Predictors of post-deployment mental healthcare utilization among active duty Marines
Dickstein, Benjamin D.
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Service members returning from deployment to Iraq and Afghanistan consistently report high rates of behavioral health problems, such as posttraumatic stress disorder, depression, and alcohol misuse. However, despite signs of treatment need, research suggests that mental health services are underutilized by military personnel. Although several factors have been hypothesized to undermine service use in the military, research investigating the relationship between hypothesized treatment-barriers and mental healthcare utilization has been scant and equivocal. Moreover, there has been limited investigation into factors that may facilitate mental health treatment-seeking. The aim of this study was to further examine predictors of mental healthcare utilization among returning service members, and to develop a multi-factorial model explaining the interplay among combat stress exposure, psychological distress, perceived barriers to care (stigma, logistical barriers, negative beliefs about treatment), facilitating factors (unit cohesion and post-deployment social support) and mental health service utilization. Data were collected from 447 active duty U.S. Marines one week, three months, and six months following return from Afghanistan. A four-stage analytic approach was used to test predictors of service use, examine latent measurement models, investigate the longitudinal associations between psychological distress and perceived treatment-barriers, and evaluate a multi-factorial model addressing the primary study aim. Findings from analytic stages 1 - 3 informed modeling decisions specified in the fourth and final stage. Results suggest that the perception of treatment-barriers has a deleterious effect on service members' psychological symptomatology, which may be reduced, in part, by leveraging unit cohesion and post-deployment social support. Contrary to expectations, only a modest relationship was observed between hypothesized treatment-barriers and mental health service use, and no direct effect was observed between facilitating factors and service utilization. More research is needed to replicate these findings; however, it appears that, in addition to targeting stigma and other perceived treatment-barriers, interventionists attempting to promote mental healthcare utilization in the military will need to broaden their investigation of constructs influencing service members' decisions to seek care. Recommendations for future work are discussed.
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