Mental Health Stigma in Active Duty Service Members Receiving Mental Health Services
Authors: Zumwalde Jennifer K , Hawkins Brent L , Young Kathleen M 
Published: May 2023

ABSTRACT

Introduction
Mental health treatment is a service for military service members who have experienced psychological injury or trauma. Unfortunately, the stigma associated with treatment can prevent many service members from seeking and receiving treatment designed to help them recover. Previous studies have examined the impacts of stigma among military personnel as well as civilians; however, stigma among service members currently receiving mental health treatment is unknown. The purpose of this study is to understand the relationships between stigma, demographic variables, and mental health symptoms in a sample of active duty service members receiving mental health services in a partial hospitalization program.

Materials and Methods
This cross-sectional, correlational study collected data from participants in the Psychiatric Continuity Services clinic at Walter Reed National Military Medical Center, which offers a four-week partial hospitalization program specializing in trauma recovery for active duty service members of all branches. The data from behavioral health assessments were gathered over a 6-month timespan, including the Behavior and Symptom Identification Scale-24, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item scale, and Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Stigma was measured using the Military Stigma Scale (MSS). The demographic data collected included military rank and ethnicity. Pearson correlations, t-tests, and linear regression were used to further explore the relationships between the MSS scores, demographic covariates, and behavioral health measures.

Results
In unadjusted linear regression models, non-white ethnicity and higher behavioral health assessment intake measures were associated with higher MSS scores. However, after adjusting for gender, military rank, race, and all mental health questionnaires, only Post-traumatic Stress Disorder Checklist for DSM-5 intake scores remained associated with MSS scores. No relationship between gender or military rank and average stigma score was observed in either the unadjusted or adjusted regression models. One-way analysis of variance detected a statistically significant difference between the white/Caucasian group and Asian/Pacific Islander group and a near significant difference between white/Caucasian group and black/African American group. The rates of stigma were higher in non-whites than whites.

Conclusions
In this active duty military cohort, greater mental health stigma was associated with greater severity of mental health symptoms, especially post-traumatic stress symptoms. Some evidence found that ethnicity may also play a role in stigma score differences, particularly in the Asian/Pacific Islander group. Service providers could consider assessing mental health stigma to meet the clinical needs of their patients within the context of their willingness to obtain and adhere to treatment. Anti-stigma efforts to reduce stigma and its impacts on mental health are discussed. Additional research investigating the effect stigma has on treatment outcomes would help guide the relative importance of assessing stigma, in addition to other behavioral health realms.