Conceptualizing the healthcare utilization needs of military service members and Veterans with posttraumatic stress injury belonging to the Black, Indigenous, People of Color (BIPOC) communities: An exploratory study

Abstract: Background: Veterans are at high risk for trauma-related injuries, including posttraumatic stress (PTSD) and/ or Traumatic Brain Injuries (TBI). Several evidence-based psychotherapies, such as cognitive-behavioral therapy, are available for treating symptoms of PTSD and/ or TBI in the veteran population; however, many veterans are reluctant to seek or continue mental health care. The National Center for Veterans Analysis and Statistics notes that in 2014, 45.6% of minority veterans were enrolled in the Veterans Health Administration (Office of Data Governance and Analytics & Department of Veterans Affairs, 2017). However, the majority sought care at non-VA facilities or did not seek care. Challenges and barriers to seeking mental health care involve the stigma associated with seeking mental health treatments (Richards et al., 2016) and geographical barriers to access care (Rosen et al., 2021). Complete and reliable racial and ethnic background data is critical for evaluating health equity and disparity measurement. Missing data on race/ethnicity has led to several inconsistencies in research findings among previous studies. Methods: Data were obtained from the 2022 National Health Interview Survey (NHIS) to characterize the target population. The study was limited to college-aged veterans (18-35 years) who identify as black, indigenous, and people of color (BIPOC). Primary data collection was done using a survey to further understand the current state of healthcare utilization among veterans belonging to BIPOC communities. Group concept mapping (GCM), a mixed-methods approach, was then used for the exploration of factors that were deemed important for treating and managing PTSD by eligible participants. Results: Through the GCM process, eleven participants made 91 unique statements that were sorted into 7 clusters namely, barriers to accessing quality treatment for PTSD for veterans, racial issues in treatment of veterans, societal stereotypes affecting veterans, patient preferences for treatment, racial perceptions of veterans receiving treatment for PTSD, factors contributing to success in the treatment of PTSD and treatment options for PTSD patients. Point and cluster maps were created based on how these participants sorted the statements. This study found several actionable statements in each of the 7 clusters that might help address the low utilization of regular mental health services among BIPOC veterans through GCM. Three barriers to accessing quality PTSD treatment include the lack of shared perspectives and representation among healthcare practitioners, internal struggle to open up, and costs of care. Conclusions: The study underscores the urgent need for more aggressive risk assessment, monitoring, and management of mental health injuries among minority veterans in non-VA health centers. It is imperative that changes to clinical practice guidelines, policies, and processes be implemented to enable support services that can help veterans stay committed to therapy and promote recovery.