A systematic review of help-seeking and mental health service utilization among military service members

Hom, Melanie A.; Stanley, Ian H.; Schneider, Mark; Joiner, Thomas E.

doi:10.1016/j.cpr.2017.01.008

Cited by 155 publications

(149 citation statements)

References 110 publications

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“…, & Wessely, 2004;Hoge et al, 2004), with some of the reasons being related general career harm, not wanting to link medical information to employment (i.e. military) records, and concerns that medical information will not remain confidential (Bonar, Bohnert, Walters, Ganoczy, & Valenstein, 2015;Gould et al, 2010;Hom, Stanley, Schneider, & Joiner, 2017;Rüsch et al, 2017). Some of these concerns are not unfounded, considering that there is substantial ambiguity surrounding medical confidentiality in military medical settings (Auster, 1985;Hoyt, 2013).…”

Section: Discussionmentioning

confidence: 99%

Help-seeking for mental health issues in deployed Canadian Armed Forces personnel at risk for moral injury

Nazarov

Fikretoglu

Liu

et al. 2020

European Journal of Psychotraumatology

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Objective: Potentially morally injurious experiences (PMIE) (events that transgress an individual's subjective moral standards) have been associated with psychologically distressing moral emotions such as shame and guilt. Military leaders and clinicians have feared that those with PMIEs may be less likely to seek help due to the withdrawing nature of shame/ guilt; however, to date, help-seeking patterns of military personnel with PMIEs has not been explored. Our objective is to address this research gap. Method: Data from a nationally-representative mental health survey of active Canadian military personnel were analysed. To assess the association between exposure to three PMIEs and past-year help-seeking across different provider categories (i.e. professionals, para-professionals (those delegated with mental health advisory tasks but are not licenced to practice as medical professionals), non-professionals), a series of logistic regressions were conducted, controlling for exposure to other deployment and non-deployment-related psychological trauma, psychiatric variables, military factors, and sociodemographic variables. Analytical data frame included only personnel with a history of Afghanistan deployment (N = 4854). Results: Deployed members exposed to PMIEs were more likely to seek help from their family doctor/general practitioner (OR = 1.72; 95%CI = 1.25-2.36), paraprofessionals (OR = 1.72; 95% CI = 1.25-2.36), and non-professionals (OR = 1.44; 95%CI = 1.06-1.95) in comparison to members not exposed to PMIEs. Those exposed to PMIEs were also more likely to seek professional care from the civilian health care system (OR = 1.94; 95%CI = 1.27-2.96). Conclusion: Contrary to long-held, but untested, assumptions regarding the impact of PMIEs on help-seeking, we found those with PMIEs are more likely to seek help from gatekeeper professionals (i.e. general practitioners), para-professionals, and nonprofessionals rather than specialized mental health professionals (e.g. psychologists). Increased utilization of civilian professionals raises concerns that active military members may be avoiding military health services. Clinically, this highlights the need to increase awareness of moral injury to ensure that actively serving military members are provided with appropriate advice and treatment.

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Section: Discussionmentioning

confidence: 99%

Help-seeking for mental health issues in deployed Canadian Armed Forces personnel at risk for moral injury

Nazarov

Fikretoglu

Liu

et al. 2020

European Journal of Psychotraumatology

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“…Second, individuals who are separating from the military on medical grounds are often posted to a JPSU, and may be more willing to disclose their depressive symptoms. Fear of negative career repercussions is commonly reported as a barrier to mental health care among military personnel [34], but that barrier is unlikely to impact individuals already in the process of releasing from military service. Third, the process of transitioning out of an operational unit and into a JPSU may represent a stressful life event for some individuals which may, therefore, increase their risk of major depression onset [35].…”

Section: Discussionmentioning

confidence: 99%

Incidence of major depression diagnoses in the Canadian Armed Forces: longitudinal analysis of clinical and health administrative data

