Fighting Stigma On the Front Lines: Study Findings to Inform the Development of Interventions to Increase Treatment Seeking Among Soldiers
Although efficacious research-based treatments for serious behavioral health conditions experienced by military Service Members are increasingly available, stigma associated with mental health difficulties may serve as a substantial barrier for accessing this care. Little research has been conducted to examine levels of stigma among active duty Soldiers or to examine stigma regarding particular disorders. A recent study noted only 23-40% of service members who needed behavioral health treatments actually sought treatment. Among Army Soldiers, stigma sends a message to those who need treatment that seeking care could lead to negative consequences. The military ethos “Army Strong” is indoctrinated into Soldiers from basic training, making seeking behavioral health care a behavior that may label one as “weak.”
The three studies in this symposia collected data from Army Soldiers stationed at Ft. Hood, TX. The first study examined Soldiers' knowledge, attitudes, and behaviors regarding treatment for posttraumatic stress disorder (PTSD) to help inform intervention development that can increase treatment seeking. The second study piloted an intervention to increase Soldiers' willingness to seek treatment and to improve their knowledge about PTSD based on the recognition of the powerful influence of leadership in military organizations. If an intervention can decrease stigma about seeking treatment for PTSD at a leadership level, those serving under the leader are more likely to feel that seeking care is not stigmatized. Finally, the third study sought to understand whether Soldiers' perceptions of treatment seeking for insomnia differ from treatment seeking for PTSD.
Military briefings were scheduled through a military medical office at Ft Hood, TX. At each briefing Soldiers were offered the opportunity to participate in each study by completing measures before and/or after each presentation. The Perceived Barriers to Seeking Mental Health Services Scale (Britt, 2000; Hoge et al., 2004) was used to assess stigma related to either PTSD or insomnia in each of the studies. Additional measures were developed to assess symptom and treatment knowledge, and treatment seeking behaviors.
Close to 300 Active Duty Soldiers participated in briefings on PTSD and insomnia. In general Soldiers' attitudes toward treatment seeking were not favorable, their knowledge of effective treatments were quite low, and their reported likelihood of seeking treatment was low due to perceptions of career harm and concerns regarding how leaders and peers would view them. Results of the pilot intervention support a group-based model to increase knowledge about PTSD and effective treatments, to improve attitudes related to stigma, and to elicit behavior change around treatment seeking through leadership interaction with enlisted soldiers. Overall, similar levels of perceived stigma and barriers to care were reported for insomnia and for PTSD.
Reducing stigma can potentially circumvent the unnecessary suffering and problematic symptoms of PTSD and insomnia present in service member’s personal and professional lives. Understanding treatment seeking from Soldiers' perspectives can inform interventions that address their concerns within a military cultural environment.