title: Stigma Predicts Treatment Preferences and Care Engagement Among Veterans Affairs Primary Care Patients with Depression.
abstract: Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed.
  
  
  
  This study tests whether stigma, defined as depression label avoidance, predicted patients' preferences for depression treatment providers, patients' prospective engagement in depression care, and care quality.
  
  
  
  We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression.
  
  
  
  Relative to low-stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care.
  
  
  
  High stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement.
authors.affiliation: Department of Psychology, University of Montana, Missoula, MT, USA. duncan.campbell@umontana.edu.
authors.forename: Duncan G
authors.identifier: 0000-0001-6077-3003
authors.initials: DG
authors.lastname: Campbell
authors.affiliation: Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.|Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle, WA, USA.|Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Bonner
authors.affiliation: Department of Human Development, Washington State University Vancouver, Vancouver, WA, USA.
authors.forename: Cory R
authors.initials: CR
authors.lastname: Bolkan
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Lanto
authors.affiliation: Center for Clinical Management Research, Health Services Research and Development Service, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.|Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.|Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
authors.affiliation: Center for Clinical Management Research, Health Services Research and Development Service, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.|Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Waltz
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Klap
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.|UCLA School of Medicine, Los Angeles, CA, USA.|RAND Health Program, Santa Monica, CA, USA.
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.affiliation: Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle, WA, USA.|Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Edmund F
authors.initials: EF
authors.lastname: Chaney
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D011320:Primary Health Care; D011446:Prospective Studies; D057545:Social Stigma; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*
keywords: Depression; Primary care; Stigma; Treatment engagement; Treatment preferences; Veterans