 2013: 23 · 2012: 23
- FWCI
- 37.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for PTSD, U.S. Department of Veterans Affairs
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Gender Studies › Gender Roles and Identity Studies
- Keywords
- mental health perceptions, barriers to mental health care, help-seeking, military personnel, veterans, public stigma
- MeSH terms
- Attitude to Health, Mental Disorders, Culture, Female, Health Services Accessibility, Humans, Male, Mental Health, Mental Health Services, Military Personnel, Stereotyping, United States, Veterans
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