Impact of OEF/OIF Veterans’ Beliefs about
Mental Illness and Mental Health Treatment
on Treatment Seeking
American Legion TBI and PTSD Symposium
June 24, 2014
Dawne Vogt, PhD
Research Psychologist and Acting Deputy Director,
WHSD, National Center for PTSD, VA Boston Healthcare System &
Associate Professor, Division of Psychiatry, Boston University School
of Medicine
Background
• Research indicates that OEF/OIF/OND Veterans are at risk for
a variety of mental health problems following return from
deployment.
o 14% of OEF/OIF Veterans in a large, nationally
representative study met criteria for probable PTSD and
same proportion also met criteria for major depression.1
o Another nationally representative study found an identical
rate of probable PTSD (14%) and an even higher rate of
probable alcohol abuse (39%).2
• Variety of effective treatments for PTSD and other mental
health problems - cognitive-behavioral therapy and
pharmacotherapy.3
1 Schell
& Marshall (2008)
2 Eisen et al. (2012)
3
Watts et al. (2011)
Background
• Many Veterans with mental health problems do not
receive mental health care.
• Nearly half (47%) of national sample of OEF/OIF
Veterans with probable PTSD or major depression had
not received mental health care in the previous year.1
• Treatment drop-out a substantial problem
• Among both female and male OEF/OIF/OND VA users
with newly diagnosed PTSD, median number of
psychotherapy visits in last year was three.2
1
Schell & Marshall (2008)
2
Maguen, Cohen, et al. (2012)
Beliefs about Mental Illness
and Mental Health Treatment
• Concerns about Stigma
• Beliefs about how loved ones would react if one were to
experience a mental health problem
• Beliefs about stigma in the workplace
• Personal beliefs about mental illness and mental
health treatment
• Beliefs about mental illness
• Beliefs about treatment-seeking
• Beliefs about mental health treatment
Barriers to Care Study
• Study of a national sample of female and male
OEF/OIF Veterans (n=707) conducted in 2011
• Nonresponse bias and design weights applied to
item-level results to enhance representativeness
• Overview of findings regarding:
• Common mental health beliefs that may serve as barriers to care
• Relationship between mental health beliefs and use of VA mental
health treatment among veterans with probable mental health
conditions (PTSD, depression, alcohol abuse)
• Contribution above and beyond VA system factors
Concerns about Stigma
from Loved Ones
If I had a mental health problem and friends
and family knew about it, they would…
…feel uncomfortable around me.
…be afraid that I might be violent or
dangerous.
Negative
Neutral
…see me as weak.
Positive
…think less of me.
0%
20%
40%
60%
80%
100%
Concerns about Stigma
in the Workplace
If I had a mental health problem
and people at work knew…
…my career/job options would be
limited.
…they would think I was incapable of
doing my job.
Negative
Neutral
…they would feel uncomfortable
around me.
Positive
…they would not want to be around
me.
0%
20%
40%
60%
80% 100%
Beliefs about Mental Illness
Difficult to have a normal relationship with
someone with mental health problems.
People with mental health problems use their
health problems as an excuse.
Negative
Neutral
Positive
People with mental health problems cannot be
counted on.
People with mental health problems require too
much attention.
0%
20%
40%
60%
80% 100%
Beliefs about Help-Seeking
A problem has to be really bad for me to be
willing to seek mental health care.
Negative
I would prefer to deal with a mental health
problem myself rather than to seek treatment.
Neutral
Positive
I would feel uncomfortable talking about my
problems with a mental health provider.
If I were to seek mental health treatment, I
would feel stupid for not being able to fix the
problem on my own.
0%
20%
40%
60%
80%
100%
Beliefs about Mental Health Treatment
Medications for mental health problems have too
many negative side effects.
People who seek mental health treatment are often
required to undergo treatments they don't want.
Negative
Neutral
Medications for mental health problems are
ineffective.
Positive
Mental health providers often make inaccurate
assumptions about patients.
0%
20%
40%
60%
80%
100%
Summary of Item-Level Results
• Substantial minority of OEF/OIF Veterans endorse
negative beliefs about mental illness and mental
health treatment
• Concerns about stigma more commonly reported
than negative personal beliefs
• Diversity in responses, with greatest proportion of
respondents either explicitly rejecting these beliefs or
reporting being “on the fence”
Predictors of VA Mental Health Service Use
Variable
B
S.E.
OR
Availability of services
.017
.047
1.017
Ease of use
.003
.026
1.003
Staff skill and sensitivity
-.100
.038
0.905*
Negative beliefs about mental health treatment
.112
.042
1.118*
Negative beliefs about treatment seeking
-.136
.032
0.873*
Negative beliefs about mental illness
-.089
.040
0.915*
Concerns about stigma from loved ones
.062
.030
1.064*
Concerns about stigma in the workplace
.033
.027
1.034
System Factors
Stigma and Personal Beliefs
Note. Analysis controls for comorbidity. *p<.05.
Conclusions
• Veterans report a variety of mental health beliefs
that may serve as barriers to care.
• Findings suggest that concerns about stigma are less
important barrier to treatment than personal beliefs
about mental illness & mental health treatment
• Negative mental health beliefs predict service use
above and beyond Veterans’ perceptions of systemlevel barriers
• Longitudinal studies needed to confirm these findings
Conclusions
• Need for attention to attitudinal barriers to treatment
engagement
• Findings underscore the value of educational initiatives
that target negative beliefs about mental illness and
mental health treatment
• VA’s Make the Connection (www.maketheconnection.net)
• NCPTSD’s About Face (http://www.ptsd.va.gov/apps/AboutFace/)
Acknowledgements
• Funding for Barriers to Care study was provided by VA
HSR&D
• For more information about this presentation, please
contact:
Dawne Vogt
Women’s Health Sciences Division
National Center for PTSD (116B-3)
VA Boston Healthcare System
150 S. Huntington Ave
Boston, MA 02130
857-364-5976
Dawne.Vogt@va.gov
Demographic & Background Factors
• Factors addressed in Anderson Model (1968)
• Predisposing factors such as gender, age, and marital status
• Enabling/impeding factors such as service-connected disability
status, caregiving and work responsibilities
• Need-based factors such as symptom severity, comorbidity, and
functional impairment
Institutional Factors
• Availability of services such as whether preferred type of
treatment is available
• Ease of access such as convenience of location, wait times for
care, paperwork
• Staff skill and sensitivity, including perception that therapists
understand client experiences and are trustworthy
Availability of Services
Availability of primary care services
Availability of emergency medical
services
Negative
Neutral
Availability of mental health services
Postive
Amount of privacy
0%
20% 40% 60% 80% 100%
Ease of Use
Waiting time to get an appointment
when you’re sick
Waiting time to get an appointment for
a regular check-up
Negative
Neutral
The amount of paperwork required to
receive care
Positive
Ability to reach medical staff by phone
0%
20% 40% 60% 80% 100%
Staff Skill & Sensitivity
Staff knowledge of healthcare needs of
veterans from your cohort (for example,
OEF/OIF veterans)
Staff courtesy and respect toward patients
Negative
Neutral
Healthcare provider skill and expertise
Positive
Healthcare provider interest in patients’
thoughts and opinions
0%
20%
40%
60%
80% 100%