Sayer Nina A, Friedemann-Sanchez Greta, Spoont Michele, Murdoch Maureen, Parker Louise E, Chiros Christine, Rosenheck Robert
Center for Chronic Diseases Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
Psychiatry. 2009 Fall;72(3):238-55. doi: 10.1521/psyc.2009.72.3.238.
Although there are effective treatments for Posttraumatic Stress Disorder (PTSD), many PTSD sufferers wait years to decades before seeking professional help, if they seek it at all. An understanding of factors affecting treatment initiation for PTSD can inform strategies to promote help-seeking. We conducted a qualitative study to identify determinants of PTSD treatment initiation among 44 U.S. military veterans from the Vietnam and Afghanistan/Iraq wars; half were and half were not receiving treatment. Participants described barriers to and facilitators of treatment initiation within themselves, the post-trauma socio-cultural environment, the health care and disability systems, and their social networks. Lack of knowledge about PTSD was a barrier that occurred at both the societal and individual levels. Another important barrier theme was the enduring effect of experiencing an invalidating socio-cultural environment following trauma exposure. In some cases, system and social network facilitation led to treatment initiation despite individual-level barriers, such as beliefs and values that conflicted with help-seeking. Our findings expand the dominant model of service utilization by explicit incorporation of factors outside the individual into a conceptual framework of PTSD treatment initiation. Finally, we offer suggestions regarding the direction of future research and the development of interventions to promote timely help-seeking for PTSD.
尽管创伤后应激障碍（PTSD）有有效的治疗方法，但许多PTSD患者要等数年甚至数十年才会寻求专业帮助，有些人甚至根本不寻求帮助。了解影响PTSD治疗启动的因素有助于制定促进寻求帮助的策略。我们进行了一项定性研究，以确定44名来自越南战争以及阿富汗/伊拉克战争的美国退伍军人中PTSD治疗启动的决定因素；其中一半正在接受治疗，一半未接受治疗。参与者描述了自身、创伤后社会文化环境、医疗保健和残疾系统以及他们的社交网络中治疗启动的障碍和促进因素。对PTSD缺乏了解是在社会和个人层面都出现的障碍。另一个重要的障碍主题是创伤暴露后经历无效社会文化环境的持久影响。在某些情况下，尽管存在个人层面的障碍，如与寻求帮助相冲突的信念和价值观，但系统和社交网络的促进作用仍导致了治疗的启动。我们的研究结果通过将个体之外的因素明确纳入PTSD治疗启动的概念框架，扩展了主导的服务利用模型。最后，我们就未来研究的方向以及促进及时寻求PTSD帮助的干预措施的开发提出了建议。
