A Latent Class Analysis of Mental Health Beliefs Related to Military Sexual Trauma

Abstract

Military veterans with histories of military sexual trauma (MST) are at risk for several negative mental health outcomes and report perceived barriers to treatment engagement. To inform interventions to promote gender‐sensitive access to MST‐related care, we conducted an exploratory, multiple‐group latent class analysis of negative beliefs about MST‐related care. Participants were U.S. veterans (N = 1,185) who screened positive for MST within the last 2 months and reported a perceived need for MST‐related treatment. Associations between class membership, mental health screenings, logistical barriers, difficulty accessing care, and unmet need for MST‐related care were also examined. Results indicated a four‐class solution, with classes categorized as (a) low barrier, with few negative beliefs; (b) high barrier, with pervasive negative beliefs; (c) stigma‐related beliefs; and (d) negative perceptions of care (NPC). Men were significantly less likely than women to fall into the low barrier class (27.9% vs. 34.5%). Relative to participants in the low barrier class, individuals in all other classes reported more scheduling, ps < .001; transportation, p < .001 to p = .014; and work‐related barriers, p < .001 to p = .031. Participants in the NPC class reported the most difficulty with access, p < .001, and those in the NPC and high barrier classes were more likely to report unmet needs compared to other classes, ps < .001. Brief cognitive and behavioral interventions, delivered in primary care settings and via telehealth, tailored to address veterans’ negative mental health beliefs may increase the utilization of mental health treatment related to MST.

Mental Health Beliefs, Access, and Engagement with Military Sexual Trauma–Related Mental Health Care

“…An affirmative response to either question results in a positive screen. The current study is an extension of Hahn et al, 12 a cross-sectional study that identified latent classes of mental health beliefs among a subsample of 1,185 Veterans who endorsed perceived need for MST-related mental health care by an affirmative response to the survey item: "In the past year, did you ever want or need help with any emotional or mental health concerns related to any military sexual trauma experience?" We linked those survey data with VHA administrative data in order to examine associations with outpatient MST-related care in the year following MST detection.…”

“…Instructions for these items were specifically focused on MST-related care. We examined the latent classes of mental health beliefs as constructed by Hahn et al 12 Using a multiple-group (with gender as the grouping variable) LCA, Hahn et al 12 identified four mutually exclusive groups of treatment belief classes: low barrier class (32.4%); stigma-related beliefs class (34.1%); negative perceptions of care class (10.1%); and high barrier class (23.5%). Model fit indices indicated that the four-class solution was the superior fit; sample size adjusted Bayesian information criteria = 5,219.66 and entropy = .78.…”

“…As a result, fears regarding being blamed or seen as responsible or not believed are particularly salient to treatment-seeking MST survivors. [6][7][8][9][10][11] In a recent study of women and men Veterans with recently detected MST, Hahn et al 12 examined a wide range of such mental health beliefs related to MST and found 4 classes of beliefs. The same classes were constructed separately by gender using multiple group latent class analysis (LCA), so these classes represent gender-tailored treatment beliefs: low barrier, with few negative beliefs; high barrier, with extensive negative beliefs; stigma-related beliefs, including shame and embarrassment and others finding out; and negative perceptions of care, characterized by concerns about secondary victimization.…”

“…Gender differences emerged in the composition of classes consistent with prior work. For women, 8,12,13 the stigma-related beliefs class indicated heightened concerns regarding opposite-sex providers and negative perceptions of care indicated discomfort with the majority male environment of VHA settings. Among men, 6,12 the stigma-related beliefs class revealed concerns about same-sex providers, as well as concerns regarding sexual orientation, and the negative perceptions of care class indicated heightened concerns about not being believed, perhaps associated with perceptions that sexual trauma occurs primarily among women Veterans.…”

“…Moreover, VHA's proactive policies such as the co-pay release for MSTrelated care create an ideal context to explore the role of treatment beliefs in engagement due to the lack of barriers to disclosure or limited availability of mental health services that are common to other health care systems. We extend Hahn et al's 12 analysis of mental health beliefs to determine the impact on access to and engagement with MST-related care. We conceptualize the study within Andersen's Behavioral Model of Health Services Use, 18 which asserts that use of health care services is a function of predisposing factors (preexisting and belief characteristics), need factors (symptom severity), and enabling factors (those that support or impede use).…”