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Articles   |    
Factors Affecting Help Seeking for Mental Health Problems After Deployment to Iraq and Afghanistan
Lindsey A. Hines, M.Sc.; Laura Goodwin, Ph.D.; Margaret Jones, B.A.; Lisa Hull, M.Sc.; Simon Wessely, F.R.C.Psych., F.Med.Sci.; Nicola T. Fear, D.Phil. (Oxon.); Roberto J. Rona, Ph.D., F.F.P.H.
Psychiatric Services 2014; doi: 10.1176/appi.ps.004972012
View Author and Article Information

Ms. Hines, Dr. Goodwin, Ms. Jones, Ms. Hull, Professor Wessely, and Professor Rona are with the King's Centre for Military Health Research, King's College London (e-mail: lindsey.hines@kcl.ac.uk). Dr. Fear is with the Academic Centre for Defence Mental Health at King’s College London.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  This study assessed the prevalence of general medical problems, stress or emotional problems, and alcohol problems reported by members of the armed forces of the United Kingdom after deployment in Iraq or Afghanistan. The study also identified types of help seeking and factors associated with help seeking.

Methods  A total of 4,725 military personnel who were deployed to Iraq, Afghanistan, or both were asked about health problems attributable to the deployment and whether they had sought help for them. Data were collected through postal surveys between 2007 and 2009. Service and sociodemographic covariates and measures of current mental health, alcohol misuse, and functional impairment were included in the analyses.

Results  Of the 19% who reported stress or emotional problems, 42% sought help, most commonly medical help (29%). Of the 6% who reported alcohol problems, 31% sought help, most commonly medical help (17%). Medical help seeking for stress or emotional problems was associated with being female, holding a lower rank, having functional impairment, and meeting criteria for two or more mental health problems. Being divorced or separated was positively associated with nonmedical help seeking for stress or emotional problems. Help seeking for alcohol problems was associated with current mental disorders.

Conclusions  Medical help seeking for stress or emotional problems was uncommon and was related to meeting criteria for two or more mental health problems. Commissioned officers were reluctant to seek medical help for stress or emotional problems. Help seeking for alcohol problems increased if personnel were experiencing additional mental health problems.

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Table 1Characteristics of 4,725 military personnel after deployment to Iraq or Afghanistana
Table Footer Note

a For those deployed to both Iraq and Afghanistan, the most recent deployment was used.

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b Total personnel for whom information was available

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c Percentages are weighted.

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d The PTSD Checklist–Civilian Version (PCL-C) identifies posttraumatic stress disorder; the General Health Questionnaire (GHQ) identifies psychological distress; the Alcohol Use Disorders Identification Test (AUDIT) identifies serious alcohol misuse (score 16–19) and serious alcohol misuse with functional impairment (score ≥20); and the Multiple Physical Symptom (MPS) scale identifies a case of multiple physical symptoms.

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Table 2Prevalence of help seeking among 4,725 military personnel, by problema
Table Footer Note

a Percentages are weighted.

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Table 3Factors associated with help seeking among 888 military personnel who reported stress or emotional problems after deploymenta
Table Footer Note

a Percentages are weighted.

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b Multinomial odds ratios (MORs) were adjusted for age, sex, marital status, engagement type, and rank. Age was a continuous variable and was rescaled by dividing by 10.

Table Footer Note

c AUDIT, Alcohol Use Disorders Identification Test. Scores <16 indicate no serious alcohol misuse; 16–19, serious alcohol misuse; and ≥20, serious alcohol misuse with probable functional impairment.

Table Footer Note

d Mental health problems were identified by a composite cumulative measure reflecting the results of the PTSD Checklist–Civilian Version, the General Health Questionnaire, and the Multiple Physical Symptom scale.

Table Footer Note

*p<.05, **p<.01, ***p<.005

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Table 4Factors associated with help seeking among 291 military personnel with alcohol problemsa
Table Footer Note

a Percentages are weighted.

Table Footer Note

b Odds ratios (ORs) were adjusted for age, sex, marital status, engagement type, and rank.

Table Footer Note

c Mental health problems were identified by a composite cumulative measure reflecting the results of the PTSD Checklist–Civilian Version, the General Health Questionnaire, and the Multiple Physical Symptom scale.

Table Footer Note

d AUDIT, Alcohol Use Disorders Identification Test. Scores <16 indicate no serious alcohol misuse; 16–19, serious alcohol misuse; and ≥20, serious alcohol misuse with probable functional impairment.

Table Footer Note

*p<.05, **p<.01, ***p<.005

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