title: Social networks, mental health problems, and mental health service utilization in OEF/OIF National Guard veterans.
abstract: OBJECTIVE
  Low social support and small social network size have been associated with a variety of negative mental health outcomes, while their impact on mental health services use is less clear. To date, few studies have examined these associations in National Guard service members, where frequency of mental health problems is high, social support may come from military as well as other sources, and services use may be suboptimal.
  
  
  METHODS
  Surveys were administered to 1448 recently returned National Guard members. Multivariable regression models assessed the associations between social support characteristics, probable mental health conditions, and service utilization.
  
  
  RESULTS
  In bivariate analyses, large social network size, high social network diversity, high perceived social support, and high military unit support were each associated with lower likelihood of having a probable mental health condition (p < .001). In adjusted analyses, high perceived social support (OR .90, CI .88-.92) and high unit support (OR .96, CI .94-.97) continued to be significantly associated with lower likelihood of mental health conditions. Two social support measures were associated with lower likelihood of receiving mental health services in bivariate analyses, but were not significant in adjusted models.
  
  
  CONCLUSIONS
  General social support and military-specific support were robustly associated with reduced mental health symptoms in National Guard members. Policy makers, military leaders, and clinicians should attend to service members' level of support from both the community and their units and continue efforts to bolster these supports. Other strategies, such as focused outreach, may be needed to bring National Guard members with need into mental health care.
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA. rekaufma@umich.edu.|VA Ann Arbor Health Care System, Ann Arbor, MI, USA. rekaufma@umich.edu.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA. rekaufma@umich.edu.
authors.forename: Rebecca K
authors.identifier: http://orcid.org/0000-0002-2844-3458
authors.initials: RK
authors.lastname: Sripada
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.|VA Ann Arbor Health Care System, Ann Arbor, MI, USA.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Amy S B
authors.initials: AS
authors.lastname: Bohnert
authors.affiliation: Portland VA Medical Center, Portland, OR, USA.|Oregon Health and Science University, Portland, OR, USA.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Teo
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.|VA Ann Arbor Health Care System, Ann Arbor, MI, USA.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Debra S
authors.initials: DS
authors.lastname: Levine
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.|VA Ann Arbor Health Care System, Ann Arbor, MI, USA.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Pfeiffer
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.|VA Ann Arbor Health Care System, Ann Arbor, MI, USA.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Nicholas W
authors.initials: NW
authors.lastname: Bowersox
authors.affiliation: Department of Sociology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Mizruchi
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.|VA Ann Arbor Health Care System, Ann Arbor, MI, USA.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Chermack
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.
authors.forename: Dara
authors.initials: D
authors.lastname: Ganoczy
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.|VA Ann Arbor Health Care System, Ann Arbor, MI, USA.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Walters
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.|VA Ann Arbor Health Care System, Ann Arbor, MI, USA.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012944:Social Support; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Depression; National Guard; PTSD; Social network; Social support; Veteran