title: Understanding Barriers to Mental Health Care for Recent War Veterans Through Photovoice.
abstract: Despite an urgent need for mental health care among U.S. service members returning from deployments to Iraq and Afghanistan, many veterans do not receive timely or adequate treatment. We used photovoice methods to engage veterans in identifying barriers to utilizing mental health services. Veterans described how key aspects of military culture and identity, highly adaptive during deployment, can deter help-seeking behavior and hinder recovery. Veterans' photographs highlighted how mental health symptoms and self-coping strategies operated as barriers to care. Many veterans' photos and stories revealed how negative health care encounters contributed to avoidance and abandonment of treatment; some veterans described these experiences as re-traumatizing. Visual methods can be a powerful tool for engaging recent war veterans in research. In particular, community-based participatory research approaches, which have rarely been used with veterans, hold great promise for informing effective interventions to improve access and enhance provision of patient-centered care for veterans.
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA Jennifer.True2@va.gov.
authors.forename: Gala
authors.initials: G
authors.lastname: True
authors.affiliation: University of South Florida, Tampa, Florida, USA.
authors.forename: Khary K
authors.initials: KK
authors.lastname: Rigg
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Anneliese
authors.initials: A
authors.lastname: Butler
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D055826:Afghan Campaign 2001-; D055812:Community-Based Participatory Research; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D015279:Organizational Culture; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D010781:Photography; D036301:Qualitative Research; D012107:Research Design; D014481:United States; D014728:Veterans / Q000523:psychology*
keywords: health care, access to; health care, users’ experiences; lived experience; mental health and illness; participatory action research; photography / photovoice; post-traumatic stress disorder; stigma; visual methods; vulnerable populations