Mental health treatment engagement across mental health concerns in U.S. servicemembers

Abstract: Understanding the prevalence of mental health concerns, rates of treatment access, and barriers to care can help identify strategies for improving mental health support and access. In a sample of U.S. military servicemembers, we examined (a) the rate and type of care sought for various mental health concerns and (b) barriers to care across presenting concerns. We conducted cross-sectional analyses using web-based survey data collected via population-based stratified random sampling from the Department of Defense 2018 Health-Related Behavior Survey (N = 33,641 U.S. military servicemembers, 67.1% male). We assessed the percentage of participants reporting a range of mental health concerns (e.g., posttraumatic stress disorder, suicidality, aggression, and alcohol problems) who received various treatments, perceived an unmet treatment need, and reported specific barriers to care. Treatment rates were highest for suicidality and posttraumatic stress disorder and lowest for alcohol binges, gambling problems, and risky sexual behavior. Practical difficulties with care access, concerns about confidentiality, and concerns about harm to career were among the most endorsed barriers across all mental health variables. Treatment rates were similar or slightly higher than previous findings for internalizing psychopathology, and rates were generally lower for externalizing behaviors. Significant treatment gaps persist for all mental health concerns examined. Organization-based interventions to enhance access to confidential care and allow time off for mental health treatment may help close treatment gaps for all mental health concerns. Prevention and intervention efforts should focus on raising awareness about the health and social consequences of externalizing behavior to encourage help-seeking from mental health professionals in these areas.