Military Members’ Perceptions of Social Norms About Mental Health for Combat Stress

Abstract

Low rates of mental health help-seeking for combat stress are reported in prior literature, with perceptions of stigma as a common factor preventing help-seeking. This article explores the Social Norms Approach as a message strategy for increasing help-seeking and encouragement of help-seeking among military members. The Social Norms Approach specifies messages for correcting misperceptions about prevalence and social approval of health behaviors. This article examined whether military members have misperceptions about the approval of seeking help and encouraging others to seek help for combat stress. Surveys with service members at an Army installation, a Naval station, and a convenience sample were used to assess military members’ perceptions of norms about whether others would encourage or approve of help-seeking, as well as their own willingness and approval of encouraging others to seek help. Results indicated misperceptions in norms, with a larger percentage of participants personally approving or indicating they would encourage others to seek help than their perceptions of what others would approve of or do. Results are discussed in terms of stigma research and campaign message interventions.

Keywords:

• Combat stress
• peer intervention
• mental health stigma
• social norms and stigma
• encouraging help-seeking
• stigma and peer encouragement
• peer encouragement mental health

Notes

1 The Department of Defense (DoD Directive 6490.5) defines combat and operational stress reactions (COSRs) as potential precursors to PTSD. PTSD is a clinical diagnosis however COSRs have a wide range of symptoms and severity. Consistent with the Army Field Manual No. 4-02.51 from Headquarters, Department of the Army, July 2006, the phrase COSRs will be used throughout this article, and when referring to literature that specifically cites “PTSD,” it will be provided in parentheses after “COSRs.” Although PTSD is a clinical diagnosis, COSRs involve a large range of symptoms and levels of severity. PTSD is a potential long-term consequence of COSRs, thus this project aims to learn about messages that may increase encouraging help-seeking for COSRs.

2 Encouragement is used purposely as opposed to “referral” because within the military context “referral” connotes being officially required to seek professional help rather than seeking help based on free choice; rather, the goal here is to encourage service members to seek help under their own volition.

3 Note that because of a software error through the Army post’s online survey system, a section of the survey data was lost, thus for those 35 responses there is no data available for actual descriptive norms for encouraging others.

4 The question measuring this item was initially written, “I intend to encourage another service member to seek help,” with a response of just 48% agreeing, whereas the participants perceived that 69%, a much larger percentage, would encourage others to seek help. Mid-data collection, it appeared that a strong possibility was that because people did not necessarily have a certain person in mind to encourage to seek help, they did not respond in agreement to the degree that they would if the question was worded, “I would encourage another service member to seek help if needed,” thus this question was added to the survey and the results are reported above for the 49 participants answering that question. Notably, the item was originally worded using the latter phrase (“I would encourage if needed”) in the initial proposal for this project, however the Army post that distributed the survey instructed that it should be worded “I intend to encourage another service member to seek help for combat stress.”

5 For this sample, there is no correlation between rank and personal approval of encouraging mental health help-seeking, r(150) = 0.128, p = 0.121, or approval of others seeking help, r(150) = .114, p = .168.