Impact of OEF/OIF Veterans’ Beliefs about Mental Illness and Mental Health Treatment on Treatment

Seeking

Dawne Vogt, PhDResearch Psychologist and Acting Deputy Director,

WHSD, National Center for PTSD, VA Boston Healthcare System &

Associate Professor, Division of Psychiatry, Boston University School of Medicine

American Legion TBI and PTSD SymposiumJune 24, 2014

Background • Research indicates that OEF/OIF/OND Veterans are at risk

for a variety of mental health problems following return from deployment. o 14% of OEF/OIF Veterans in a large, nationally

representative study met criteria for probable PTSD and same proportion also met criteria for major depression.1

o Another nationally representative study found an identical rate of probable PTSD (14%) and an even higher rate of probable alcohol abuse (39%).2

• Variety of effective treatments for PTSD and other mental health problems - cognitive-behavioral therapy and pharmacotherapy.3

1 Schell & Marshall (2008)2 Eisen et al. (2012)

3 Watts et al. (2011)

Background • Many Veterans with mental health problems do not

receive mental health care.• Nearly half (47%) of national sample of OEF/OIF

Veterans with probable PTSD or major depression had not received mental health care in the previous year.1

• Treatment drop-out a substantial problem• Among both female and male OEF/OIF/OND VA users

with newly diagnosed PTSD, median number of psychotherapy visits in last year was three.2

1 Schell & Marshall (2008)2 Maguen, Cohen, et al. (2012)

Beliefs about Mental Illness and Mental Health Treatment

• Concerns about Stigma • Beliefs about how loved ones would react if one were to

experience a mental health problem• Beliefs about stigma in the workplace

• Personal beliefs about mental illness and mental health treatment• Beliefs about mental illness• Beliefs about treatment-seeking• Beliefs about mental health treatment

Barriers to Care Study• Study of a national sample of female and male

OEF/OIF Veterans (n=707) conducted in 2011

• Nonresponse bias and design weights applied to item-level results to enhance representativeness

• Overview of findings regarding:• Common mental health beliefs that may serve as barriers to care• Relationship between mental health beliefs and use of VA mental

health treatment among veterans with probable mental health conditions (PTSD, depression, alcohol abuse)

• Contribution above and beyond VA system factors

Concerns about Stigma from Loved Ones

…think less of me.

…see me as weak.

…be afraid that I might be violent or dangerous.

…feel uncomfortable around me.

0% 50% 100%

NegativeNeutralPositive

If I had a mental health problem and friends and family knew about it, they would…

Concerns about Stigma in the Workplace

…they would not want to be around me.

…they would feel uncomfortable around me.

…they would think I was incapable of doing my job.

…my career/job options would be limited.

0% 50% 100%

NegativeNeutralPositive

If I had a mental health problem and people at work knew…

Beliefs about Mental Illness

People with mental health problems require too much attention.

People with mental health problems cannot be counted on.

People with mental health problems use their health problems as an excuse.

Difficult to have a normal relationship with someone with mental health problems.

0% 50% 100%

NegativeNeutralPositive

Beliefs about Help-Seeking

If I were to seek mental health treatment, I would feel stupid for not being able to fix the problem on my own.

I would feel uncomfortable talking about my problems with a mental health provider.

I would prefer to deal with a mental health problem myself rather than to seek treatment.

A problem has to be really bad for me to be willing to seek mental health care.

Negative

Neutral

Positive

Beliefs about Mental Health Treatment

Mental health providers often make inaccurate as-sumptions about patients.

Medications for mental health problems are ineffective.

People who seek mental health treatment are often required to undergo treatments they don't want.

Medications for mental health problems have too many negative side effects.

0% 50% 100%

NegativeNeutralPositive

Summary of Item-Level Results

• Substantial minority of OEF/OIF Veterans endorse negative beliefs about mental illness and mental health treatment

• Concerns about stigma more commonly reported than negative personal beliefs

• Diversity in responses, with greatest proportion of respondents either explicitly rejecting these beliefs or reporting being “on the fence”

Predictors of VA Mental Health Service Use

Note. Analysis controls for comorbidity. *p<.05.

  Variable B S.E. OR

System Factors

  Availability of services .017 .047 1.017

  Ease of use .003 .026 1.003

  Staff skill and sensitivity -.100 .038 0.905*

Stigma and Personal Beliefs

  Negative beliefs about mental health treatment .112 .042 1.118*

  Negative beliefs about treatment seeking -.136 .032 0.873*

  Negative beliefs about mental illness -.089 .040 0.915*

  Concerns about stigma from loved ones .062 .030 1.064*

Concerns about stigma in the workplace .033 .027 1.034

Conclusions• Veterans report a variety of mental health beliefs

that may serve as barriers to care.

• Findings suggest that concerns about stigma are less important barrier to treatment than personal beliefs about mental illness & mental health treatment

• Negative mental health beliefs predict service use above and beyond Veterans’ perceptions of system-level barriers• Longitudinal studies needed to confirm these findings

Conclusions• Need for attention to attitudinal barriers to treatment

engagement

• Findings underscore the value of educational initiatives that target negative beliefs about mental illness and mental health treatment• VA’s Make the Connection (www.maketheconnection.net)• NCPTSD’s About Face (http://www.ptsd.va.gov/apps/AboutFace/)

Acknowledgements• Funding for Barriers to Care study was provided by VA

HSR&D

• For more information about this presentation, please contact: Dawne Vogt

Women’s Health Sciences DivisionNational Center for PTSD (116B-3)

VA Boston Healthcare System150 S. Huntington Ave

Boston, MA 02130857-364-5976

Dawne.Vogt@va.gov

Demographic & Background Factors

• Factors addressed in Anderson Model (1968)• Predisposing factors such as gender, age, and marital status• Enabling/impeding factors such as service-connected disability

status, caregiving and work responsibilities• Need-based factors such as symptom severity, comorbidity,

and functional impairment

Institutional Factors• Availability of services such as whether preferred type of

treatment is available• Ease of access such as convenience of location, wait times

for care, paperwork• Staff skill and sensitivity, including perception that

therapists understand client experiences and are trustworthy

Availability of Services

Amount of privacy

Availability of mental health services

Availability of emergency medical services

Availability of primary care services

0% 50% 100%

NegativeNeutralPostive

Ease of Use

Ability to reach medical staff by phone

The amount of paperwork required to receive care

Waiting time to get an appointment for a regular check-up

Waiting time to get an appointment when you’re sick

0% 50% 100%

NegativeNeutralPositive

Staff Skill & Sensitivity

Healthcare provider interest in patients’ thoughts and opinions

Healthcare provider skill and expertise

Staff courtesy and respect toward patients

Staff knowledge of healthcare needs of veterans from your cohort (for example, OEF/OIF veterans)

0% 50% 100%

NegativeNeutralPositive