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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

Published online by Cambridge University Press:  14 March 2017

S. J. Coleman ,
S. A. M. Stevelink ,
S. L. Hatch ,
J. A. Denny  and
N. Greenberg
S. J. Coleman*
Affiliation:
King's College London, Clinical Psychology, Institute of Psychology, Psychiatry and Neuroscience, Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK
S. A. M. Stevelink
Affiliation:
King's Centre for Military Health Research, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
S. L. Hatch
Affiliation:
King's College London, Psychological Medicine, Institute of Psychiatry, 10 Cutcombe Road, London SE5 9RJ, UK
J. A. Denny
Affiliation:
Queen's University Belfast, University Road, Belfast BT7 1NN, UK
N. Greenberg
Affiliation:
King's Centre for Military Health Research, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
*
*Address for correspondence: S. J. Coleman, King's College London, Clinical Psychology, Institute of Psychology, Psychiatry and Neuroscience, Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK. (Email: sarah.coleman@kcl.ac.uk)
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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.

Keywords

Health-related stigmahelp-seeking behaviourmental healthmilitary personnelqualitative methods
Type
Review Article
Information
Psychological Medicine , Volume 47 , Issue 11 , August 2017 , pp. 1880 - 1892
Copyright
Copyright © Cambridge University Press 2017 

