Heterogeneity in Unmet Treatment Need and Barriers to Accessing Mental Health Services Among U.S. Military Service Members with Serious Psychological Distress

Michael S Dunbar; Joshua Breslau; Rebecca Collins; Robin Beckman; Charles C Engel

doi:10.1007/s10488-023-01289-4

Heterogeneity in Unmet Treatment Need and Barriers to Accessing Mental Health Services Among U.S. Military Service Members with Serious Psychological Distress

Adm Policy Ment Health. 2023 Aug 18. doi: 10.1007/s10488-023-01289-4. Online ahead of print.

Authors

Michael S Dunbar¹, Joshua Breslau², Rebecca Collins³, Robin Beckman³, Charles C Engel^{3

4

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Affiliations

¹ RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213-2665, USA. mdunbar@rand.org.
² RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213-2665, USA.
³ RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
⁴ Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
⁵ Health Services Research & Development Center for Innovation, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.

PMID: 37596460
DOI: 10.1007/s10488-023-01289-4

Abstract

The goal of the current study is to examine heterogeneity in mental health treatment utilization, perceived unmet treatment need, and barriers to accessing care among U.S. military members with probable need for treatment. Using data from the 2018 Department of Defense Health Related Behavior Survey, we examined a subsample of 2,336 respondents with serious psychological distress (SPD; past-year K6 score ≥ 13) and defined four mutually exclusive groups based on past-year mental health treatment (treated, untreated) and self-perceived unmet treatment need (recognized, unrecognized). We used chi-square tests and adjusted regression models to compare groups on sociodemographic factors, impairment (K6 score; lost work days), and endorsement of treatment barriers. Approximately 43% of respondents with SPD reported past-year treatment and no unmet need (Needs Met). The remainder (57%) met criteria for unmet need: 18% endorsed treatment and recognized unmet need (Treated/Additional Need); 7% reported no treatment and recognized unmet need (Untreated/Recognized Need); and 32% reported no treatment and no unmet need (Untreated/Unrecognized Need). Compared to other groups, those with Untreated/Unrecognized Need tended to be younger (ages 18-24; p = 0.0002) and never married (p = 0.003). The Treated/Additional Need and Untreated/Recognized Need groups showed similar patterns of treatment barrier endorsement, whereas the Untreated/Unrecognized Need group endorsed nearly all barriers at lower rates. Different strategies may be needed to increase appropriate mental health service use among different subgroups of service members with unmet treatment need, particularly those who may not self-perceive need for treatment.

Keywords: Mental health treatment; Military; Psychological distress; Treatment barriers; Unmet treatment need.