Dawne Vogt PhD Research Psychologist and Acting Deputy Director WHSD National Center for PTSD VA Boston Healthcare System amp Associate Professor Division of Psychiatry Boston University School of Medicine ID: 727546
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Slide1
Impact of OEF/OIF Veterans’ Beliefs about Mental Illness and Mental Health Treatment on Treatment Seeking
Dawne Vogt, PhD
Research Psychologist and Acting Deputy Director,
WHSD, National Center for PTSD, VA Boston Healthcare System &Associate Professor, Division of Psychiatry, Boston University School of Medicine
American Legion TBI and PTSD Symposium
June 24, 2014Slide2
Background
Research indicates that OEF/OIF/OND Veterans are at risk for a variety of mental health problems following return from deployment.
14% of OEF/OIF Veterans in a large, nationally representative study met criteria for probable PTSD and same proportion also met criteria for major depression.
1 Another nationally representative study found an identical rate of probable PTSD (14%) and an even higher rate of probable alcohol abuse (39
%).
2
Variety of effective treatments for PTSD and other mental health problems - cognitive-behavioral therapy and pharmacotherapy.
3
1
Schell & Marshall (2008)2 Eisen et al. (2012)
3
Watts et al. (2011)Slide3
Background
Many Veterans with mental health problems do
not receive
mental health care.Nearly half (47%) of national sample of OEF/OIF Veterans with probable PTSD or major depression had not received mental health care in the previous year.1
Treatment
drop-out
a substantial problem
Among both female and male OEF/OIF/OND VA users with newly diagnosed PTSD, median number of psychotherapy visits in last year was three.
2
1
Schell & Marshall (2008)
2
Maguen, Cohen, et al. (2012)Slide4
Beliefs about Mental Illness and Mental Health Treatment
Concerns about Stigma
Beliefs
about how loved ones would react if one were to experience a mental health problemBeliefs about stigma in the workplace
Personal beliefs about mental illness and mental health treatment
B
eliefs about mental illness
Beliefs about treatment-seekingBeliefs about mental health treatmentSlide5
Barriers to Care Study
Study of a national sample of female and male OEF/OIF Veterans (n=707)
conducted in 2011
Nonresponse bias and design weights applied to item-level results to enhance representativenessOverview of findings regarding:
Common mental health
b
eliefs that may serve as barriers to care
Relationship between mental health beliefs and use of VA mental health treatment among veterans with probable mental health conditions (PTSD, depression, alcohol abuse)Contribution above and beyond VA system factorsSlide6
Concerns about Stigma from Loved Ones
If I had a mental health problem and friends and family knew about it, they would…Slide7
Concerns about Stigma in the Workplace
If I had a mental health problem and people at work knew…Slide8
Beliefs about Mental IllnessSlide9
Beliefs about Help-SeekingSlide10
Beliefs about Mental Health TreatmentSlide11
Summary of Item-Level Results
Substantial minority of OEF/OIF Veterans endorse negative beliefs about mental illness and mental health treatment
Concerns about stigma more commonly reported than negative personal beliefs
Diversity in responses, with greatest proportion of respondents either explicitly rejecting these beliefs or reporting being “on the fence”Slide12
Predictors of VA Mental Health Service Use
Note.
Analysis controls for comorbidity. *p<.05.
Variable
B
S.E.
OR
System Factors
Availability of services
.017
.047
1.017
Ease of use
.003
.026
1.003
Staff skill and sensitivity
-.100
.038
0.905
*
Stigma and Personal Beliefs
Negative beliefs about mental health treatment
.112
.042
1.118*
Negative beliefs about treatment seeking
-.136
.032
0.873*
Negative beliefs about mental illness
-.089
.040
0.915*
Concerns about stigma from loved ones
.062
.030
1.064*
Concerns about stigma in the workplace
.033
.027
1.034Slide13
Conclusions
Veterans report a variety of mental health beliefs that may serve as barriers to care.
Findings suggest that concerns about stigma are less important barrier to treatment than personal beliefs about mental illness & mental health treatment
Negative mental health beliefs predict service use above and beyond Veterans’ perceptions of system-level barriers
L
ongitudinal
studies needed to confirm these findingsSlide14
Conclusions
Need for attention to attitudinal barriers to treatment engagement
Findings underscore the value of educational initiatives that target negative beliefs about mental illness and mental health treatment
VA’s Make the Connection (www.maketheconnection.net
)
NCPTSD’s About Face (http
://www.ptsd.va.gov/apps/AboutFace
/)Slide15
Acknowledgements
Funding for
Barriers to Care study
was provided by VA HSR&D
For more information about this presentation, please contact:
Dawne
Vogt
Women’s Health Sciences
Division
National
Center for PTSD (116B-3)
VA Boston Healthcare System
150 S. Huntington Ave
Boston, MA 02130
857-364-5976
Dawne.Vogt@va.govSlide16
Demographic & Background Factors
Factors addressed in Anderson Model (1968)
Predisposing factors such as gender, age, and marital status
Enabling/impeding factors such as service-connected disability status, caregiving and work responsibilities
Need-based factors such as symptom severity, comorbidity, and functional impairmentSlide17
Institutional Factors
Availability of services such as whether preferred type of treatment is available
Ease of access such as convenience of location, wait times for care, paperwork
Staff skill and sensitivity, including perception that therapists understand client experiences and are trustworthySlide18
Availability of ServicesSlide19
Ease of UseSlide20
Staff Skill & Sensitivity