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References

Britt, TW (2000). The stigma of psychological problems in a work environment: evidence from the screening of service members returning from Bosnia. Journal of Applied Social Psychology 30, 1599–1618.Google Scholar
Britt, TW, Wright, KM, Moore, D (2012). Leadership as a predictor of stigma and practical barriers toward receiving mental health treatment: a multilevel approach. Psychological Services 9, 26–37.Google Scholar
Bull, S, Thandi, G, Keeling, M, Chesnokov, M, Greenberg, N, Jones, N, Rona, R, Hatch, SL (2015). Medical and Welfare Officers beliefs about post-deployment screening for mental health disorders in the UK Armed Forces: a qualitative study. BMC Public Health 15, 338.Google Scholar
Campbell, R, Pound, P, Morgan, M, Daker-White, G, Britten, N, Pill, R, Yardley, L, Pope, C, Donovan, J (2011). Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research. Health Technology Assessment 15, 1–164.CrossRefGoogle ScholarPubMed
Clement, S, Lassman, F, Barley, E, Evans-Lacko, S, Williams, P, Yamaguchi, S, Slade, M, Rusch, N, Thornicroft, G (2013). Mass media interventions for reducing mental health-related stigma. The Cochrane Database of Systematic Reviews, issue 7, CD009453.Google Scholar
Clement, S, Schauman, O, Graham, T, Maggioni, F, Evans-Lacko, S, Bezborodovs, N, Morgan, C, Rüsch, N, Brown, JSL, Thornicroft, G (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine 45, 11–27.Google Scholar
Cohen, BE, Gima, K, Bertenthal, D, Kim, S, Marmar, CR, Seal, KH (2010). Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. Journal of General Internal Medicine 25, 18–24.Google Scholar
Corrigan, PW (2004). Don't call me nuts: an international perspective on the stigma of mental illness. Acta Psychiatrica Scandinavica 109, 403–404.Google Scholar
Corrigan, PW, Watson, AC (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice 9, 35–53.Google Scholar
Critical Appraisal Skills Programme (CASP) (2014). CASP Checklists. CASP: Oxford (http://media.wix.com/ugd/dded87_29c5b002d99342f788c6ac670e49f274.pdf).Google Scholar
Dickstein, BD, Vogt, DS, Handa, S, Litz, BT (2010). Targeting self-stigma in returning military personnel and veterans: a review of intervention strategies. Military Psychology 22, 224–236.Google Scholar
Dunt, D (2009). Review of Mental Health Care in the ADF and Transition through Discharge. Letter of submission of report to Ministers. Acknowledgments (http://www.peacekeepers.asn.au/veterans/studies/ReviewofMentalHealth1May2009.pdf).Google Scholar
Evans-Lacko, S, Brohan, E, Mojtabai, R, Thornicroft, G (2012). Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychological Medicine 42, 1741–1752.Google Scholar
Fear, NT, Jones, M, Murphy, D, Hull, L, Iversen, AC, Coker, B, Machell, L, Sundin, J, Woodhead, C, Jones, N, Greenberg, N, Landau, S, Dandeker, C, Rona, RJ, Hotopf, M, Wessely, S (2010). What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. Lancet 375, 1783–1797.CrossRefGoogle ScholarPubMed
Fikretoglu, D, Guay, S, Pedlar, D, Brunet, A (2008). Twelve month use of mental health services in a nationally representative, active military sample. Medical Care 46, 217–223.Google Scholar
Gibbs, DA, Rae Olmsted, KL, Brown, JM, Clinton-Sherrod, AM (2011). Dynamics of stigma for alcohol and mental health treatment among army soldiers. Military Psychology 23, 36–51.Google Scholar
Goffman, E (1963). Stigma: Notes on the Management of Spoiled Identity. Prentice Hall: Englewood Cliffs, NJ.Google Scholar
Gould, M, Adler, A, Zamorski, M, Castro, C, Hanily, N, Steele, N, Kearney, S, Greenberg, N (2010). Do stigma and other perceived barriers to mental health care differ across armed forces? Journal of the Royal Society of Medicine 103, 148–156.Google Scholar
Greenberg, N, Brooks, S, Dunn, R (2015). Latest developments in post-traumatic stress disorder: diagnosis and treatment. British Medical Bulletin 114, 147–155.Google Scholar
Greene-Shortridge, TM, Britt, TW, Castro, CA (2007). The stigma of mental health problems in the military. Military Medicine 172, 157–161.Google Scholar
Hoerster, KD (2012). Association of perceived barriers with prospective use of VA mental health care among Iraq and Afghanistan veterans. Psychiatric Services 63, 380.CrossRefGoogle ScholarPubMed
Hoge, C, Castro, C, Messer, S, McGurk, D, Cotting, D, Koffman, R (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351, 13–22.Google Scholar
Iversen, AC, van Staden, L, Hughes, JH, Browne, T, Hull, L, Hall, J, Greenberg, N, Rona, RJ, Hotopf, M, Wessely, S, Fear, NT (2009). The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study. BMC Psychiatry 9, 68.CrossRefGoogle ScholarPubMed
Iversen, AC, van Staden, L, Hughes, JH, Greenberg, N, Hotopf, M, Rona, RJ, Thornicroft, G, Wessely, S, Fear, NT (2011). The stigma of mental health problems and other barriers to care in the UK Armed Forces. BMC Health Services Research 11, 31.Google Scholar
Jorm, AF (2012). Mental health literacy: empowering the community to take action for better mental health. American Psychologist 67, 231–243.CrossRefGoogle ScholarPubMed
Langston, V, Greenberg, N, Fear, N, Iversen, A, French, C, Wessely, S (2010). Stigma and mental health in the Royal Navy: a mixed methods paper. Journal of Mental Health 19, 8–16.Google Scholar
Milliken, CS, Auchterlonie, JL, Hoge, CW (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA: Journal of the American Medical Association 298, 2141–2148.Google Scholar
Mittal, D, Drummond, KL, Blevins, D, Curran, G, Corrigan, P, Sullivan, G (2013). Stigma associated with PTSD: perceptions of treatment seeking combat veterans. Psychiatric Rehabilitation Journal 36, 86–92.Google Scholar
Murphy, D, Hunt, E, Luzon, O, Greenberg, N (2014). Exploring positive pathways to care for members of the UK armed forces receiving treatment for PTSD: a qualitative study. European Journal of Psychotraumatology 5, 10.3402/ejpt.v5.21759.Google Scholar
