title: Stigma-related barriers and facilitators to help seeking for mental health issues in the armed forces: a systematic review and thematic synthesis of qualitative literature.
abstract: A recent quantitative review in the area of stigma and help seeking in the armed forces has questioned the association between these factors (Sharp et al. 2015). To date, the contribution of qualitative literature in this area has largely been ignored, despite the value this research brings to the understanding of complex social constructs such as stigma. The aim of the current systematic review of qualitative studies was to identify appropriate literature, assess the quality and synthesize findings across studies regarding evidence of stigma-related barriers and facilitators to help seeking for mental health issues within the armed forces. A multi-database text word search incorporating searches of PsycINFO, MEDLINE, Social Policy and Practice, Social Work Abstracts, EMBASE, ERIC and EBM Review databases between 1980 and April 2015 was conducted. Literature was quality assessed using the Critical Appraisal Skills Programme tool. Thematic synthesis was conducted across the literature. The review identified eight studies with 1012 participants meeting the inclusion criteria. Five overarching themes were identified across the literature: (1) non-disclosure; (2) individual beliefs about mental health; (3) anticipated and personal experience of stigma; (4) career concerns; and (5) factors influencing stigma. The findings from the current systematic review found that unlike inconsistent findings in the quantitative literature, there was substantial evidence of a negative relationship between stigma and help seeking for mental health difficulties within the armed forces. The study advocates for refinement of measures to accurately capture the complexity of stigma and help seeking in future quantitative studies.
authors.affiliation: King's College London, Clinical Psychology, Institute of Psychology, Psychiatry and Neuroscience,Addiction Sciences Building,4 Windsor Walk,London SE5 8AF,UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Coleman
authors.affiliation: King's Centre for Military Health Research, King's College London, Weston Education Centre,Cutcombe Road,London SE5 9RJ,UK.
authors.forename: S A M
authors.initials: SAM
authors.lastname: Stevelink
authors.affiliation: King's College London, Psychological Medicine, Institute of Psychiatry,10 Cutcombe Road,London SE5 9RJ,UK.
authors.forename: S L
authors.initials: SL
authors.lastname: Hatch
authors.affiliation: Queen's University Belfast,University Road,Belfast BT7 1NN,UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Denny
authors.affiliation: King's Centre for Military Health Research, King's College London, Weston Education Centre,Cutcombe Road,London SE5 9RJ,UK.
authors.forename: N
authors.initials: N
authors.lastname: Greenberg
mesh_terms: D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D008889:Military Personnel / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D057545:Social Stigma; D014342:Truth Disclosure
keywords: Health-related stigma; help-seeking behaviour; mental health; military personnel; qualitative methods