title: Mental health stigmatisation in deployed UK Armed Forces: a principal components analysis.
abstract: BACKGROUND
  UK military research suggests that there is a significant link between current psychological symptoms, mental health stigmatisation and perceived barriers to care (stigma/BTC). Few studies have explored the construct of stigma/BTC in depth amongst deployed UK military personnel.
  
  
  METHODS
  Three survey datasets containing a stigma/BTC scale obtained during UK deployments to Iraq and Afghanistan were combined (n=3405 personnel). Principal component analysis was used to identify the key components of stigma/BTC. The relationship between psychological symptoms, the stigma/BTC components and help seeking were examined.
  
  
  RESULTS
  Two components were identified: 'potential loss of personal military credibility and trust' (stigma Component 1, five items, 49.4% total model variance) and 'negative perceptions of mental health services and barriers to help seeking' (Component 2, six items, 11.2% total model variance). Component 1 was endorsed by 37.8% and Component 2 by 9.4% of personnel. Component 1 was associated with both assessed and subjective mental health, medical appointments and admission to hospital. Stigma Component 2 was associated with subjective and assessed mental health but not with medical appointments. Neither component was associated with help-seeking for subjective psycho-social problems.
  
  
  CONCLUSIONS
  Potential loss of credibility and trust appeared to be associated with help-seeking for medical reasons but not for help-seeking for subjective psychosocial problems. Those experiencing psychological symptoms appeared to minimise the effects of stigma by seeking out a socially acceptable route into care, such as the medical consultation, whereas those who experienced a subjective mental health problem appeared willing to seek help from any source.
authors.affiliation: Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Fertout
authors.affiliation: Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Jones
authors.affiliation: Center for Innovation and Research on Veterans and Military Families (CIR), School of Social Work, University of Southern California, Los Angeles, California, USA.
authors.forename: M
authors.initials: M
authors.lastname: Keeling
authors.affiliation: Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Greenberg
mesh_terms: D000293:Adolescent; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008889:Military Personnel / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D025341:Principal Component Analysis; D057545:Social Stigma; D006113:United Kingdom; D055815:Young Adult
keywords: Help Seeking; MENTAL HEALTH; Principle Components; Stigma