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PPO 09-314 – HSR&D Study

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PPO 09-314
Service Utilization and Barriers to Care for Veterans in Rural and Urban Settings
Julia M Whealin PhD
VA Pacific Islands Health Care System, Honolulu, HI
Honolulu, HI
Funding Period: June 2010 - May 2011

BACKGROUND/RATIONALE:
More than 40% of current Operation Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) Veterans are from rural areas. Because OEF/OIF/OND Veterans are at high risk for mental health problems, there is a need to better understand barriers to obtaining needed mental health care. Unfortunately, fear of stigma can keep Veterans from seeking the care they need, especially for those Veterans living in rural areas that lack anonymity.

OBJECTIVE(S):
The objectives of this study were to generate data from a survey of OEF/OIF/OND Veterans to: 1. Determine if Veterans in rural communities perceive more community mental health stigma than urban Veterans, and 2. Determine if community stigma about mental health is associated with decreased mental health care (MHC) use. The dataset also provided a resource for quantitative and qualitative analysis of additional research questions.

METHODS:
A multi-stage mailing procedure with a monetary incentive was used to maximize response rates. Hierarchical regression was used to evaluate whether rural status was associated with higher levels of community stigma, after controlling for individual variables associated with community stigma. Logistic regression analysis was used to identify if community stigma was associated with MHC utilization, controlling for covariates.

FINDINGS/RESULTS:
Surveys were mailed to 450 Veterans and 233 usable surveys were returned (52% response rate). Significantly more rural than urban Veterans screened positive for alcohol abuse, post traumatic stress disorder, and traumatic brain injury. Rural status was not associated with higher levels of community stigma, and explained less than 1% of the variance in community stigma scores (Rs =.004, F(3, 201)=.294, p=.830). However, adding PTSD to the model explained 8% of the variance in perceived community stigma (R =.077, F(4, 200)=4.158, p=.003). Community stigma did not predict lower rates of MHC utilization. Income, education, rurality, age, and PTSD were non-significant and predicted less than 1% of the variance in rates of MHC utilization.

IMPACT:
This study is the first to identify increased mental health problems in rural OEF/OIF/OND Veterans, pointing to the need for specialized MHC in rural areas. The finding that having PTSD is associated with perceived community stigma increases our ability to better service Veterans who are suffering from PTSD. Additional qualitative data revealed education and outreach are needed to help Veterans overcome individual obstacles, change institutional procedures, and address stigma.

PUBLICATIONS:

Conference Presentations

  1. Whealin J, Nelson D, Stotzer R, Vogt D, Pietrzak R. Perceived logistical, individual, and community barriers to mental health treatment in diverse U. S. Veterans. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2012 Nov 1; Los Angeles, CA.
  2. Nelson DD, Whealin J, Bozik-Lyman S, Stotzer R. Overcoming attitudinal barriers to care in OEF/OIF Veterans. Paper presented at: International Conference on Violence, Abuse, and Trauma; 2012 Sep 1; San Diego, CA.
  3. Whealin JM, Bozik-Lyman SC, Nelson DD, Stotzer RL, Vogt D, Pietrzak RH, Southwick S. Community, institutional, and individual issues and access to care among rural and urban Veterans of Operation Enduring Freedom/Iraqi Freedom/New Dawn. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 16; National Harbor, MD.
  4. Whealin J. Translating research to improve outreach and intervention for Veterans with PTSD. Paper presented at: University of Pennsylvania Department of Psychiatry Grand Rounds; 2012 Feb 1; Philadelphia, PA.
  5. Whealin J, Stotzer R, Pietrzak R, Vogt D, Darden D, Bozik Lyman S, Southwick S. Exploring veteran preferences and needs to improve mental health care utilization in rural and urban locations. Poster session presented at: VA Office of Mental Health Services Conference; 2011 Aug 1; Baltimore, MD.
  6. Whealin J, Darden DD, Bozik-Lyman SC. Understanding is key: The experience of military veterans and barriers to mental health care. Paper presented at: Institute on Violence, Abuse and Trauma Hawaii Conference on Preventing, Assessing & Treating Annual Child, Adolescent and Adult; 2011 Mar 1; Honolulu, HI.


DRA: Mental, Cognitive and Behavioral Disorders
DRE: Epidemiology
Keywords: Disparities, PTSD, Rural, Substance Use and Abuse
MeSH Terms: none

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