Are Iraq and Afghanistan Veterans Using Mental Health Services? New Data From a National Random-Sample Survey

Abstract

Objective This study analyzed data from a national survey of Iraq and Afghanistan veterans to improve understanding of mental health services use and perceived barriers. Methods The National Post-Deployment Adjustment Survey randomly sampled post-9/11 veterans separated from active duty or in the Reserves or National Guard. The corrected response rate was 56% (N=1,388). Results Forty-three percent screened positive for posttraumatic stress disorder (PTSD), major depression, or alcohol misuse. Past-year psychiatric treatment was reported by 69% of the PTSD group, 67% of the depression group, and 45% of those with alcohol misuse. Most received care at Veterans Affairs (VA) facilities, although women were more likely than men to seek non-VA services. Veterans with more severe symptoms reported greater treatment utilization. Eighteen percent saw a pastoral counselor (chaplain) in the past year. Veterans with mental health needs who did not access treatment were more likely to believe that they had to solve problems themselves and that medications would not help. Those who had accessed treatment were more likely to express concern about being seen as weak by others. Conclusions Veterans in greatest need were more likely to access services. More than two-thirds with probable PTSD obtained past-year treatment, mostly at VA facilities. Treatment for veterans may be improved by increasing awareness of gender differences, integrating mental health and pastoral services, and recognizing that alcohol misuse may reduce utilization. Veterans who had and had not used services endorsed different perceptions about treatment, indicating that barriers to accessing care may be distinct from barriers to engaging in care.

An examination of the broader effects of warzone experiences on returning Iraq/Afghanistan veterans׳ psychiatric health

“…Third, the findings presented here are based on a convenience sample of predominantly White Iraq/Afghanistan veterans enrolled in the VA system. Notably, the sample used in the present research was older and had a higher proportion of males relative to other recent nationally-representative studies of Iraq/Afghanistan veterans (e.g., Elbogen et al, 2013). Thus, the degree to which the findings from the present research might generalize to more diverse groups of veterans is unclear.…”

The factor structure of psychiatric comorbidity among Iraq/Afghanistan-era veterans and its relationship to violence, incarceration, suicide attempts, and suicidality

“…Iraq/Afghanistan-era veterans are at increased risk for a range of psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, and alcohol misuse (Hoge et al, 2004;Elbogen et al, 2013). High rates of psychiatric comorbidity are also common among veterans (Orsillo et al, 1996;Thomas et al, 2010), which is consistent with factor analytic studies demonstrating that common psychiatric disorders load onto three higher-order factors: (1) an externalizing/substance-use disorder (SUD) factor characterized by alcohol and drug disorders, nicotine dependence, and antisocial personality disorder; (2) a distress factor characterized by depression and generalized anxiety disorder; and (3) a fear factor characterized by social phobia, simple phobia, and panic disorder (Krueger, 1999;Eaton et al, 2011).…”

Chaplaincy and Mental Health in the Department of Veterans Affairs and Department of Defense

“…Chaplains have long been front-line service providers in understanding and caring for Veterans and Service members who are dealing with mental health issues (Bonner et al, 2013; Department of the Army, 2012; Elbogen et al, 2013;Hamilton, Jackson, Abbott, Zullig, & Provenzale, 2011;Zullig et al, 2012), ranging from problems like adjusting to military life or a medical diagnosis to significant psychiatric problems like posttraumatic stress disorder (PTSD), mood disorders, and suicidality. In the extensive 2010 report produced by the DoD Task Force on the Prevention of Suicide by Members of the Armed Forces, chaplains were frequently cited as vital to the prevention of suicide by members of the military (Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces, 2010).…”