MIL13012 775..784

Military health care providers experience considerable stressors related to their exposure to death and traumatic injuries in others. This study used survey data from 799 active duty U.S. Army Combat Medics deployed to Operation Iraqi Freedom/Operation Enduring Freedom. Military experiences, combat exposures, and mental health care seeking of active duty Combat Medics were explored and compared across both genders. Barriers to care were also assessed. Male and female Combat Medics reported surprisingly similar experiences, exposures, and health issues. Overall, results indicate no striking differences in barriers for females compared to their male counterparts, suggesting the barriers to utilization of mental health services may be consistent across gender. Although medics endorsed barriers and stigma related to mental health counseling services, they still sought these health services. Female and male medics who endorsed barriers were more likely to report seeking services than those who did not endorse barriers. This study provides an initial description of utilization of mental health counseling services for U.S. Army Combat Medics, the majority of whom were involved in combat operations in Afghanistan or Iraq. Our findings indicate that comprehensive assessment of the military experiences and combat exposures is needed to appreciate their potential influence on military health care providers. INTRODUCTION Operations in Afghanistan and Iraq have moved military health care system personnel close to the patients on the front lines, resulting in a need to examine combat exposure and mental health sequelae among health care providers and to develop interventions to promote postdeployment reintegration. Currently, over 35,000 Combat Medics serve alongside the combat forces in the U.S. Army, providing a full continuum of services from tactical combat casualty care on the battlefield to preventive medicine. Although Combat Medics care for patients with combat-related injuries, trauma, and death on a daily basis, little is known about the impact of these experiences on related utilization of health care services or differences by gender. Various studies have examined the psychosocial impact of military experiences and combat exposures of current wars on a variety of service members and their health services utilization. The frequency and intensity of exposure to combat experiences is associated with a risk of chronic posttraumatic stress disorder (PTSD). Additionally, severity and type of traumatic event, the extent to which the traumatic event related to an injury, and additional stressors have also been identified as risk factors for PTSD. Previous reports have suggested that medical personnel experience higher rates of PTSD than the general population. Emergency room personnel, intensive care unit nurses, and ambulance service personnel have increased risk of PTSD as a result of their job experiences, with a substantial proportion of ambulance workers meeting criteria for psychiatric symptoms. Carson et al reported that combat experiences such as witnessing death and serious injury to others contributed to PTSD among veterans who served as nurses during Vietnam. However, a study of U.S. health care providers, other than Combat Medics, working at military hospitals in Iraq and Afghanistan found that frequent exposure to injured or dead personnel did not increase the risk of either PTSD or depression. Yet, the stress and outcomes experienced by front line military health care providers such as Combat Medics have received limited attention to date. For example, Jones et al reported that traumatic medical experiences, but not traumatic combat experiences, explained associations with psychological ill health. The high prevalence of depression and PTSD among Iraq war veterans has important implications for health services utilization. Investigators have identified discrepancies between the mental health needs and the utilization of mental health services for Operation Enduring Freedom/Operation Iraq Freedom (OEF/OIF) deployed military members. One challenge to the appropriate use of mental health services are systematic barriers and stigma related to utilization. Among military health care providers, both attitudes about mental health care and the culture of the military may impact health services utilization. Jones et al found greater utilization of health resources by medical personnel that could be *James A. Haley Veterans Hospital, Research Section, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612. †Uniformed Services University, 4301 Jones Bridge Road, Bethesda,