title: National Guard families after combat: mental health, use of mental health services, and perceived treatment barriers.
abstract: OBJECTIVE
  National Guard forces have deployed in large numbers to Iraq and Afghanistan since September 11, 2001. The purpose of this cross-sectional study was to assess mental health symptoms, utilization of mental health services, and perceived barriers to service use among National Guard members and their significant others (including spouses and others with whom they share a committed relationship) from a Midwestern state.
  
  
  METHODS
  Participants were recruited for the study at military-sponsored reintegration workshops, which took place 45-90 days after service members' return from deployment. A sample of 332 National Guard members and 212 significant others volunteered to complete a survey that assessed mental health symptoms, service utilization, and barriers to treatment.
  
  
  RESULTS
  Forty percent of National Guard members and 34% of significant others met the screening criteria for one or more mental health problems. Of those meeting the criteria, 53% reported seeking help of some kind (50% of soldiers; 61% of significant others). Stigma associated with mental health care and concerns about service utilization appearing on military records ranked high as barriers among service members. Concerns about the influence of mental health issues on career advancement were of note. For significant others, barriers included the costs of mental health care, trouble with scheduling appointments, difficulty in getting time off work, and not knowing where to get help.
  
  
  CONCLUSIONS
  The mental health effects of combat on the soldier and his or her significant other remain a challenge for National Guard families, who often reside in communities that show little understanding of the psychological costs of war. Barriers remain for mental health service utilization.
authors.affiliation: University Outreach and Engagement-National Guard Project, Michigan State University, 22 Kellogg Center, East Lansing, MI 48824, USA. gormanl1@msu.edu
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Gorman
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Blow
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Ames
authors.forename: Philip L
authors.initials: PL
authors.lastname: Reed
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D002322:Career Mobility; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000453:epidemiology / Q000517:prevention & control*; D008603:Mental Health; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D008889:Military Personnel / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D057545:Social Stigma