title: Trends in mental health services utilization and stigma in US soldiers from 2002 to 2011.
abstract: OBJECTIVE
  We characterized trends in mental health services utilization and stigma over the course of the Afghanistan and Iraq wars among active-component US soldiers.
  
  
  METHODS
  We evaluated trends in mental health services utilization and stigma using US Army data from the Health-Related Behavior (HRB) surveys from 2002, 2005, and 2008 (n = 12,835) and the Land Combat Study (LCS) surveys administered to soldiers annually from 2003 to 2009 and again in 2011 (n = 22,627).
  
  
  RESULTS
  HRB and LCS data suggested increased mental health services utilization and decreased stigma in US soldiers between 2002 and 2011. These trends were evident in soldiers with and without posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or PTSD and MDD. Despite the improving trends, more than half of soldiers with mental health problems did not report seeking care.
  
  
  CONCLUSIONS
  Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of US soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention.
authors.affiliation: Phillip J. Quartana, Joshua E. Wilk, Jeffrey L. Thomas, Paul Y. Kim, Kristina Clark-Walper, and Charles W. Hoge are with the Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD. Robert M. Bray, Kristine L. Rae Olmsted, Janice M. Brown, and Jason Williams are with RTI International, Research Triangle Park, NC.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Quartana
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Wilk
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Thomas
authors.forename: Robert M
authors.initials: RM
authors.lastname: Bray
authors.forename: Kristine L
authors.initials: KL
authors.lastname: Rae Olmsted
authors.forename: Janice M
authors.initials: JM
authors.lastname: Brown
authors.forename: Jason
authors.initials: J
authors.lastname: Williams
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Kim
authors.forename: Kristina
authors.initials: K
authors.lastname: Clarke-Walper
authors.forename: Charles W
authors.initials: CW
authors.lastname: Hoge
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006306:Health Surveys; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000523:psychology*; D057545:Social Stigma; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014481:United States; D055815:Young Adult