Recreational Therapist, Psychiatric Continuity Services, Directorate of Behavioral Health, Walter Reed National Military Medical Center, Bethesda, MD 20889-5611, USA.
Professor, Recreation Therapy Degree Program, School of Applied Health and Human Sciences, University of North Carolina Wilmington, Wilmington, NC 28403-5625, USA.
Mil Med. 2023 Aug 29;188(9-10):e3152-e3159. doi: 10.1093/milmed/usad159.
Mental health treatment is a service for military service members who have experienced psychological injury or trauma. Unfortunately, the stigma associated with treatment can prevent many service members from seeking and receiving treatment designed to help them recover. Previous studies have examined the impacts of stigma among military personnel as well as civilians; however, stigma among service members currently receiving mental health treatment is unknown. The purpose of this study is to understand the relationships between stigma, demographic variables, and mental health symptoms in a sample of active duty service members receiving mental health services in a partial hospitalization program.
This cross-sectional, correlational study collected data from participants in the Psychiatric Continuity Services clinic at Walter Reed National Military Medical Center, which offers a four-week partial hospitalization program specializing in trauma recovery for active duty service members of all branches. The data from behavioral health assessments were gathered over a 6-month timespan, including the Behavior and Symptom Identification Scale-24, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item scale, and Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Stigma was measured using the Military Stigma Scale (MSS). The demographic data collected included military rank and ethnicity. Pearson correlations, t-tests, and linear regression were used to further explore the relationships between the MSS scores, demographic covariates, and behavioral health measures.
In unadjusted linear regression models, non-white ethnicity and higher behavioral health assessment intake measures were associated with higher MSS scores. However, after adjusting for gender, military rank, race, and all mental health questionnaires, only Post-traumatic Stress Disorder Checklist for DSM-5 intake scores remained associated with MSS scores. No relationship between gender or military rank and average stigma score was observed in either the unadjusted or adjusted regression models. One-way analysis of variance detected a statistically significant difference between the white/Caucasian group and Asian/Pacific Islander group and a near significant difference between white/Caucasian group and black/African American group. The rates of stigma were higher in non-whites than whites.
In this active duty military cohort, greater mental health stigma was associated with greater severity of mental health symptoms, especially post-traumatic stress symptoms. Some evidence found that ethnicity may also play a role in stigma score differences, particularly in the Asian/Pacific Islander group. Service providers could consider assessing mental health stigma to meet the clinical needs of their patients within the context of their willingness to obtain and adhere to treatment. Anti-stigma efforts to reduce stigma and its impacts on mental health are discussed. Additional research investigating the effect stigma has on treatment outcomes would help guide the relative importance of assessing stigma, in addition to other behavioral health realms.
心理健康治疗是为经历心理伤害或创伤的军人提供的一项服务。不幸的是，与治疗相关的污名可能会阻止许多军人寻求和接受旨在帮助他们康复的治疗。先前的研究已经检查了军人和平民中的污名影响；然而，目前正在接受心理健康治疗的军人中的污名情况尚不清楚。这项研究的目的是了解在接受部分住院计划心理健康服务的现役军人样本中，污名、人口统计学变量和心理健康症状之间的关系。
这项横断面、相关性研究从沃尔特·里德国家军事医疗中心精神病连续服务诊所的参与者那里收集数据，该诊所提供为期四周的部分住院计划，专门为所有军种的现役军人提供创伤康复服务。在六个月的时间内，从行为健康评估中收集数据，包括行为和症状识别量表-24、患者健康问卷-9、广泛性焦虑症 7 项量表和创伤后应激障碍检查表诊断和统计手册第五版（DSM-5）。使用军事污名量表（MSS）测量污名。收集的人口统计学数据包括军阶和种族。使用 Pearson 相关、t 检验和线性回归进一步探讨 MSS 评分、人口统计学协变量和行为健康测量之间的关系。
在未调整的线性回归模型中，非白人种族和较高的行为健康评估摄入量与较高的 MSS 评分相关。然而，在调整性别、军阶、种族和所有心理健康问卷后，只有 PTSD 检查表 DSM-5 摄入量与 MSS 评分相关。在未调整或调整后的回归模型中，都没有观察到性别或军阶与平均污名评分之间的关系。方差分析发现，白人/高加索组和亚洲/太平洋岛民组之间存在统计学显著差异，白人/高加索组和非裔/非裔美国人组之间存在接近显著差异。非白人比白人的污名率更高。
在这个现役军人队列中，更大的心理健康污名与更严重的心理健康症状相关，尤其是创伤后应激症状。一些证据表明，种族也可能在污名评分差异中起作用，特别是在亚洲/太平洋岛民群体中。服务提供者可以考虑评估心理健康污名，以满足患者的临床需求，并考虑他们获得和坚持治疗的意愿。讨论了减少污名和其对心理健康影响的反污名努力。进一步研究污名对治疗结果的影响将有助于指导评估污名的相对重要性，除了其他行为健康领域。
