Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Robert H. Pietrzak

Abstract

BARRIERS TO MENTAL HEALTH CARE IN US MILITARY VETERANS. Connor Lewis, Ian Fischer, and Robert Pietrzak. Department of Psychiatry, Yale University, School of Medicine, New Haven, CT.

Objectives: The aims of this study were to analyze data from a nationally representative sample of US veterans to: (1) Determine the prevalence of barriers to mental health care among current US veterans spanning numerous conflicts and generations of service and who have no history of mental health treatment; and (2) Identify predisposing, enabling, and needs factors associated with barriers to care. Aims were examined in both the full sample of veterans and a subsample of veterans who screened positive for a psychiatric disorder.

Methods: Descriptive statistics were computed to summarize the prevalence of endorsed barriers to care. A series of multivariable binary logistic regression analyses were performed to identify independent predisposing, enabling, and need variables associated with endorsement of any stigma, instrumental barrier to care, and negative belief about mental healthcare. Relative importance analyses were utilized to determine the variance in endorsement of any stigma, instrumental barrier to care, and negative belief about mental healthcare item explained by each significant independent variable.

Results: In the full sample, 33.7% endorsed any barrier to care, with 22.2% endorsing any instrumental barrier to care, 19.1% any perceived stigma item, and 13.9% any negative belief about mental healthcare. The endorsement of all barriers to care were greater in the subsample with psychiatric need: 47.1% endorsed any barrier to care, with 38.7% endorsing any instrumental barrier to care, 28.8% any perceived stigma item, and 22.0% any negative belief about mental healthcare. Several correlates were identified for each barrier to care, with differences in the strength and direction of association for each correlate. Lower purpose in life, grit, and received social support were most consistently associated with barriers to care.

Conclusion: Results of this study provide the first known data on the prevalence and key predisposing, enabling, and need-based correlates of barriers to mental health care in a current, nationally representative sample of U.S. veterans. Results can be used to inform resource allocation, as well as prevention, psychoeducation, and treatment efforts to help reduce barriers to care and promote engagement with mental health care services in this population.

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This is an Open Access Thesis.

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