Barriers to mental health seeking in Army aviation personnel

Abstract: OVERVIEW: Aviation operations require constant vigilance where personnel must perform their duties under significant physical and psychological stress. Prolonged or intense stress events can lead to mental health issues, even among those with formal resilience training. Barriers to mental health seeking prevent military aviation personnel from receiving the assistance they need, yet little is known about these barriers, undiagnosed symptom levels, and perceived acceptability of self-help mental wellness options. METHODS: Quantitative survey responses were collected from more than 525 current and former U.S. Army Aviation aircrews, ATC personnel, and UAS operators recruited via social media between October 2023 and February 2024. We assessed barriers to seeking mental healthcare using the Barriers to Access to Care Evaluation - Version 3 (BACE3). Additionally, we measured self-reported anxiety, depression, and posttraumatic stress symptoms using the Public Health Questionnaire 4 (PHQ4) and the four-item PTSD Checklist for DSM-5 (PCL4-5). To evaluate the acceptability of three self-help mental wellness techniques—Mindfulness Training, Transcendental Meditation, and Internet-based Cognitive Behavioral Therapy (I-CBT)—we used an author-developed questionnaire that considered scenarios with and without approval from civilian and military regulators. RESULTS: The results indicate organizational stigma and attitudinal barriers play the most significant role in inhibiting mental healthcare seeking among the population, while instrumental barriers play a lesser but significant role, especially among UAS operators. Self-assessed mental health symptom levels were nearly four times those documented in previous research utilizing medical records reviews, with UAS operators exhibiting higher levels than other aviation career fields. Finally, I-CBT and Mindfulness Training demonstrated the greatest acceptability among self-help mental wellness options. DISCUSSION: These findings indicate that a large percentage of U.S. Army Aviation personnel operate with diagnosable mental health symptom levels. To overcome mental health hesitance, outreach should focus on combatting perceived stigma by employers and regulators, along with dispelling internal mindsets against mental health within the Army Aviation community. Mindfulness Training and I-CBT demonstrate promising self-help options, providing possible avenues for overcoming stigma and attitudinal barriers among this and other aviation populations.