Mental health care utilization and stigma in the military: comparison of Asian Americans to other racial groups

ABSTRACT

Objective: To investigate race disparities in the US Military among Asian, White, Black, Native American and Other, seeking mental health care in the context of stigma defined by perceived damage to career.

Design: Using 2008 survey data taken from US military personnel, mental disorders including depression, generalized anxiety disorder, suicidal ideation, suicidal attempt and post-traumatic stress disorder serious psychological distress (as defined in Kessler – 6), as well as seeking mental health care in past 12 months and stigma were dichotomized and weighted logistic regression models were used.

Results: A significant race disparity existed in seeking mental health care when data were stratified by stigma and depression adjusted for demographic variables. Compared to Asians with depression that perceived stigma, Blacks were more likely to seek mental health care (OR with 95% confidence interval for Asians: 3.97[2.21, 7.15], Black: 9.25[6.02, 14.20], p < .005) adjusting for demographic variables. Similar results held for other mental disorders with the exception of suicide attempts and serious psychological distress. Compared to Asians with serious psychological distress who did not perceive stigma, only Whites were more likely to seek mental health care (OR for Asians: 3.27[2.15, 4.97], White: 6.47[4.60, 9.11], p < .005). Among those without a mental health disorder, regardless of the presence or absence of perceived stigma, there was no disparity between any two race groups in seeking mental health care.

Conclusion: Among individuals having perceived stigma with mental health disorders, Asian American active-duty personnel may be less likely to use mental health care when compared to non-Asian peers.

KEYWORDS:

• Ethnic disparity
• mental health care
• patient barrier
• mental health disorder

Acknowledgements

Authors wish to express our gratitude to Dr. Robert Bray at Research Triangle Institute for providing codes of defining MHC. Data use agreement DUA#07-467D with Health Affairs/TRICARE Management Activity Privacy Office and USU institutional review board approval were obtained before data analysis.

Disclosure statement

The views expressed are those of the authors and do not necessarily reflect the official views of the Uniformed Services University of the Health Sciences, the Department of the Air Force, the Department of the Navy, or the Department of Defense. No potential conflict of interest was reported by the authors.

Additional information

Funding

Partial support was funded by the Uniformed Services University of the Health Sciences (USU) Intramural Grant R087U7 (Principal Investigator: Tzu-Cheg Kao, Ph.D.).