title: Resilience, Stress, Stigma, and Barriers to Mental Healthcare in U.S. Air Force Nursing Personnel.
abstract: BACKGROUND
  Stigma may deter military service members from seeking mental health (MH) services. Previously, substantial proportions of U.S. Air Force (USAF) registered nurses and medical technicians reported concerns about stigma with accessing MH services; in particular, that unit members might lose confidence in them or perceive them as weak, unit leadership might treat them differently, or accessing care might affect career advancement.
  
  
  OBJECTIVE
  This study assessed the extent to which stigma and barriers to accessing MH services as perceived by USAF nursing personnel are associated with resilience, stress, previous deployment, or demographic characteristics.
  
  
  METHODS
  An anonymous, online survey was administered to active-duty USAF registered nurses and medical technicians at three locations (N = 250). The survey included demographic items, the Stigma and Barriers to Care scales, Conner-Davidson Resilience Scale, and Perceived Stress Questionnaire.
  
  
  RESULTS
  Mean resilience was high, and perceived stress was moderate. About half of participants agreed that unit members might have less confidence in me (54%) or unit leadership might treat me differently (58%). Many also had concerns that it would harm my career (47%), I would be seen as weak (47%), or there would be difficulty getting time off work for treatment (45%). Stigma was positively correlated with perceived stress (r = .40, p < .01) and negatively correlated with resilience (r = -.24, p < .01). Officers had significantly higher stigma and resilience scores and lower stress scores compared with enlisted personnel, but those differences were small.
  
  
  CONCLUSIONS
  This study validated previous findings that substantial percentages of USAF nursing personnel have concerns that accessing MH services may adversely affect their careers and how they are viewed by unit leaders and peers. In addition, higher levels of concern about stigma were associated with higher levels of stress and lower levels of resilience. Limitations included a low response rate (18%) and self-selection biases.
authors.affiliation: Stephen H. A. Hernandez, Lt Col, USAFR, NC, PhD, RN, is Assistant Professor, College of Nursing, University of New Mexico, Albuquerque. Brenda J. Morgan, Col, USAF, NC, PhD, RN, is Director, 59th Medical Wing Nursing Research Division, Joint Base San Antonio-Lackland, Texas. Mark B. Parshall, PhD, RN, FAAN, is Professor, College of Nursing, University of New Mexico, Albuquerque.
authors.forename: Stephen H A
authors.initials: SH
authors.lastname: Hernandez
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Morgan
authors.forename: Mark B
authors.initials: MB
authors.lastname: Parshall
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D008887:Military Medicine / Q000458:organization & administration*; D008889:Military Personnel / Q000523:psychology*; D009740:Nursing Staff / Q000523:psychology*; D057545:Social Stigma; D013315:Stress, Psychological / Q000628:therapy*; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult