In Reply: We thank Mr. Murphy for bringing greater visibility to the stigma that is associated with mental health treatment. Although our study focused on examining the role of readjustment stressors in treatment seeking, multiple factors contribute to returning soldiers’ decision to seek mental health care. Recent studies illustrate the range of factors (1,2). Examples include distance to the nearest VA facility, type of clinic where the individual is seeking treatment, and attitudes toward treatment, to name only a few.

Indeed, the stigma associated with mental health symptoms and with seeking treatment is among the key barriers to care. Consistent with Mr. Murphy’s emphasis, a literature review summarizing recent studies of veterans indicated that the stigma associated mental health treatment is beginning to emerge as a primary barrier to care among returning soldiers (3). Research with nonveteran populations has shown that stigma has multiple effects, with impacts on self-esteem and social mobility (4).

Thus additional research that can inform policy decisions is clearly needed. Of note, it is important to continue to promote cultural shifts that validate attending to one’s emotional resiliency after deployment and that decrease fears often expressed by veterans about the impact that seeking treatment may have on their military careers or employment prospects. Also needed are innovations in mental health service delivery that can either bypass or address the deleterious effects of stigma. As Mr. Murphy notes, the increased availability of mental health services within primary care in the VA may enhance care seeking among veterans who do not seek mental health specialty care because of stigma concerns. Nevertheless, research examining targeted interventions to reduce stigma among returning soldiers is greatly needed (5). We look forward to the expansion of the research base and to informed policies that can help address this ubiquitous barrier.