Study Explores Determinants of Veteran Treatment-Seeking for PTSD
The prevalence of post-traumatic stress disorder (PTSD) is highest among segments of the population with high trauma rates, such as combat Veterans. For example, although the 12-month prevalence of PTSD in the U.S. population is estimated to be less than 4%, it is as high as 15% among combat Veterans. Moreover, an additional 10% of combat Veterans may experience partial PTSD. Therefore, understanding how and why Veterans initiate treatment for PTSD is particularly crucial. This qualitative study explored determinants of PTSD treatment initiation among 21 treatment-seeking and 23 non-treatment-seeking Veterans who had served in Vietnam, or the current conflicts in Afghanistan and Iraq (14 of the 44 participants were women Veterans). Investigators analyzed data from in-depth interviews conducted with participating Veterans who submitted disability claims to VA on the basis of military-related PTSD.
Findings show that both Veterans who were and were not in treatment for PTSD described similar factors that hindered their help-seeking, including their own values and priorities (e.g., pride in self reliance), treatment-discouraging beliefs (e.g., providers would not believe them, or would treat them as if they were “crazy”), and trauma-related avoidance (e.g., avoiding discussion of the traumatic event). They also cited an invalidating post-trauma environment as a detriment to seeking treatment; for example, some women cited a military culture that silenced the reporting of sexual assault. But for some participants, facilitators located within the healthcare system and Veterans’ social networks led to help-seeking despite individual-level barriers. In some cases, it was a trusting relationship with the primary care provider that led the Veteran to follow the provider’s recommendation to seek mental health care. This suggests that factors outside the individual can promote mental health service use for PTSD, even when the Veteran is reluctant. Thus, the authors suggest that some interventions may be needed that tailor outreach strategies specifically for these groups, such as women Veterans with a history of military sexual trauma.
Sayer N, Friedemann-Sanchez G, Spoont M, Murdoch M, et al. A qualitative study of determinants of PTSD treatment initiation in Veterans. Psychiatry Fall 2009;72(3):238-255.
This study was funded by HSR&D. Drs. Sayer, Spoont, and Murdoch are part of HSR&D’s Center for Chronic Disease Outcomes Research in Minneapolis, MN.