August bitcoin filetype pdfstima del bitcoin 2018, ; Accepted date: September 27, ; Published date: J Psychol Psychother 3: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The response rate was Non-medical help sources were accessed more frequently than military medical services. Friends or family were the commonest preferred and actual help source; unit commanders were among the least preferred but were the second most commonly accessed help source. A substantial number of symptomatic personnel had not sought help.
Perceptions of potential negative occupational and social consequences of help-seeking and current mental health status may influence the decision to seek support. Military stigma reduction strategies may need to focus upon reassuring personnel and their families that adverse consequences are not inevitable and that help-seeking from any source may be a useful step in addressing mental health problems. Alcohol misusers may benefit from a strategy that helps them to view their alcohol use as potentially socially and occupationally problematic.
Stigmatising beliefs about seeking help for mental health problems are commonplace among military personnel [ 1 ]. Holding such beliefs may influence bitcoin filetype pdfstima del bitcoin 2018 decision to seek help particularly when social position, social connectedness or occupational functioning may be adversely affected bitcoin filetype pdfstima del bitcoin 2018 2 ]. The mechanism by which stigmatisation operates is unclear; it may be a direct impediment to help-seeking, however, research suggests that it may have variable effects or be wholly unrelated to help-seeking behaviours [ 3 ].
Some research suggests that military personnel may fail to recognise that sub-threshold mental health symptoms are often linked to occupational impairment and may need to be addressed [ 4 ]. In this case, stigma is not the prime driver of non-help seeking. The effectiveness of such an approach is mixed bitcoin filetype pdfstima del bitcoin 2018 some suggesting that measurable and durable positive effects upon stigma-related knowledge may occur [ 9 ], while others suggest that rates of stigmatisation remain largely unaffected [ 1011 ].
Our research question was, is there a relationship between perceived stigmatisation, barriers to care and help-seeking and if so, what role does current mental health status have in modulating the decision to seek help? We chose to sample military personnel in a garrison setting some of whom had previously deployed as this area is under-researched and the bulk bitcoin filetype pdfstima del bitcoin 2018 our previous studies have been conducted with deployed personnel as described by Osorio et al.
Study participants were serving bitcoin filetype pdfstima del bitcoin 2018 of the British Army BA who provided baseline information prior to voluntarily participating in the evaluation of a stigma reduction intervention. The study took place at an army base and the soldiers gave consent to take part in the stigma reduction study after having been given a full briefing by the study co-ordinator.
They were randomly selected a priori to receive either a comedy show with an active stigma reduction component or a standard comedy show. They were informed that their responses would be used for further research purposes and they were offered the opportunity to withdraw prior to providing baseline information. At no time were they asked to volunteer for the study. Mental health indices included current alcohol use, which was assessed using the 3 item Alcohol Use Disorders Identification Test AUDIT-Ca brief validated screening tool used to identify potential alcohol use disorders [ 12 ].
This scale has been reported as having high internal consistency [ 18 ]. The adaptation included the deletion of four items, which did not apply to UK samples, including cost of care, arranging transport, scheduling appointments and getting time off work.
In the UK military, logistics and work absence are provided for and care is free. Two further items were not included as they were rarely endorsed in our previous surveys and instead we included four items which included the availability of services, thinking less of colleagues, lack of military support for mental health problems and giving responsibility to those with mental health problems, all of which have been used to assess military samples [ 1920 ].
Respondents were asked to rate their strength of agreement with each stigma or BTC item using a four-point Likert scale which yielded scores ranging from In addition, strongly agree and agree responses were combined for each stigma scale item as were strongly disagree and disagree responses.
A count variable was generated, giving a scale ranging from This was endorsed using a Likert scale, indicating strength of agreement with four statements: I would live with, work with, live nearby and continue a relationship with someone with a bitcoin filetype pdfstima del bitcoin 2018 health problem.
The scale bitcoin filetype pdfstima del bitcoin 2018 summed to give a range of scores from 4 to 20 with lower scores bitcoin filetype pdfstima del bitcoin 2018 greater levels of potential discrimination. Tertiles were then generated and the middle and upper tertiles were combined so that greater levels of potential discrimination the lower tertile could be compared with lower levels the middle and upper tertiles. As identified in the introduction, recent research suggests that individuals experiencing mental health problems often report that they wish to manage their symptoms themselves.
