Family Stigma As a Barrier to Seeking Mental Health Services Among Military Veterans

Military veterans are at a high risk for needing mental health services, but help-seeking may be compromised by family stigma toward mental health problems. Although there are self-report measures of barriers to care seeking, there is no established measure of family stigma. This study examines group differences and the concurrent validity of a new measure that assesses family stigma as a barrier to seeking mental health services. We specifically test demographic differences in family stigma and whether family stigma predicts need for mental health services.

Participants were 623 veterans from Hawaii’s OEF/OIF/OND program registry and National Guard Members.  The Family Stigma Scale (FSS) is comprised of four items (e.g., “People in my family would blame me for the problem”) rated on a 5-point Likert scale. It demonstrates good internal reliability (a = .86). We examined group differences in mean FSS scores by gender, ethnicity, income level, deployment history, education level, urban/rural location, marital status, and military rank. There was a significant interaction between urban/rural location and deployment history, F(1, 419) = 5.97, p = .015, η_p² = .014. For deployed veterans, FSS was higher for urban than rural residents, but for non-deployed veterans FSS was higher for rural than urban residents. There was also a significant interaction between income level and education level, F(4, 419) =4.06, p = .003, η_p² = .037. For participants who achieved at most a college education, there was a positive linear relationship between income level and FSS. However, for participants who had at least some graduate school level education, there was a curvilinear relationship between income level and FSS. In addition to the significant interaction, there was a significant main effect by rank, such that the FSS scores of those who were enlisted were significantly higher than the FSS scores of those who were senior enlisted, all else being equal F(2, 419) = 3.87, p = .022, η_p² = .018. Next, we examined if the FSS significantly predicted the likelihood of participants needing or wanting help for an emotional problem. A logistic regression found a significant interaction between gender and FSS, controlling for ethnicity, p= .018. While an increase in FSS scores predicted a higher probability of reporting a need or want for mental health services, for women, each one point increase in FSS scores predicted a likelihood of reporting mental health services need/desire three times that of men.

These findings demonstrate the need to consider family stigma as a potentially significant barrier to seeking health services among military veterans. Given the role of family stigma, it is important to consider targeted and context-sensitive mental health promotion programs that address family stigma as a barrier to mental health services.