Osório, C, Jones, N, Fertout, M, Greenberg, N (2013). Perceptions of stigma and barriers to care among UK military personnel deployed to Afghanistan and Iraq. Anxiety, Stress, and Coping 26, 539–557.CrossRefGoogle ScholarPubMed
Pury, CLS, Britt, TW, Zinzow, HM, Raymond, MA (2014). Blended courage: moral and psychological courage elements in mental health treatment seeking by active duty military personnel. Journal of Positive Psychology 9, 30–41.Google Scholar
Rona, RJ, Hyams, KC, Wessely, S (2005). Screening for psychological illness in military personnel. JAMA 293, 1257–1260.CrossRefGoogle ScholarPubMed
Rüsch, N, Thornicroft, G (2014). Does stigma impair prevention of mental disorders? British Journal of Psychiatry 204, 249–251.Google Scholar
Sayer, NA, Friedemann-Sanchez, G, Spoont, M, Murdoch, M, Parker, LE, Chiros, C, Rosenheck, R (2009). A qualitative study of determinants of PTSD treatment initiation in veterans. Psychiatry 72, 238–255.Google Scholar
Schomerus, G, Matschinger, H, Angermeyer, MC (2006). Preferences of the public regarding cutbacks in expenditure for patient care: are there indications of discrimination against those with mental disorders? Social Psychiatry and Psychiatric Epidemiology 41, 369–377.CrossRefGoogle ScholarPubMed
Sharp, ML, Fear, NT, Rona, RJ, Wessely, S, Greenberg, N, Jones, N, Goodwin, L (2015). Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiologic Reviews 37, 144–162.Google Scholar
Stecker, T, Fortney, JC, Hamilton, F, Ajzen, I (2007). An assessment of beliefs about mental health care among veterans who served in Iraq. Psychiatric Services 58, 1358–1361.Google Scholar
Thomas, J, Harden, A, Chalmers, I, Oakley, A, Cooper, H, Hedges, L, Petticrew, M, Roberts, H, Chalmers, I, Hedges, L, Cooper, H, Juni, P, Altman, D, Egger, M, Mulrow, C, White, H, Campbell, R, Pound, P, Pope, C, Britten, N, Pill, R, Morgan, M, Donovan, J, Dixon-Woods, M, Bonas, S, Booth, A, Jones, DR, Miller, T, Sutton, AJ, Shaw, RL, Smith, JA, Young, B, Sandelowski, M, Barroso, J, Thorne, S, Jensen, L, Kearney, MH, Noblit, G, Sandelowski, M, Harden, A, Garcia, J, Oliver, S, Rees, R, Shepherd, J, Brunton, G, Oakley, A, Harden, A, Brunton, G, Fletcher, A, Oakley, A, Thomas, J, Sutcliffe, K, Harden, A, Oakley, A, Oliver, S, Rees, R, Brunton, G, Kavanagh, J, Thomas, J, Kavanagh, J, Tucker, H, Burchett, H, Tripney, J, Oakley, A, Bryman, A, Hammersley, M, Harden, A, Thomas, J, Oakley, A, Harden, A, Oakley, A, Oliver, S, Harden, A, Rees, R, Shepherd, J, Brunton, G, Oliver, S, Oakley, A, Rees, R, Harden, A, Shepherd, J, Brunton, G, Oliver, S, Oakley, A, Shepherd, J, Harden, A, Rees, R, Brunton, G, Oliver, S, Oakley, A, Thomas, J, Harden, A, Oakley, A, Oliver, S, Sutcliffe, K, Rees, R, Brunton, G, Kavanagh, J, Davies, P, Newman, M, Thompson, C, Roberts, AP, Popay, J, Noblit, GW, Hare, RD, Britten, N, Campbell, R, Pope, C, Donovan, J, Morgan, M, Pill, R, Paterson, B, Thorne, S, Canam, C, Jillings, C, Dixon-Woods, M, Cavers, D, Agarwal, S, Annandale, E, Arthur, A, Harvey, J, Katbamna, S, Olsen, R, Smith, L, Riley, R, Sutton, AJ, Dixon-Woods, M, Agarwal, S, Jones, D, Young, B, Sutton, A, Boyatzis, RE, Braun, V, Clarke, V, Doyle, LH, Barroso, J, Gollop, C, Sandelowski, M, Meynell, J, Pearce, PF, Collins, LJ, Walters, LA, Wilczynski, NL, Haynes, RB, Hedges, T, Wong, SSL, Wilczynski, NL, Haynes, RB, Seale, C, Spencer, L, Ritchie, J, Lewis, J, Dillon, L, Boulton, M, Fitzpatrick, R, Swinburn, C, Cobb, A, Hagemaster, J, Mays, N, Pope, C, Alderson, P, Egger, M, Davey-Smith, G, Altman, D, Sandelowski, M, Barroso, J, Sandelowski, M, Thomas, J, Brunton, J, Fisher, M, Qureshi, H, Hardyman, W, Homewood, J, Dixey, R, Sahota, P, Atwal, S, Turner, A, Daly, A, Willis, K, Small, R, Green, J, Welch, N, Kealy, M, Hughes, E, Popay, J, Strike, K, Posner, G, Marston, C, King, E (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology 8, 45.CrossRefGoogle ScholarPubMed
Visco, R (2009). Postdeployment, self-reporting of mental health problems, and barriers to care. Perspectives in Psychiatric Care 45, 240–253.Google Scholar
Vogt, D (2011). Mental health-related beliefs as a barrier to service use for military personnel and veterans: a review. Psychiatric Services (Washington, D.C.) 62, 135–142.Google Scholar
Vohringer, PA, Jimenez, MI, Igor, MA, Fores, GA, Correa, MO, Sullivan, MC, Holtzman, NS, Whitham, EA, Barroilhet, SA, Alvear, K, Logvinenko, T, Kent, DM, Ghaemi, NS (2013). Detecting mood disorder in resource-limited primary care settings: comparison of a self-administered screening tool to general practitioner assessment. Journal of Medical Screening 20, 118–124.Google Scholar
Wang, PS, Lane, M, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 629–640.Google Scholar
Whybrow, D, Jones, N, Evans, C, Minshall, D, Smith, D, Greenberg, N (2016). The mental health of deployed UK maritime forces. Occupational and Environmental Medicine 73, 75–82.Google Scholar
Woodhead, C, Rona, RJ, Iversen, AC, MacManus, D, Hotopf, M, Dean, K, McManus, S, Meltzer, H, Brugha, T, Jenkins, R, Wessely, S, Fear, NT (2011). Health of National Service veterans: an analysis of a community-based sample using data from the 2007 Adult Psychiatric Morbidity Survey of England. Social Psychiatry and Psychiatric Epidemiology 46, 559–566.CrossRefGoogle ScholarPubMed
Wright, KM, Cabrera, OA, Bliese, PD, Adler, AB, Hoge, CW, Castro, CA (2009). Stigma and barriers to care in soldiers postcombat. Psychological Services 6, 108–116.Google Scholar
Zinzow, HM, Britt, TW, Pury, CLS, Raymond, MA, McFadden, AC, Burnette, CM (2013). Barriers and facilitators of mental health treatment seeking among active-duty army personnel. Military Psychology 25, 514–535.Google Scholar
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