Respondents were asked to rate their strength of agreement with each item using a four-point Likert scale which yielded scores ranging from 5—20; lower scores indicated greater bitcoin filetype pdfstima del bitcoin 2018 with the five statements and therefore a more substantial personal role in managing mental health problems.
The scale was first summed, tertiles were generated and the lower and middle tertiles were combined so that those rating the personal role in managing mental health less markedly the upper tertilecould be compared with those who felt that it was more important the middle and lower tertiles. Personnel were asked if they were currently accessing support for a stressful, emotional or family problem and if they were bitcoin filetype pdfstima del bitcoin 2018 interested in receiving support.
They were asked to consider nine potential help sources, which represented military medical assistance mental health professional, regimental medical officer or doctor and other medical staff and non-medical help friend or family, unit chain of command, colleague, Trauma Risk Management TRiM practitioner, chaplain and Big White Wall therapist support.
TRiM practitioners are military peers serving in the same unit trained to provide support following exposure to traumatic events [ 23 ]; the Big White Wall is an online early intervention service for people experiencing psychological distress which has been further developed for use by those with a history of military service [ 24 ].
Participants were further asked whether they would be willing to use these help sources in bitcoin filetype pdfstima del bitcoin 2018 future. All analyses were conducted in the Statistical Package for Social Sciences version These included rank, categorised into three groups Junior Rank, Senior Rank and Officerage grouped into five categories, service length grouped into five categories, sex, being in a relationship or not and being deployed in the last year or not.
Numbers and percentages of those who returned a valid answer are reported in this paper, whereas missing data are not; percentages and numbers may not sum to sample and sub-sample totals. Official statistics give the median age of the Army as 29 years [ 27 ]; for the study sample, this was 25 years.
The study sample consisted primarily of regular forces rather than reserves Of the probable PTSD cases, Respondents were most willing to engage with friends and family followed by a mental health professional; personnel were least willing to engage with an online therapist and the unit chain of command.
Potential sources were ranked in a similar pattern to actual sources of help with the exception bitcoin filetype pdfstima del bitcoin 2018 the unit chain of command, which constituted the second commonest source of actual support. Of the RIBS items; two thirds of respondents reported that they would continue a relationship with a friend who had a mental health problem; around half would live nearby and work with someone who they knew had a mental health problem.
Around one third would be prepared to live with someone with a mental health problem. The bitcoin filetype pdfstima del bitcoin 2018 of personnel viewed mental health support as helpful and that help-seeking for a mental health problem required courage or strength.
Around a quarter of personnel felt that mental health problems tend to work themselves out without help. When the sample was stratified by class of help, personnel who sought help from military medical sources were no more likely to report high levels of stigma than those who had not sought help at all, however, those seeking help from non-medical sources had significantly increased odds of reporting stigma compared to non-help-seekers, an effect that remained significant after adjusting for a range of socio demographic factors and deployment in the last year.
Viewing mental health management as requiring higher levels of personal responsibility was also associated with significantly increased odds of reporting stigmatising beliefs. When the sample was stratified by mental health status, the odds of reporting stigmatising beliefs were significantly higher in those reporting symptoms of either CMD and or PTSD but not amongst those drinking alcohol at potentially harmful levels. This study describes the association between help-seeking, potential stigmatising beliefs about help-seeking and mental health problems in a randomly chosen sample of non-deployed British Army personnel; there were a number of key findings.
Firstly, we found that around a third bitcoin filetype pdfstima del bitcoin 2018 those surveyed reported potentially harmful alcohol use and approximately a quarter of personnel screened positive for a probable mental health disorder. Secondly, of those who screened positive for a possible mental health disorder, around Seeking support was lower amongst probable harmful alcohol users than potential CMD and PTSD cases; around three quarters of probable alcohol misusers had not sought any form of help.
Despite nearly a quarter of personnel screening positive for a probable mental health condition, just under half of these personnel had not sought or received help from any source, which is in keeping with rates reported in previous surveys of military personnel [ 28 ]. Previous studies have reported a complex association between perceived need for support, attitudes about mental health, and severity of symptoms [ 29 ]. In our study, around a fifth of personnel who did not have substantial mental health symptoms nevertheless sought help for a bitcoin filetype pdfstima del bitcoin 2018, stressful or relationship problem.
