Perceived Barriers to Care Among Veterans Health Administration Patients With Posttraumatic Stress Disorder

被引:123
作者
Ouimette, Paige [1 ]
Vogt, Dawne [2 ]
Wade, Michael [1 ]
Tirone, Vanessa [1 ]
Greenbaum, Mark A. [3 ]
Kimerling, Rachel [4 ]
Laffaye, Charlene [4 ]
Fitt, Julie E. [4 ]
Rosen, Craig S. [4 ,5 ]
机构
[1] Syracuse Univ, Ctr Integrated Healthcare, Syracuse VA Med Ctr, Syracuse, NY 13210 USA
[2] Boston Univ, Womens Hlth Sci Div, Natl Ctr PTSD, VA Boston Healthcare Syst,Div Psychiat, Boston, MA 02215 USA
[3] VA Palo Alto Hlth Care Syst, Sierra Pacific Mental Illness Res Educ & Clin Ctr, Palo Alto, CA USA
[4] VA Palo Alto Hlth Care Syst, Disseminat & Training Div, Natl Ctr PTSD, Palo Alto, CA USA
[5] Stanford Univ, Dept Psychiat & Behav Sci, Stanford, CA 94305 USA
关键词
PTSD; access barriers; Iraq War; veterans; stigma; Longitudinal Veterans Health Survey; MENTAL-HEALTH; AFRICAN-AMERICAN; SERVICE USE; LOW-INCOME; STIGMA; DEPRESSION; ATTITUDES; IRAQ; DETERMINANTS; AFGHANISTAN;
D O I
10.1037/a0024360
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Despite the availability of specialty posttraumatic stress disorder (PTSD) care within Department of Veterans Affairs (VA) facilities, many VA patients with PTSD do not seek needed PTSD treatment. This study examined institutional and stigma-related barriers to care among a large diverse group of Vietnam and Iraq/Afghanistan veterans who had been diagnosed with PTSD by a VA provider. A total of 490 patients who had not received VA treatment for PTSD in the previous 2 years (31% response rate) were asked about psychological symptoms and reasons for not using care. Stigma related barriers (concerns about social consequences and discomfort with help-seeking) were rated as more salient (rated in the "slightly" to "moderately" problematic range) than institutional factors (not "fitting into" VA care, staff skill and sensitivity, and logistic barriers; rated in the "not at all" to "slightly" problematic range). Regression analyses revealed that younger age and White females were associated with higher ratings on not fitting into VA health care, whereas non-White males were associated with higher ratings on logistic barriers. PTSD symptoms were positively associated with perceived barriers to care, with the most consistent results observed for PTSD avoidance symptoms. Magnitude of effects was generally small, suggesting the possibility that other factors not assessed in this study may also contribute to perceptions of barriers to care. Future research should attend to the effects of stigma, as well as institutional barriers to care, on VA mental health treatment seeking.
引用
收藏
页码:212 / 223
页数:12
相关论文
共 40 条
[1]   Ethnic variations in mental health attitudes and service use among low-income African American, Latina, and European American young women [J].
Alvidrez, J .
COMMUNITY MENTAL HEALTH JOURNAL, 1999, 35 (06) :515-530
[2]  
American Psychological Association (APA) Presidential Task Force on Military Deployment Services for Youth Families and Service Members, 2007, PSYCH NEEDS US MIL S
[3]  
[Anonymous], 2000, MAIL TELEPHONE SURVE
[4]   Perceived barriers to health care access in a treated population [J].
Bauer, MS ;
Williford, WO ;
McBride, L ;
McBride, K ;
Shea, NM .
INTERNATIONAL JOURNAL OF PSYCHIATRY IN MEDICINE, 2005, 35 (01) :13-26
[5]   The stigma of mental health problems in the military [J].
Britt, Thomas W. ;
Greene-Shortridge, Tiffany M. ;
Castro, Carl Andrew .
MILITARY MEDICINE, 2007, 172 (02) :157-161
[6]   Screening for depression in a hepatitis C population: the reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) [J].
Clark, CH ;
Mahoney, JS ;
Clark, DJ ;
Eriksen, LR .
JOURNAL OF ADVANCED NURSING, 2002, 40 (03) :361-369
[7]   How stigma interferes with mental health care [J].
Corrigan, P .
AMERICAN PSYCHOLOGIST, 2004, 59 (07) :614-625
[8]   Psychometric properties of the Impact of Event Scale - Revised [J].
Creamer, M ;
Bell, R ;
Failla, S .
BEHAVIOUR RESEARCH AND THERAPY, 2003, 41 (12) :1489-1496
[9]   Treatment barriers for low-income, urban African Americans with undiagnosed posttraumatic stress disorder [J].
Davis, Regina G. ;
Ressler, Kerry J. ;
Schwartz, Ann C. ;
Stephens, Kisha James ;
Bradley, Rebekah G. .
JOURNAL OF TRAUMATIC STRESS, 2008, 21 (02) :218-222
[10]   The role of psychiatric diagnosis in satisfaction with primary care - Data from the department of veterans affairs [J].
Desai, RA ;
Stefanovics, EA ;
Rosenheck, RA .
MEDICAL CARE, 2005, 43 (12) :1208-1216