title: Stigma as a barrier to seeking health care among military personnel with mental health problems.
abstract: Approximately 60% of military personnel who experience mental health problems do not seek help, yet many of them could benefit from professional treatment. Across military studies, one of the most frequently reported barriers to help-seeking for mental health problems is concerns about stigma. It is, however, less clear how stigma influences mental health service utilization. This review will synthesize existing research on stigma, focusing on those in the military with mental health problems. We conducted a systematic review and meta-analysis of studies between 2001 and 2014 to examine the prevalence of stigma for seeking help for a mental health problem and its association with help-seeking intentions/mental health service utilization. Twenty papers met the search criteria. Weighted prevalence estimates for the 2 most endorsed stigma concerns were 44.2% (95% confidence interval: 37.1, 51.4) for "My unit leadership might treat me differently" and 42.9% (95% confidence interval: 36.8, 49.0) for "I would be seen as weak." Nine studies found no association between anticipated stigma and help-seeking intentions/mental health service use and 4 studies found a positive association. One study found a negative association between self-stigma and intentions to seek help. Counterintuitively, those that endorsed high anticipated stigma still utilized mental health services or were interested in seeking help. We propose that these findings may be related to intention-behavior gaps or methodological issues in the measurement of stigma. Positive associations may be influenced by modified labeling theory. Additionally, other factors such as self-stigma and negative attitudes toward mental health care may be worth further attention in future investigation.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Sharp
authors.forename: Nicola T
authors.initials: NT
authors.lastname: Fear
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Rona
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
authors.forename: Neil
authors.initials: N
authors.lastname: Greenberg
authors.forename: Norman
authors.initials: N
authors.lastname: Jones
authors.forename: Laura
authors.initials: L
authors.lastname: Goodwin
mesh_terms: D001315:Australia; D006801:Humans; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008889:Military Personnel / Q000523:psychology*; D009520:New Zealand; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D057545:Social Stigma; D006113:United Kingdom; D014481:United States
keywords: barriers to care; health care; help-seeking; mental health; military; service utilization; stigma; veterans