It seems however, that thoughts do not always translate into behaviour, as the chain of command was the second most frequently accessed source of support. Commensurate with previous research [ 30 ], help-seeking personnel were more likely to access non-medical rather than military medical sources. Personnel appear to have the greatest concerns about possible adverse reactions from leaders and loss of military credibility with peers, while believing that they will not be supported by the military system.
Given that there are potential short-term negative occupational consequences associated with military medical treatment of mental health problems in the form of medically imposed restrictions on deployment and other work activity [ 31 ], it is not surprising that personnel may avoid seeking out military medical help. An alternative explanation for this finding is that military personnel are closely supervised and concealing a mental health problem by self-certification, where individuals supply their employer with a reason for short periods of sickness absence without consulting a doctor or by other forms of absenteeism is difficult.
In this sense, military personnel may be compelled to interact with the chain of command when behavioural or psychological disturbance is present. Previous research has indicated that the perceived utility of mental health services is a fundamental component in the decision to seek help [ 33 ].
Amongst our sample population, there was a somewhat conflicted view of mental health where such problems are deemed bitcoin filetype pdfstima del bitcoin 2018, but that they can be effectively treated, though such treatment may be associated with potentially negative outcomes. Personnel appear to seek out help from non-medical sources that offer the possibility of negotiating a desirable occupational outcome or avoiding a potential negative consequence, rather than having an undesirable occupational outcome imposed by military medical practitioners.
Military commanders may therefore wish to consider the inclusion of a message in any stigma reduction programme that seeks to maximise appropriate help-seeking, that effective mental health treatment is available from military sources.
Furthermore it could be emphasised that such support facilitates recovery and may help to avoid potential negative occupational outcomes. Such a strategy might also include families as they were an important source of support in this study. Given the cross sectional nature of our data, we are unable to say whether the form of support influences long-term mental health outcome; however, published outcome data regarding occupational outcomes in UK AF personnel, suggests that around three quarters will return to full occupational fitness if they engage with military medical services [ 34 - 36 ].
In keeping with other published data, alcohol use was substantial in our sample with a full third screening positive for possible harmful alcohol use using a high screening cut off score. Only a quarter bitcoin filetype pdfstima del bitcoin 2018 those deemed to be cases had sought help.
This figure is commensurate with the rate of help-seeking for alcohol problems reported by Iversen et al. Similar low rates of help-seeking amongst young people have been reported in international studies [ 3738 ]. It seems that treatment engagement for alcohol misuse is a stubborn and widespread problem that has not improved over a five year period amongst UK AF personnel.
This may be a reflection of the greater than expected number of bitcoin filetype pdfstima del bitcoin 2018 soldiers in this study, who are thought to be at greater risk of alcohol misuse [ 40 ]. This may be related to research findings that suggest that functional impairment appears to be concentrated in those reporting very high levels of alcohol use bitcoin filetype pdfstima del bitcoin 2018 than the cut-off used in this study [ 42 ]. Some form of public health intervention that helps alcohol misusers to view their drinking as problematic might be helpful in promoting engagement with support.
The strengths of this study included the random selection of personnel and achieving a high response rate. Although we used an explicit definition of what constituted help-seeking, we were not able to objectively verify actual sources of support and we are unable to say whether those accessing medical forms of support received a definitive evidence-based intervention.
Similarly, we cannot comment on the quality of support received from the non-medical support sources including the unit chain of command, chaplain and so on.
This study examined the psychological determinants of help seeking in a randomly chosen sample of British Army personnel. Although there appears to be a complex interaction between psychological symptoms, the desire for help and actual help seeking, we suggest that perceptions of the perceived potential negative occupational and social consequences of bitcoin filetype pdfstima del bitcoin 2018 may be more acute in those with poorer mental health and may act to influence the decision to seek support.
We tentatively suggest that military stigma reduction strategies should focus upon reassuring personnel that adverse occupational consequences are not inevitable, not dissimilar to seeking help for a physical problem and that help-seeking from any source may be a useful first step to improved mental health. Partial funding for the project was received from a People Award grant from the Wellcome Trust; funding for military research personnel was received from the Ministry of Defence. Please leave a message, we will get back you shortly.
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