Army Soldiers' Knowledge, Attitudes and Treatment Seeking Behaviors Regarding Posttraumatic Stress Disorder

Purpose: Military personnel are at substantial risk for developing posttraumatic stress disorder (PTSD) due to combat-related trauma experienced during deployment to Iraq and Afghanistan. Numerous studies have documented the prevalence of combat-related PTSD among military personnel, ranging from 5-45%. Substantial research has shown cognitive behavioral therapy (CBT) treatment for PTSD to be effective in a variety of trauma populations. Federal VA and Department of Defense Clinical Practice Guideline (2010) recommend CBT as the most effective treatment for PTSD. Despite effective treatments, a recent study noted only 23-40% of Service Members who needed these treatments actually sought treatment. Studies of service members have reported that admitting to a psychological problem was far more stigmatizing than a medical problem and most believed their career would be hurt by admitting they needed treatment.

Method: In order to reach those who need care, this mixed-methods study documented 266 Service Members’ perceptions about PTSD, treatment seeking, and knowledge of effective treatments. Self-report survey items were administered before unit level briefings and included the Perceived Barriers to Seeking Mental Health Services Scale (Britt, 2000). The briefing included information about symptoms of PTSD, effective cognitive behavioral treatments for PTSD available on-post and the process by which to obtain PTSD treatment on post. Semi-structured interactive discussions during the presentation revealed qualitative themes regarding soldiers’ beliefs and assumptions about the disorder. Quantitative analyses of self-reported survey responses provided additional support for these beliefs.

Results: The mean age of respondents was 34.16 (SD= 7.65); 51.2 percent had some college; 90.8% were male. The mean years of service was 12.96 (SD=6.86), and the mean number of months deployed was 26.31 months (SD=13.22). 42.9 percent of survey respondents were unsure that PTSD treatment would work. 28.9% were not aware of treatment options for PTSD on post, and very few attendees reported knowledge of the leading evidence-based treatments for PTSD. Soldiers anecdotally described hyper-vigilance, hyper-arousal and numbing symptoms of PTSD as normal and adaptive responses to being deployed both in a combat zone and at home), rather than problematic symptoms of PTSD. At each of the 10 briefings, a common theme vocalized by attendees was that soldiers who report having PTSD are doing so to obtain a medical separation from the military. In fact, 56.1 percent agreed that, "some soldiers who claim to have PTSD don't really have PTSD." Soldiers' indicated significant concerns about how their leaders' would view them if they sought care. 23.6 percent agreed it would harm their career to seek treatment for PTSD. 31.0 percent were concerned that their peers would have less confidence in them, and 32.2 percent agreed unit leaders would treat them differently.

Implications: Findings from this survey should inform the design of an effective approach to increasing treatment seeking that draws from Soldiers' perceptions and needs. Through better understanding of active duty Soldiers’ assumptions about PTSD and their beliefs about treatment seeking, better interventions for encouraging treatment can be developed.