Perceived Damage to Career As a Barrier to Utilization of Mental Health Services for Active Duty Personnel with Possible Traumatic Brain Injury and Posttraumatic Stress Symptoms

Purpose:  Over the last decade, the U.S. military has been engaged in a number of combat operations. As the large mobilization for these operations comes to an end, a growing number of service members may require access to mental health services to cope with conditions such as traumatic brain injury (TBI) and posttraumatic stress (PTS). One major barrier to seeking mental health services in the military is perceived stigma toward help-seeking in the form of perceived damage to career. This study seeks to examine this stigma as a barrier to help-seeking, and differences in help-seeking behaviors based on perceived need for counseling and PTS and TBI symptomology.

Methods:  This study utilizes data from the 2011 Survey of Health Related Behaviors of Active Duty Military Personnel, the Department of Defense and Coast Guard’s largest anonymous survey of active duty personnel with approximately 40,000 online respondents. The sample was stratified to ensure representativeness by service, gender, and pay grade.

Results:  We found that 37.7% of active duty personnel reported seeking mental health services while in the military would damage their career. Examination of stigma by gender and pay grade produced no differences between groups. However, we see marked differences when examining this perceived stigma for individuals who have PTS and TBI symptoms. For those who have PTS symptoms, 61.4% report perceived stigma versus 36.4% who are not experiencing PTS symptoms (χ² <.001). Additionally, 51.7% of those with possible TBI report perceived stigma versus 36.8% of those with unlikely TBI (χ² <.001). Furthermore, when looking at those who reported a need for counseling, logistic regressions show that personnel who did not perceive stigma were more likely to have sought counseling than those who did (OR=1.66; CI=1.63-1.69).  In addition when TBI and PTS symptoms were included in the model, those not perceiving stigma were even more likely than those perceiving stigma (OR=1.75; CI=1.47-2.07) to have received counseling.

Conclusion:  Results indicate that stigma surrounding the receipt of mental health services continue to impede our military personnel’s mental well-being. Moreover, when personnel demonstrate symptoms of TBI or PTS, the likelihood that stigma serves as a barrier to receiving mental health services increases. Therefore, it is recommended that military leadership develop policies and educational interventions that incorporate a strategic message to dispel negative beliefs that seeking counseling will damage one’s military career, with the ultimate goal of promoting a military culture that encourages the use of mental health services.