title: The association between perceived unmet medical need and mental health among the Republic of Korea Armed Forces.
abstract: BACKGROUND
  We investigated the effect of unmet medical need on the mental health of Republic of Korea (ROK) Armed Forces personnel, as most of the service members work in remote areas and often experience such unmet needs.
  
  
  METHODS
  This study used secondary data from the 2014 Military Health Survey (MHS), conducted by the ROK School of Military Medicine and designed to collect military health determinants. Descriptive statistics showed the general characteristics of the study populations by variable. We specifically compared the population after stratifying participants by suicide ideation. An analysis of variance was also carried out to compare Kessler Psychological Distress Scale 10 Scores. Additionally, dependent spouses and children of both active-duty service members and retirees are included among those entitled to Military Health System healthcare.
  
  
  RESULTS
  Among the 4967 military personnel, 681 (13.7%) individuals reported an experience of unmet medical need within the past 12 months and gave reasons of 'no time (5.15%)', 'long office wait (2.6%)', 'no money (0.22%)', 'long distance from base (1.19%)', 'illness but not very serious (1.65%)', 'mistrust in doctors (1.95%)' and 'pressure due to performance appraisal (0.95%)'. Regression analysis revealed that unmet medical need was significantly associated with negative mental health (β=1.753, p<0.0001) and increased suicide ideation (OR=2.649, 95% CI 1.84 to 3.82). Also, soldiers reporting unmet medical need due to 'no money', 'no time' or 'pressure due to performance appraisal' were significantly more likely to experience similar negative mental health effects.
  
  
  CONCLUSIONS
  Our study indicates that unmet medical need is significantly associated with soldiers' mental health decline and suicide ideation, highlighting the importance of providing military personnel with timely, affordable and sufficient medical care.
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.|Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
authors.forename: Tae Kyung
authors.initials: TK
authors.lastname: Kim
authors.affiliation: Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
authors.forename: S G
authors.initials: SG
authors.lastname: Lee
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
authors.forename: K-T
authors.initials: KT
authors.lastname: Han
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
authors.forename: Y
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Nursing, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: S Y
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
authors.forename: E-C
authors.initials: EC
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D005843:Geography; D017048:Health Care Costs; D006301:Health Services Needs and Demand; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D008887:Military Medicine; D008889:Military Personnel / Q000523:psychology*; D020380:Needs Assessment; D056910:Republic of Korea; D013315:Stress, Psychological / Q000523:psychology*; D059020:Suicidal Ideation; D013997:Time Factors; D035502:Trust; D055815:Young Adult
keywords: HEALTH SERVICES ADMINISTRATION & MANAGEMENT; MENTAL HEALTH; unmet medical need