Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney).
Psychiatr Serv. 2021 May 1;72(5):521-529. doi: 10.1176/appi.ps.201900275. Epub 2021 Mar 11.
Veterans, especially those residing in rural areas, continue to underutilize mental health care. This longitudinal study assessed attitudes relevant to seeking mental health care services from the Veterans Health Administration (VHA) over 12 months, adjusting for residence.
A questionnaire addressing attitudes, sociodemographic factors, residence, place identity, perceived health status and needs, and structural barriers was administered by telephone to 752 veterans with previous VHA service use. Service use data were obtained from a VHA database.
In adjusted models, four attitudes were significantly associated with underuse of VHA mental health care (no use vs. any use; no use vs. nonsustained use vs. sustained use). Higher levels of mistrust of others (adjusted odds ratio [AOR]=1.06, p=0.046), emotional stoicism (AOR=1.08, p=0.003), belief in the self-resolving nature of mental health problems (AOR=1.91, p=0.015), and belief in the efficacy of religious counseling for such problems (AOR=1.09, p=0.022) were associated with no subsequent service use versus any use. Place identity (suburban), older age, and greater need were associated with greater odds of VHA use. For the comparison of no use versus sustained use, women had lower odds of no use (AOR=0.49, p<0.001); similarly, women had lower odds of nonsustained use versus sustained use (AOR=0.45, p<0.001).
The association of potentially modifiable attitudes with underuse of VHA mental health services suggests that attitudes offer useful targets for efforts to increase mental health care use. That these attitudes were influential regardless of residence suggests that programs addressing attitudinal barriers can be broadly targeted.
退伍军人，尤其是居住在农村地区的退伍军人，继续较少利用心理健康保健服务。本纵向研究评估了在 12 个月期间，从退伍军人健康管理局（VHA）获得心理健康保健服务的相关态度，同时调整了居住因素。
对 752 名曾使用过 VHA 服务的退伍军人进行了电话调查，内容包括态度、社会人口因素、居住地、地方认同、感知健康状况和需求以及结构性障碍。从 VHA 数据库中获得服务使用数据。
在调整后的模型中，有四种态度与 VHA 心理健康保健服务的利用不足显著相关（未使用与任何使用、未使用与非持续使用与持续使用）。对他人的不信任程度较高（调整后的优势比[OR]=1.06，p=0.046）、情绪克制（OR=1.08，p=0.003）、对心理健康问题自我解决性质的信念（OR=1.91，p=0.015）以及对宗教咨询对这类问题的疗效的信念（OR=1.09，p=0.022）与未随后使用服务相比，与任何使用服务相关。地方认同（郊区）、年龄较大和需求较大与 VHA 使用的几率较高相关。对于未使用与持续使用的比较，女性未使用的几率较低（OR=0.49，p<0.001）；同样，女性未持续使用的几率低于持续使用的几率（OR=0.45，p<0.001）。
与 VHA 心理健康服务利用不足相关的潜在可改变态度表明，态度为增加心理健康保健服务的使用提供了有用的目标。这些态度无论居住因素如何都具有影响力，这表明可以广泛针对解决态度障碍的项目。
