“Mental Health Care Utilization: How Race, Ethnicity and Veteran Status Are Associated with Seeking Help”

PURPOSE:  Many veterans are exposed to potentially traumatic experiences often associated with higher rates of mental health (MH) problems compared to the civilian population (Kessler et al., 2014). Over 36% of recently returning veterans received a MH diagnosis (Seal et al., 2009), and approximately 22 veterans die from suicide each day (U.S. Department of Veterans Affairs, 2013), but MH service utilization is low (Seal et al., 2010; Hoge et al., 2014). Understanding factors influencing veterans’ MH service utilization, including stigma and help-seeking attitudes, may be vital to increase access and utilization. 

METHOD: The 2007 Texas BRFSS (CDC, 2014) examined respondents’ (n=8,563) dichotomous outcomes including MH treatment attitudes and stigma. The core BRFSS questionnaire collected information on veteran status in addition to the demographic covariates used in the analyses. The frequency of receiving social and emotional support was used as a predictor of MH treatment utilization. Logistic regression evaluated the prevalence of utilizing MH treatment across different races/ethnicities for veterans and non-veterans.  The model was run in Stata/SE version 12 and applied the sampling weights for the Texas sample splits 1 and 2.

RESULTS:  Although not significant (p=0.259), slightly higher weighted percentage of veterans (12%) utilized MH treatment compared to non-veterans (11%). Logistic regression indicated that Blacks and Latino ethnicity moderated the effect of veteran status on MH utilization.  While controlling for MH stigma, help seeking attitudes, frequency of social and emotional support, gender, age, education, marital status, and employment, the main effect of veteran status (OR=1.00, p=0.983) indicated no differences in treatment utilization between veterans and non-veterans for NHWs. Black veterans were over three times more likely than Black non-veterans (OR=3.22, p<0.05) to use services and Hispanic veterans vs. Hispanic non-veterans (OR=3.35, p<0.05) had similar odds ratios. 

Black non-veterans had almost 60% lower odds of utilizing MH services compared to NHWs  (OR=0.44, p<0.05) while Black and NHW veterans had similar rates (OR=1.41, p=0.419).  Likewise, Hispanic non-veterans were less likely to utilize treatment that NHW non-veterans (OR=0.33, p<0.05), while there was no difference between Hispanic and NHW veterans (OR=1.10, p=0.79).

IMPLICATIONS:  This study found that while there were no differences in health care utilization between NHW veterans and non-veterans, there were distinct patterns among racial/ethnic minority veterans and non-vets. Consistent with the literature, Black and Latino non-veterans reported significantly lower health care usage rates compared to NHW non-veterans (Alegria et al., 2002). Yet among veterans, there were no differences in reported utilization rates comparing NHWs and Latinos and also NHWs and Blacks.  Our study adds to the literature by examining health care utilization among a diverse group of veterans by not only focusing on VA services, but all services available to veterans. Utilization patterns among veterans should be further explored to provide accessible, culturally appropriate, effective healthcare. Future studies should address differences in help-seeking patterns among different racial/ethnic groups. Veteran status as a protective factor of MH treatment utilization among Black and Latino veterans should be explored specifically to understand underlying factors that confer this protection.