摘要：Objectives. We characterized trends in mental health services utilization and stigma over the course of the Afghanistan and Iraq wars among active-component US soldiers. Methods. We evaluated trends in mental health services utilization and stigma using US Army data from the Health-Related Behavior (HRB) surveys from 2002, 2005, and 2008 (n = 12 835) and the Land Combat Study (LCS) surveys administered to soldiers annually from 2003 to 2009 and again in 2011 (n = 22 627). Results. HRB and LCS data suggested increased mental health services utilization and decreased stigma in US soldiers between 2002 and 2011. These trends were evident in soldiers with and without posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or PTSD and MDD. Despite the improving trends, more than half of soldiers with mental health problems did not report seeking care. Conclusions. Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of US soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention. Mental health problems associated with deployment to the wars in Iraq (Operation Iraqi Freedom) and Afghanistan (Operation Enduring Freedom) have had significant impact on military personnel. In studies involving active-component infantry soldiers, as many as 28% of soldiers met self-reported criteria for posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) in the postdeployment period. 1–5 Studies have shown that no more than 40% of soldiers with mental health problems utilize mental health services, and as few as 50% seek intervention following a clinical referral. 1,4,6 Few studies 4 have systematically evaluated trends in mental health services utilization over the course of the wars. Moreover, there has been limited study of trends in mental health stigma. Mental health stigma is an important barrier to care among soldiers deployed in Iraq and Afghanistan. 5–12 Stigma is particularly salient among soldiers reporting existing mental health problems. 5,10,12,13 Attitudes contributing to stigma are deeply rooted in society, and are reinforced by the military culture of being physically and psychologically resilient. Data obtained at the beginning of the Iraq war suggested that seeking mental health treatment was perceived by at least half of soldiers as likely to have a negative impact on career advancement and that doing so would be associated with a lack of unit support. 5 Consistent with civilian efforts 14 and in response to the available data during and after deployment, the military has implemented a number of initiatives to increase mental health awareness and diminish stigma. 15–20 If these initiatives have been effective, an increasing trend in utilization rates and a decreasing trend in stigma over the course of the wars would be expected. We aimed to characterize trends in mental health services utilization and stigma in US Army personnel over the course of the Iraq and Afghanistan wars using 2 independent data sources: (1) Army data from the 2002, 2005, and 2008 Health-Related Behavior (HRB) surveys of the Department of Defense 21 and (2) Land Combat Study (LCS) surveys, 2,5,6 which were administered to active-component infantry soldiers by a trained research team 3 to 6 months after deployment annually from 2003 to 2009 and again in 2011.
