1081 — Reported Barriers to Mental Health Care in Three Sequential Samples of a Midwestern Army National Guard

Valenstein M, COIN-Ann Arbor; Walters H, COIN-Ann Arbor; Gorma L, Michigan Public Health Institute; Blow A, Michigan State University; Ganoczy D, COIN-Ann Arbor; Kees M, University of Michigan Dept of Psychiatry; Pfeiffer P, COIN-Ann Arbor; Kim HM, COIN-Ann Arbor; Rauch M, Veterans Affairs Ann Arbor Health System; Dalack G, University of Michigan Dept of Psychiatry

Objectives:
The military community and its partners have made vigorous efforts to address treatment barriers and increase appropriate mental health services use among returning National Guard soldiers. We assessed whether there were differences in reports of treatment barriers in 3 categories (stigma, logistics, or negative beliefs about treatment) in sequential cross-sectional samples of U.S. soldiers from a Midwestern Army National Guard Organization who were returning from overseas deployments.

Methods:
Data were collected during 3 time periods: September 2007-August 2008 (n = 333), March 2009-March 2010 (n = 884), and August 2011-August 2012 (n = 737

Results:
In analyses using discretized time periods and in trend analyses, the percentages of soldiers endorsing negative beliefs about treatment declined significantly across the 3 sequential samples (19.1%, 13.9%, and 11.1%). The percentages endorsing stigma barriers (37.8%, 35.2%, 31.8%) decreased significantly only in trend analyses. Within the stigma category, endorsement of individual barriers regarding negative reactions to a soldier seeking treatment declined, but barriers related to concerns about career advancement did not. Negative treatment beliefs were associated with reduced services use (OR = 0.57; 95% CI [0.33, 0.97]).

Implications:
This is the first report documenting reductions in important barriers to mental health care-- negative beliefs about treatment and stigma- over a 5-year period in a National Guard population. Barriers related to negative beliefs about treatment were associated with reduced mental health services use and require continued attention. Stigma-related concerns regarding potential harm to one's career also require continued attention.

Impacts:
Decreases in the prevalence of negative treatment beliefs and many stigma beliefs in a National Guard population indicate that current VA, National Guard, and Department of Defense efforts to increase acceptance of mental health conditions and reduce barriers to treatment may be having an impact. Further research is needed that prospectively examines soldiers' report of barriers to treatment, changes in these barriers, and subsequent treatment engagement and outcomes.