OIF and OEF veterans are expected to be the fastest growing segment of VA mental health user population as they are involved in one of the longest deployment periods that the US Armed forces personnel have ever had to endure, resulting in hundreds of thousands of veterans exposed to the stress of combat and protracted deployments. Recent studies on returning Iraq and Afghanistan veterans have found high rates of mental health complaints (Hoge, Castro, Messer et al, 2004; Harpaz-Rotem & Rosenheck, 2011). It was reported that 78 - 86% of those who were screened were positive for depression, posttraumatic stress disorder (PTSD), or generalized anxiety disorder (GAD). However, only 13 - 21% had received help from a mental health professional within a year prior to assessment. The specific reasons for why veterans choose not to seek mental health treatment are not well understood and speculative at best. Understanding the barriers to mental health care among this population is crucial for the future development of an intervention that will increase retention and adherence to recommended treatment.
The objectives of this study were to: (1) a. Compare and contrast psychologically symptomatic veterans who do utilize mental health services with symptomatic veterans who do not utilize mental health services (e.g. differences in symptoms severity, beliefs and perceived barriers to care, psychological resilience); b. Evaluate the link between subjective barriers to mental healthcare and actual utilization of behavioral health services in veterans returning from Iraq and Afghanistan. (2) Analyze the relationship between beliefs about mental health (i.e. psychotherapy, medication, and attributions) and mental healthcare utilization.
To achieve these objectives we used both quantitative and qualitative data collection methods. Out of the 100 veterans we proposed to recruit for the study we have contacted 118 veterans, 102 of them consented to participate in the study (with a response rate over 88%) of which 78 have completed the study. We (1) conducted interviews with Veterans and collected narratives on their mental health needs and beliefs about mental illness and mental health services in general (2) used standardized questionnaires to assess their current mental health status, beliefs about psychotherapy and perceived barriers to mental health care. Following completion of these self-report measures, patient utilization of VA healthcare services are tracked for 1-year from the date of initial assessment. Service utilization is classified by the number of visits to each clinic, and the type of services received (diagnostic testing, psychotherapy, medication, surgery, general medical check-ups, etc.). Data regarding service utilization was analyzed in conjunction with the participant's respective beliefs and perceptions about mental health.
Preliminary data analyses indicated that the strongest correlate of measure of service use was the severity of psychological distress measured by symptoms of posttraumatic stress disorder and depression. Stigma and beliefs about psychotherapy were not associated with either the likelihood of attending mental health treatment or attrition rates. Qualitative interviews indicated that military commander and unit openness to mental health treatment were the major enabling factors in seeking help.
By examining and analyzing the relationship between beliefs about mental health and mental healthcare utilization, using both qualitative and quantitative measures, among OIF/OEF veterans, we were able to unveil and better understand the mental health needs of this population and the barriers that influence their retention in mental health treatment and adherence to recommended treatment. It also provided us with the knowledge and the basis for the development of an intervention that may increase retention and adherence to recommended psychiatric treatment.
- Harpaz-Rotem I, Rosenheck RA, Desai R. Residential treatment for homeless female veterans with psychiatric and substance use disorders: effect on 1-year clinical outcomes. Journal of rehabilitation research and development. 2012 Apr 5; 48(8):891-9.
- Harpaz-Rotem I. Pathway of Therapeutic Change. Paper presented at: European Psychiatric Association Annual Congress; 2011 Mar 12; Vienna, Austria.
- Harpaz-Rotem I. Barriers to Mental Health Care among OIF and OEF Veterans. Presented at: International Society for Traumatic Stress Studies Annual Meeting; 2010 Nov 4; Montréal, Canada.