Beyond stigma: Understanding the “inclined abstainers” in military behavioral health-care utilization

ABSTRACT

Low treatment utilization in Soldiers with combat-related Posttraumatic Stress Disorder (PTSD) is an ongoing issue. The critical concern is to better understand factors which prohibit a Soldier with PTSD who wants help from seeking treatment (an “inclined abstainer”). A total of 537 Active Duty Soldiers on a US Army post completed a brief survey comprising psychometrically validated measures of stigma, behavioral health treatment beliefs, resilience, PTSD symptoms, and treatment intentions. Health-care records were prospectively tracked for 12 months to determine the relation between survey answers and treatment utilization. Sixty-three percent of those who acknowledged having a mental health-related problem did not seek help within a one-year period. Greater severity of PTSD symptoms was associated with an increased likelihood of behavioral health engagement. Soldiers that were classified as “inclined abstainers” were also more likely to endorse negative beliefs about psychotherapy and report higher levels of resilience as compared to “inclined actors.” These results suggest that a treatment model of PTSD emphasizing self-efficacy and self-reliance, while addressing negative beliefs about psychotherapy, may help promote engagement of behavioral health services among Active Duty Soldiers.

KEYWORDS:

• Active duty
• PTSD
• stigma
• resilience
• treatment
• barriers

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funding was received from the US Army Military Operational Medicine Research Program [W81XWH-08-2-0702]. The views expressed in this article are those of the authors and do not necessarily represent the official policy or position of the US Army Medical Command or the US Army. The study was approved by the Department of Research Programs Research Oversight at the Walter Reed National Military Medical Center.