Barriers to Initiating and Continuing Mental Health Treatment Among Soldiers in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).
U.S. Army soldiers with mental disorders report a variety of barriers to initiating and continuing treatment. Improved understanding of these barriers can help direct mental health services to soldiers in need. A representative sample of 5,428 nondeployed Regular Army soldiers participating in the Army Study to Assess Risk and Resilience in Servicemembers completed a self-administered questionnaire and consented to linking self-administered questionnaire data with administrative records. We examined reported treatment barriers (perceived need, structural reasons, attitudinal reasons) among respondents with current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, mental disorders who either did not seek treatment in the past year (n = 744) or discontinued treatment (n = 145). About 82.4% of soldiers who did not initiate treatment and 69.5% of those who discontinued treatment endorsed at least two barriers; 69.8% of never-treated soldiers reported no perceived need. Attitudinal reasons were cited more frequently than structural reasons among never-treated soldiers with perceived need (80.7% vs. 62.7%) and those who discontinued treatment (71.0% vs. 37.8%). Multivariate associations with sociodemographic, Army career, and mental health predictors varied across barrier categories. These findings suggest most soldiers with mental disorders do not believe they need treatment and those who do typically face multiple attitudinal and, to a lesser extent, structural barriers.
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
James A
JA
Naifeh
Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Boulevard, Room 7137, MSC 9635, Bethesda, MD 20892.
Lisa J
LJ
Colpe
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Pablo A
PA
Aliaga
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.
Nancy A
NA
Sampson
Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48106-1248.
Steven G
SG
Heeringa
Department of Psychiatry, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, CA 92037.
Murray B
MB
Stein
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Robert J
RJ
Ursano
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Carol S
CS
Fullerton
Department of Psychology, Harvard University, William James Hall 1220, 33 Kirkland Street, Cambridge, MA 02138.
Matthew K
MK
Nock
Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Boulevard, Room 7137, MSC 9635, Bethesda, MD 20892.
Michael
M
Schoenbaum
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.
Alan M
AM
Zaslavsky
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.
Ronald C
RC
Kessler
D000223:Adaptation, Psychological; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D011795:Surveys and Questionnaires