Thériault

Hawes

Garber

et al. 2019

Soc Psychiatry Psychiatr Epidemiol

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Purpose Major depression is a leading cause of morbidity in military populations. However, due to a lack of longitudinal data, little is known about the rate at which military personnel experience the onset of new episodes of major depression. We used a new source of clinical and administrative data to estimate the incidence of major depression diagnoses in Canadian Armed Forces (CAF) personnel, and to compare incidence rates between demographic and occupational factors. Methods We extracted all data recorded in the electronic medical records of CAF Regular Force personnel, at every primary care and mental health clinical encounter since 2016. Using a 12-month lookback period, we linked data over time, and identified all patients with incident diagnoses of major depression. We then linked clinical data to CAF administrative records, and estimated incidence rates. We used multivariate Poisson regression to compare adjusted incidence rates between demographic and occupational factors. Results From January to December 2017, CAF Regular Force personnel were diagnosed with major depression at a rate of 29.2 new cases per 1000 person-years at risk. Female sex, age 30 years and older, and non-officer ranks were associated with significantly higher incidence rates. Conclusions We completed the largest study to date on diagnoses of major depression in the Canadian military, and have provided the first estimates of incidence rates in CAF personnel. Our results can inform future mental health resource allocation, and ongoing major depression prevention efforts within the Canadian Armed Forces and other military organizations.

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“…It is worth highlighting the importance of improving occupational surveillance actions in order to identify early risk factors and increase access to mental health services, so as to ensure vulnerable workers the tranquility to report symptoms and adhere to the treatment, when applicable 14 . It is noteworthy that CBMMG initiatives have innovated the work of occupational health services.…”

Section: Rev Bras Epidemiol 2019; 22: E190021mentioning

confidence: 99%

“…In the case of military firefighters, besides being under the high demands inherent to emergency professionals 12 , they are also inserted in a work environment characterized by disciplinary and hierarchical rigidity 14 . Therefore, the nature of the activities and the negative psychosocial factors can influence the mental health of these professionals 15 .…”

Section: Introductionmentioning

confidence: 99%

Fatores associados ao uso de medicamentos ansiolíticos entre bombeiros militares

Azevedo

Lima

Assunção

2019

Rev. bras. epidemiol.

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RESUMO: Introdução: O uso de ansiolíticos é uma opção no tratamento de sintomas psíquicos. Contudo, ainda que o uso seja controlado há riscos de dependência, intoxicação e alterações cognitivas. O uso não controlado entre trabalhadores agrava tais problemas. Objetivos: Identificar a prevalência do uso de ansiolíticos e conhecer os fatores associados ao consumo em bombeiros militares. Método: Pesquisa transversal de base censitária investigou 711 bombeiros de Belo Horizonte, Minas Gerais, por meio de autorrelato. Regressão logística multinomial foi utilizada para verificar associação entre características sociodemográficas, condições de vida, trabalho e saúde e consumo de ansiolíticos de modo controlado ou não. Resultados: A prevalência do uso de ansiolíticos foi 9,9%. Para 7,5% dos bombeiros o consumo ocorreu sem indicação e/ou controle terapêutico especializado. O uso controlado foi associado ao relato compatível com Transtorno Mental Comum (OR = 23,6; IC95% 6,54 - 85,11). O uso não controlado foi associado ao tempo de serviço (OR = 2,57; IC95% 1,03 - 6,40), ao tabagismo (OR = 3,22; IC95% 1,50 - 6,91) e ao Transtorno Mental Comum (OR = 4,02; IC95% 2,17 - 7,45). Conclusão: A alta prevalência de consumo indica alerta para as ações dos programas de saúde ocupacional.

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A systematic review of help-seeking and mental health service utilization among military service members

Cited by 155 publications

References 110 publications

Help-seeking for mental health issues in deployed Canadian Armed Forces personnel at risk for moral injury

Help-seeking for mental health issues in deployed Canadian Armed Forces personnel at risk for moral injury

Incidence of major depression diagnoses in the Canadian Armed Forces: longitudinal analysis of clinical and health administrative data

Fatores associados ao uso de medicamentos ansiolíticos entre bombeiros militares

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