14 CHAPTER 1 1 Stigma and discrimination Many studies identified concerns related to stigma and discrimination as barriers to treatment-seeking (48). One of the most reported concerns was the concern that seeking treatment harms one’s military career. Additionally, military personnel were concerned that treatment-seeking would result in blame, differential treatment, and less confidence in their ability from supervisors and peers (51-54). Sociodemographic factors This includes factors like sex, age, marital status, rank, and severity of MHI. For example, previous research showed that females were more likely to seek treatment than males (55-58) and that more senior ranks were less likely to seek treatment than lower ranks (55, 56). Characteristics of the health care environment Previous research reported several structural and logistical barriers to treatmentseeking. For example, difficulties scheduling appointments and getting time off work formed barriers to treatment-seeking (51, 53, 54). There were fewer concerns about the availability and costs of treatment, as military personnel in most countries have military health care benefits (57). There were also concerns about the confidentiality of consulting a mental health professional, which might be due to mental health stigma (58). Treatment and MHI beliefs Some military personnel reported that they believed that treatment is not effective. Negative attitudes towards treatment were associated with lower interest to receive treatment (56). Additionally, military personnel showed a big preference to solve problems on their own, instead of seeking treatment. This is referred to as the preference for self-management (58-62). The literature also discusses several key facilitators for treatment-seeking in the military. Social support, unit cohesion, and positive leadership were found to be key facilitators for treatment-seeking. For example, encouragement and support from a partner, family, and friends were associated with military personnel being more prone to seek treatment (52, 54, 63). Additionally, unit cohesion and positive leadership behavior were associated with lower reported barriers to care (20, 64). An important model often used to explain planned behavioral intentions, including health-related behavior such as treatment-seeking (65, 66), is the theory of planned behavior (figure 3). According to this theory, planned behavior is influenced by (1) individuals’ attitudes toward the behavior, (2) subjective norms, and (3) individuals’
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