1. 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, 2014

2. Background Research indicates that OEF/OIF/OND Veterans are at risk for a variety of mental health problems following return from deployment. o 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 o 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)

3. 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)

4. 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 problem Beliefs about stigma in the workplace Personal beliefs about mental illness and mental health treatment Beliefs about mental illness Beliefs about treatment-seeking Beliefs about mental health treatment

5. 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 representativeness Overview of findings regarding: Common mental health beliefs 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 factors

6. Concerns about Stigma from Loved Ones If I had a mental health problem and friends and family knew about it, they would…

7. Concerns about Stigma in the Workplace If I had a mental health problem and people at work knew…

8. Beliefs about Mental Illness

9. Beliefs about Help-Seeking

10. Beliefs about Mental Health Treatment

11. 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”

12. Predictors of VA Mental Health Service Use Note. Analysis controls for comorbidity. *p<.05. VariableBS.E.OR System Factors Availability of services.017.047 1.017 Ease of use.003.026 1.003 Staff skill and sensitivity-.100.0380.905* Stigma and Personal Beliefs Negative beliefs about mental health treatment.112.0421.118* Negative beliefs about treatment seeking-.136.0320.873* Negative beliefs about mental illness-.089.0400.915* Concerns about stigma from loved ones.062.030 1.064* Concerns about stigma in the workplace.033.027 1.034

13. 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 Longitudinal studies needed to confirm these findings

14. 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)www.maketheconnection.net NCPTSD’s About Face (http://www.ptsd.va.gov/apps/AboutFace/)

15. 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.gov

16. 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 impairment

17. 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 trustworthy

18. Availability of Services

19. Ease of Use

20. Staff Skill & Sensitivity