Barriers and facilitators for treatment-seeking for mental health conditions and substance misuse: multi-perspective focus group study within the military

Bogaers, Rebecca; Geuze, Elbert; Weeghel, Jaap van; Leijten, Fenna; Mheen, Dike van de; Varis, Piia; Rozema, Andrea D.; Brouwers, Evelien P. M.

doi:10.1192/bjo.2020.136

Cited by 12 publications

(17 citation statements)

References 41 publications

(80 reference statements)

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“…However, a study within the Dutch military into the decision to seek treatment for MHC/SA did find that soldiers without MHC/SA reported lack of career advancement as a barrier for treatment seeking. 24 …”

Section: Discussionmentioning

confidence: 99%

“…29 Data collection for this study happened simultaneously with data collection of a study on treatment seeking for MHC/SA. 24 Participants were recruited through (1) flyers at mental health departments, (2) flyers at military bases, (3) military psychologists, (4) military newsletters, (5) personal contacts and (6) word-of-mouth between participants. Once people showed interest in participating (through Open access email/telephone), they received the information letter and sign-up information.…”

Section: Methodsmentioning

confidence: 99%

“… 29 Data collection for this study happened simultaneously with data collection of a study on treatment seeking for MHC/SA. 24 …”

Section: Methodsmentioning

confidence: 99%

“…Additionally, they might develop MHC/SA in the future, making it relevant to examine what would influence their disclosure decision. 24 As for MMH professionals, previous research has shown that mental health professionals play a role in how stigma affects sustainable employment. 23 Moreover, MMH professionals could play a role in providing disclosure advice to patients, making it relevant to first examine how aware they are of the barriers faced by soldiers when disclosing.…”

Section: Introductionmentioning

confidence: 99%

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Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military

et al. 2021

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ObjectivesMany workers in high-risk occupations, such as soldiers, are exposed to stressors at work, increasing their risk of developing mental health conditions and substance abuse (MHC/SA). Disclosure can lead to both positive (eg, support) and negative (eg, discrimination) work outcomes, and therefore, both disclosure and non-disclosure can affect health, well-being and sustainable employment, making it a complex dilemma. The objective is to study barriers to and facilitators for disclosure in the military from multiple perspectives.DesignQualitative focus groups with soldiers with and without MHC/SA and military mental health professionals. Sessions were audiotaped and transcribed verbatim. Content analysis was done using a general inductive approach.SettingThe study took place within the Dutch military.ParticipantsIn total, 46 people participated in 8 homogeneous focus groups, including 3 perspectives: soldiers with MHC/SA (N=20), soldiers without MHC/SA (N=10) and military mental health professionals (N=16).ResultsFive barriers for disclosure were identified (fear of career consequences, fear of social rejection, lack of leadership support, lack of skills to talk about MHC/SA, masculine workplace culture) and three facilitators (anticipated positive consequences of disclosure, leadership support, work-related MHC/SA). Views of the stakeholder groups were highly congruent.ConclusionsAlmost all barriers (and facilitators) were related to fear for stigma and discrimination. This was acknowledged by all three perspectives, suggesting that stigma and discrimination are considerable barriers to sustainable employment and well-being. Supervisor knowledge, attitudes and behaviour were critical for disclosure, and supervisors thus have a key role in improving health, well-being and sustainable employment for soldiers with MHC/SA. Furthermore, adjustments could be made by the military on a policy level, to take away some of the fears that soldiers have when disclosing MHC/SA.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“… 29 Data collection for this study happened simultaneously with data collection of a study on treatment seeking for MHC/SA. 24 …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military

et al. 2021

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“…Health related stigma has also been reported to be a barrier to seeking healthcare. Untreated and worsened health conditions could subsequently lead to unemployment [8,[21][22][23]. Finally, anticipated stigma, self-stigma and the 'Why Try' effect could lead to insufficient motivation and effort to keep or find employment [9,24].…”

Section: Introductionmentioning

confidence: 99%

In What Ways Does Health Related Stigma Affect Sustainable Employment and Well-Being at Work? A Systematic Review

et al. 2021

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Purpose Studies are increasingly showing that health related stigma is a barrier to employment, but it is not known how. The aim of this systematic review is to identify, appraise and analyse studies that have directly or indirectly addressed ways in which stigma affects sustainable employment and well-being at work of people with disabilities. Methods Using a multiphase screening process, this review is based on a comprehensive literature search (2000–2019) carried out in six electronic databases: Embase, Web of Science, Medline Ovid, Cochrane CENTRAL, PsycINFO and Google Scholar. Results 7.263 publications were identified; 96 studies were found eligible to be included in the review. 72% of the studies were conducted in North America or Europe. Few studies directly assessed how stigma affects the employment of people with disabilities. Most studies highlighted that attitudes and behaviour of employers formed a barrier to employment, as well as anticipated stigma and self-stigma in people with health problems. However, the findings also showed that the attitudes and behaviour of co-workers, health care professionals, reintegration professionals, customers, and family and friends could act as a barrier to employment although these influences are under-researched. Although many similarities were seen in the relevant findings of studies about both physical and mental disabilities, several nuances were found. Conclusion Stigma hampers sustainable employment and well-being in multiple ways. Whereas the number of publications on this topic is rapidly increasing, the roles of health care professionals, reintegration professionals, co-workers, customers, and family and friends particularly warrant more attention.

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Social support and treatment utilization for posttraumatic stress disorder: Examining reciprocal relations among active duty service members

Jaffe

Walton

Walker

et al. 2023

Journal of Traumatic Stress

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Evidence‐based treatments for posttraumatic stress disorder (PTSD) are underutilized by active duty service members in the United States. Social support may help service members overcome avoidance and facilitate treatment utilization. In turn, treatment utilization may improve social support. To evaluate these possibilities, the aim of the current study was to examine potential reciprocal associations between social support and treatment utilization among service members. Secondary analyses were conducted on a randomized controlled trial of 161 U.S. military service members with PTSD. Participants completed assessments of perceived social support and attendance at individual therapy sessions at baseline and 3‐ and 6‐month follow‐ups. To determine reciprocal relations between social support and treatment utilization, a Bayesian approach was used to estimate a random‐intercept cross‐lagged panel model with a two‐part variable for treatment utilization (i.e., any therapy, and if so, dose). There were no between‐person associations between average social support and treatment utilization. One prospective cross‐lagged within‐person association emerged as significant: social support at 3 months was negatively associated with any therapy use at 6 months; the model explained 26.1% of the variance in this observed variable. The findings revealed that low social support promoted subsequent treatment utilization, but such treatment did not lead to changes in social support. This suggests service members with PTSD may have been motivated to attend individual therapy in pursuit of social connection and support. Future research is needed to determine if reciprocal associations between various forms of social support and therapy utilization differ by treatment modality.

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Barriers and facilitators for treatment-seeking for mental health conditions and substance misuse: multi-perspective focus group study within the military

Cited by 12 publications

References 41 publications

Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military

Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military

In What Ways Does Health Related Stigma Affect Sustainable Employment and Well-Being at Work? A Systematic Review

Social support and treatment utilization for posttraumatic stress disorder: Examining reciprocal relations among active duty service members

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