A servicemember participates in a sleep study at Madigan Army Medical Center, Joint Base Lewis-McChord, WA, earlier this year. Sleep technicians connect 26 sensors to patients that measure eye and muscle movements, brain activity, heart rate, and breathing. A new study finds some veterans unlikely to seek help for poor sleep. Photo by U.S. Army Staff Sgt. Christopher Klutts
COLUMBIA, MO — Military service and trauma have been linked to an increased risk for substance abuse and mental health disorders. Yet research suggests a lack of willingness to seek treatment for these problems keeps many veterans from getting the help they need. A new study, which examines the prevalence of and willingness to seek treatment for physical and mental health problems in a racially diverse sample of veterans, offers new insight into the issue and potential clues for improving it.
Mary Beth Miller, MD, assistant professor in the Department of Psychiatry, and colleague at the University of Missouri, used an online survey to screen veterans for 15 medical conditions (including heart disease, cancer, diabetes, HIV/AIDS, high blood pressure, neurological diseases) as well as insomnia, drug use, hazardous alcohol use, post-traumatic stress disorder (PTSD), anxiety and depression.
The final study, which was published in Psychology of Addictive Behaviors, included 334 veterans from 46 states—66% were men and more than 70% identified themselves as a person of color. The participants rated the importance of treatment for and, separately, indicated their willingness to seek treatment for 10 health conditions. Five of the conditions—physical injuries, chronic medical conditions (e.g., diabetes, cancer, heart disease), chronic pain and brain injuries—were conceptualized as physical health conditions. The other five—alcohol or drug use, depression, anxiety, PTSD and thoughts of suicide—were conceptualized as mental health conditions. 1
The participants also indicated how often in their day-to-day lives they experience nine forms of discrimination (e.g., you are treated with less courtesy than other people because of your race/ethnicity) on a scale from 0 (never) to 5 (almost every day) and indicated to what extent they used various coping strategies to deal with stressful events in their lives.
The findings:
- The majority of participants indicated they would be willing to seek treatment for both physical and mental health problems (72% and 64%, respectively).
- In the full sample, willingness to seek treatment was greatest for chronic pain (81%), chronic medical conditions (80%) and physical/brain injuries (79%) and lowest for alcohol/drug use (69%) and sleep (70%).
- Willingness to seek treatment for both physical and mental health problems was lower in the sub-sample of participants who reported hazardous drinking in the past year than in the full sample (67% and 60%, respectively).
- Heavy-drinking participants reported significantly greater willingness to seek treatment for physical health conditions.
Among veterans of color who said they didn’t use coping strategies for stress, experiences of discrimination were associated with less willingness to seek treatment, which suggests that empowering patients to utilize healthy coping skills may lessen the negative impact experiences of discrimination have on treatment seeking, Miller said.
“To me, the key finding from this study is that veterans in general were least willing to seek treatment for the health conditions that were most prevalent in their communities—alcohol use and sleep problems—which was consistent with one of the participant’s comments that these problems are very ‘normalized’ and, therefore, may not be viewed as problems that warrant treatment,” she added.
Miller said she was surprised that willingness to seek treatment for sleep problems wasn’t higher, and attributes that to participants’ lack of understanding that they could benefit from sleep treatment. The other potential explanation, she said, is that veterans might not understand what treatment options for nonmedical conditions look like.
“For example, treatment for sleep problems doesn’t have to be a sleeping pill,” she said. “The most-effective treatment for sleep problems is cognitive behavioral therapy. Maybe they don’t really know that or don’t know how to access it, and that’s why their willingness to seek treatment is low.”
Miller suggested that greater investment in the marketing of cognitive behavioral therapies for mental health problems might help. ”I think a lot of people don’t understand what treatment for mental health issues looks like, and that’s unfortunate, because it’s highly effective for a lot of different mental health problems that co-occur, especially in veteran populations.
“Given how reluctant veterans are to get into treatment, we need to make sure we’re providing the best and most-effective therapy available when they get there,” she continued. “So making sure we’re providing evidence-based practice and seeking training opportunities as needed. And on the physician side, making sure Veterans know that medications are not the only treatment options for mental health conditions.”
- Miller MB, Monk JK, Flores LY, Everson AT, Martinez LD, Massey K, Blanke EM, Dorimé-Williams ML, Williams MS, McCrae CS, Borsari B. Impact of discrimination and coping on Veterans’ willingness to seek treatment for physical and mental health problems. Psychol Addict Behav. 2022 Jul 4. doi: 10.1037/adb0000861. Epub ahead of print. PMID: 35787102.
