Perceived barriers to mental healthcare among spouses of military service members
Abstract: Barriers to mental healthcare services are reported among military service members. However, little is known about these barriers among the spouses of military personnel, who face unique stressors and may subsequently be at high-need for mental health services. Understanding barriers to care among this vulnerable population may help improve access to psychological services. The current study utilized data from the Millennium Cohort Family Study. Participants were referred by their military spouses or through targeted mailers. Participants completed self-report measures of mood, psychosocial functioning, and perceived barriers to mental healthcare via web- or paper-based surveys. A factor analysis was conducted to identify subscales of the barriers to mental healthcare measure, and logistic regressions were conducted adjusting for relevant sociodemographic variables, to determine psychosocial factors associated with likelihood of reporting barriers to mental healthcare. The sample comprised 9,666 military spouses (86% female; Mage: 27.73 ± 5.09; 29.2% racial/ethnic minority; 19.5% with prior/current military service). Logistic factors were the most frequently reported barrier to care (63%), followed by negative beliefs about mental healthcare (52%), fear of social/occupational consequences (35%), and internalized stigma (32%). Spouses with prior or current military service themselves and individuals with a psychiatric condition were most likely to report barriers to mental healthcare. A preponderance of military spouses reported barriers to mental healthcare services. Prospective data are needed to elucidate the associations between barriers to care and mental healthcare utilization. Efforts may be warranted to improve access to mental healthcare among the spouses of military personnel.
Abstract: Background: Exposure to potentially morally injurious events (PMIEs) during military service can lead to moral injury (MI) outcomes and posttraumatic stress symptoms (PTSS). This longitudinal study examined the relationships between PMIE exposure, MI outcomes, and PTSS among Israeli combat veterans, and the potential protective role of dispositional forgiveness in these associations. Method: Participants were 169 Israeli combat veterans who participated in a six-year longitudinal study with four measurement points (T1: 12 months before enlistment, T2: Six months following enlistment- pre-deployment, T3: 18 months following enlistment- post-deployment, and T4: 28 months following discharge). Participants’ characteristics were assessed via semi-structured interviews (T1) and validated self-report measures (T2-T4) between 2019-2024. Results: Approximately 36% of participants reported exposure to PMIEs during service, with 13% exceeding the clinical threshold for probable PTSD at T4. PMIE-Betrayal at T3 was positively associated with MI outcomes of shame and trust violation at T4. The indirect effect of PMIEs on PTSS through MI outcome-Shame depended on forgiveness levels. Among veterans with low forgiveness, higher exposure to PMIE-Betrayal was associated with increased MI shame, which was linked to more severe PTSS. Conversely, for those with high forgiveness, exposure to PMIE-Self and Other was associated with decreased MI shame and subsequently reduced PTSS. Conclusion: Dispositional forgiveness moderates the relationship between PMIE exposure and MI outcomes, particularly shame, which mediates the development of PTSS. These findings highlight forgiveness as a potential target for intervention in treating moral injury and preventing PTSS among combat veterans.