Anticipated Impacts on Veterans Healthcare: By examining and Analyzing the relationship between beliefs about mental health (subjective barriers to care, psychotherapy, medication, and attributions) and mental healthcare utilization, using both qualitative (interviews) and quantitative (valid and reliable known measures) among OIF/OEF veterans, the VA may better understand the mental health needs of this population and the barriers that may influence their retention in mental health treatment and adherence to recommended treatment. It would also provide the knowledge and the basis for the development of an intervention that may increase retention and adherence to recommended psychiatric treatment. Project Background: OIF and OEF veterans are expected to be the fastest growing segment of VA mental health users population as they are involved in one of the longest deployment period that the US Armed forces personnel was ever had to endure. Recent studies on returning Iraq and Afghanistan veterans have found high rates of mental health complaints and have involved hundreds of thousands of veterans exposed to the stress of combat and protracted deployments (Hoge, Castro, Messer et al, 2004). 78 - 86% of those who were screened were positive for depression, posttraumatic stress disorder (PTSD), or generalized anxiety disorder (GAD). However, only 13 - 21% had received help from a mental health professional within a year prior to assessment. Specific reasons veterans choose not to seek mental health treatment are not well understood and speculative at best. Understanding the barriers to mental health care among this population is crucial for the future development of an intervention that will increase retention and adherence to recommended treatment. Project Objectives: The objectives of this study are to: (1) a. Compare and contrast psychologically symptomatic veterans who do utilize mental health services with symptomatic veterans who do not utilize mental health services (e.g. differences in symptoms severity, beliefs and perceived barriers to care, psychological resilience); b. Evaluate the link between subjective barriers to mental healthcare and actual utilization of behavioral health services in veterans returning from Iraq and Afghanistan. (2) Analyze the relationship between beliefs about mental health (subjective barriers to care, psychotherapy, medication, and attributions) and mental healthcare utilization. Project Methods: To achieve these objectives we will use both quantitative and qualitative data collection methods. We will recruit veterans form Primary Care Clinic or the Mental Hygiene Clinic and will conduct: (1) interviews with Veterans to collect narratives on their mental health needs. (2) use standardized questionnaires to assess their beliefs about psychotherapy and perceived barriers to mental health care while in either the. Following completion of these self-report measures patient utilization of VA healthcare services will be tracked for 1-year from the date of initial assessment. Service utilization will be classified by the number of visits to each clinic, and the type of services received (diagnostic testing, psychotherapy, medication, surgery, general medical check-up, missed appointment, etc.) Data regarding service utilization will then be analyzed in conjunction with the participant's respective beliefs and perceptions about mental health.

Public Health Relevance

The study goal is to identify the underlying philosophy, cultural norms and ethical principles that guide the soldiers'character development and how these interfere with mental health utilization. We plan, at a later stage, to develop an intervention to increase mental health service utilization and decrease dropout rates among veterans. The study will provide VA mental health community with valuable information about the following: 1) An ability to tailor special treatment programs for veterans 'at-risk'for treatment avoidance, resistance, or non-compliance to decrease dropout and enhance clinical outcome with a culturally sensitive therapeutic intervention. 2) Knowledge of barriers to receiving mental health care in symptomatic individuals, particularly those with PTSD, anxiety and mood disorders secondary to traumatic experiences;3) the effects various barriers have on health care utilization;4) Prevailing beliefs about mental health and treatment preferences that can inform education and treatment planning efforts.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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VA Connecticut Healthcare System
West Haven
United States
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Rozanova, Julia; Noulas, Paraskevi; Smart, Kathleen et al. (2016) ""I'm Coming Home, Tell the World I'm Coming Home"". The Long Homecoming and Mental Health Treatment of Iraq and Afghanistan War Veterans. Psychiatr Q 87:427-43
DeViva, Jason C; Sheerin, Christina M; Southwick, Steven M et al. (2016) Correlates of VA mental health treatment utilization among OEF/OIF/OND veterans: Resilience, stigma, social support, personality, and beliefs about treatment. Psychol Trauma 8:310-8
Desai, Miraj U; Pavlo, Anthony J; Davidson, Larry et al. (2016) ""I Want to Come Home"": Vietnam-Era Veterans' Presenting for Mental Health Care, Roughly 40 Years After Vietnam. Psychiatr Q 87:229-39
Harpaz-Rotem, Ilan; Rosenheck, Robert A; Pietrzak, Robert H et al. (2014) Determinants of prospective engagement in mental health treatment among symptomatic Iraq/Afghanistan veterans. J Nerv Ment Dis 202:97-104