Postdeployment, Self-Reporting of Mental Health Problems, and Barriers to Care

Perspectives in Psychiatric Care, Oct 2009 by Visco, Rosanne

PURPOSE. This study explored the relationship between self-reported mental health symptoms and help-seeking behaviors of active-duty Air Force members.

DESIGN AND METHODS. Mixed-methods approach reviewed 200 postdeployment surveys from active-duty members assigned to Eglin Air Force Base, Florida, USA. Chi-square analysis examined significance between self-reporting mental health problems and accessing treatment.

FINDINGS. As the rate of self-reported mental health symptoms increased, active-duty members were less inclined to seek help. There were inconsistencies among gender for self-reporting and accessing services.

PRACTICE IMPLICATIONS. Air Force psychiatric nurses need to be at the forefront of outreach services when treating combat-stressed troops.

Search terms: Mental health, postdeployment, stigma

According to Murray (2005), 18-20% of deployment returnees from Iraq suffer from post-traumatic stress disorder (PTSD) symptoms, especially when they face multiple deployments resulting in increased combat exposure. Active-duty members most in need of mental health services are least likely to seek treatment, primarily due to stigma (Regan, Hagwood, Hamer, & Wright, 2006); Air Force active-duty members fear mental health treatment will have a negative career impact. The issue of stigma has not been widely studied in the Air Force, but it has been addressed in other branches of service. When Hoge et al. (2004) examined the responses of returning Marines and soldiers from Iraq and Afghanistan, they found the level of resistance about seeking treatment was high, along with increased concerns about stigma. While combat stress has been widely researched (Cook et al., 2005; Hobfoll �tal., 1991), sources have been limited for studies describing prevailing attitudes among active-duty Air Force members in terms of willingness to access mental health services. Additional research studies (Hoge et al., 2004; Hourani & Yuan, 1999) have focused on other branches of service such as the U.S. Marines, Army, and Navy. Self-reporting health status has received an in-depth examination in the research (Burdick, Endick, & Goldberg, 2005; Foley et al., 2006), although the literature lacks clear connections between mental health self-assessment and service usage or to barriers to treatment. The basic philosophy of the military indicates that its foundation is structured in a way distinctly different from any other organization (Kutz, 1996). Traditional values such as duty, honor, and country specifically highlight military ideology, which differs from civilian life.

The purpose of this concurrent mixed-methods study was two-fold:

1. to better understand the psychological impact that deployment had on Air Force members by looking at how those members reported mental health concerns after deployment; and

2. to examine whether they were appropriately accessing mental health services (Gavrilovic, Schutzwohl, Fazel, & Priebe, 2005).

Understanding the psychological impact of deployment and determining treatment access is important because according to Spinazzola, Blaustein, and van der Kolk (2005), early screening and treatment efficacy has proven to be an effective approach during the postdeployment period. Schnurr, Friedman, and Bernardy (2002) concur that planning intervention efforts after traumatic events was crucial when determining risk potential for PTSD symptoms. The Eglin study focused on the postdeployment period, using survey screening along with telephone triage (Kevin, 2002). This approach identified those Air Force members who were self-reporting mental health symptoms, symptom level of intensity, and potential barriers Air Force members face when seeking treatment. The study then identified areas for improvement concerning the outreach prevention services necessary to help returning Air Force members who may have felt hindered when seeking treatment (Glass & Arnkoff, 2000). This study was intended as an important step in defining perceptions about mental health in an Air Force-dominated culture (Meyer, 1992).

Since research in the Air Force in the area of selfreporting mental health concerns and barriers to treatment has been limited, this study adds to a body of knowledge within the mental health and Air Force fields.

The study explored these quantitative research questions:

1. What is the relationship between self-reported mental health symptoms and access to treatment in the Air Force?

2. Do gender differences exist in self-reporting mental health symptoms in the Air Force?

3. Are there gender differences in accessing mental health treatment in the Air Force?

The study also explored these qualitative research questions:

1. How do Air Force members describe their mental health symptoms?

2. What resources do Air Force members access when seeking help for mental health concerns?

Self-Reporting Symptoms

Hoenig et al. (1998) emphasized that selfassessment was an important key to determining an individual's physical and mental well-being. Selfreporting physical symptoms appeared to be more acceptable to service members than reporting mental symptoms, with Foley et al. (2006) indicating a positive correlation between providing psychiatric services for physical complaints and patient self-efficacy.