Abstract
The general public is aware of the impact mental health issues have on individuals. Yet, we still live in a society where we disregard individuals’ pain and suffering. When it comes to the topic of the military and veteran community, mental health stigmas have been engraved as something that is not as serious as the nature of their occupation overcasts deeper mental issues. The same attitude goes towards people from minority groups who are likely to be more stigmatized, especially in relation to mental health issues. However, such a relation is poorly grounded, as mental issues without proper address tend to lower people’s quality of life significantly.
While there are numerous studies on stigmatization in military and minority groups, practically no research is made into the stigmas imposed on people from minority groups who, at the same time, work in the military. The research aims to close this gap by determining whether people belonging to minority groups experience more mental issues and stigmatization during their time of service than people belonging to majority groups. The results of this research will advance understanding of how ethnic and minority groups are further affected by previous mental health stigmas when incorporated into a group that reinforces negative attitudes.
Introduction
Stigma around the topic of mental health (MH) has been an issue many people struggle with, as it affects a person’s ability to seek help, which can come from self-stigma, attitudes towards seeking help, and perceived public stigma. “Mental illness labeling serves as a trigger that sets off the stigmatization process in both individuals with and without mental illness” (Fox, 2022). A group that battles continuously with stigma is service members in the military and veterans, as mental health stigma is firmly grounded in military culture and breeds an attitude for service members and veterans to handle issues on their own. Perceive stigma and foresee adverse outcomes in seeking help, including career harm (Kaplan).
Military environments breed toughness, self-reliance, and teamwork, thus also promoting stigmas around mental health. Because the military revolves around trust and teamwork, it’s believed that seeking care could harm the team’s effectiveness. “Furthermore, the perception that there are career consequences may ultimately guide behavior, regardless of whether there truly are career ramifications for pursuing MH treatment among active duty members experiencing psychological or behavioral problems” (Heyman, 2022). Military culture is known for stripping a person’s identity early into their service as this is part of a transformative process, not only physically but mentally. When this happens, their organization reshapes service members’ identity, and they can adopt the values, behaviors, and culture associated with military environments.
Another group affected by mental health stigmas is ethnic and racial minority groups. “Racial and ethnic minorities are significantly more likely than whites to delay or forego needed mental health care, and, if they do seek treatment, they are more likely than whites to drop out” (Wong, 2017). Just like in military culture, ethnic and racial minorities have a perception of mental health as a taboo in many of their communities. These groups have a longstanding belief that mental health issues like anxiety and depression are not validated as challenges, as socioeconomic status, legal status, and cultural backgrounds play a bigger role in these behaviors, thus invalidating mental health.
“African Americans are less likely than Whites to seek out treatment and more likely to end treatment prematurely. On the one hand, this is due in part to long-held beliefs related to stigma, openness, and help-seeking, which can make African Americans and other people of color hesitant to reach out” (Armstrong, 2019).
Objectives
We plan to test whether minority groups within the military and veteran community are further affected by mental health stigmas than those that are not considered a minority group. This project also wants to improve the relationship between military members, minority groups, and mental health services within their communities. We expect to have a better understanding of the relationship and disconnect between military and minority groups with the ability to seek mental health services. Surveys and interviews will be conducted to collect data further to understand this topic. Some recommendations could include information on how to reach support systems within communities and psychotherapy, among other services.
Objective 1: Close the gap between available mental health resources and minority groups within the military community to reduce stigmas associated with seeking treatment.
Prediction 1: Participants who identify as a racial minority will be affected more by mental health stigmas than those who don’t identify as a minority during their service time and after separation from the military.
Prediction 2: Participants identifying as racial minorities are expected to experience mental health stigma at levels comparable to non-minority participants both during military service and after separation.
Literature Review
Many researchers trace the connection between stigmatization related to health issues and a person’s military career. Thus, Mayer et al. (2023) provide insights into stigma from the individual and the broader group perspectives within the military. Mayer et al. (2023) claim that the stigma of mental illness is experienced most acutely in the military, where teamwork is crucial to mission success and battle survival. Military units are more successful in battle and have a higher chance of surviving thanks to their unity and brotherhood.
Risks to the group’s efficacy, reputation, or longevity must be removed at any cost; therefore, individuals with mental health issues tend to be seen as a threat to the military group that has to be removed at all costs (Mayer et al., 2023). Such perception essentially leads to the isolation and ostracism of people with health issues. From the individual’s perspective, the main driver of self-stigma is a deeply rooted association of stigma with weakness that abounds in the military (Mayer et al., 2023). Seen as brave men, military personnel feel humiliated admitting they have mental problems or need help.
Other researchers have singled out internalized, expected, and public stigma as forms of stigma seen as obstacles to obtaining care (Fox et al., 2018; Williston et al., 2020). Internalized stigma is understood as veterans’ unfavorable attitudes toward mental health issues and treatment seeking within their group, as well as their idea that people with mental health issues can’t be relied upon or care for themselves. Internalized stigma argues that veterans’ own misguided views about mental health are a deterrent to getting the care they need, since holding such views would make getting help for mental health issues fearful (Fox et al., 2018).
The stigma that veterans could anticipate encountering from others is referred to as anticipated stigma (Fox et al., 2018; Schuy et al., 2019). Up to 29.9% of veterans held the belief that if they had a mental health issue, their close companions would avoid them (Krill Williston et al., 2019). According to another research, veterans’ lack of help-seeking is a result of their concern that a mental health issue may harm their careers and professional prospects (Rafferty et al., 2019). This implies that veterans may be reluctant to seek treatment for a mental health illness because they are afraid that other people would see them unfavorably.
Public stigma is the idea that people would be seen negatively by the broader public. Veterans frequently worry about the stigmatizing labels attached to mental health problems, and many of them agree that undergoing care would make them seem frail (Cheney et al., 2018). Veterans also claimed that certain civilians regard them as killers, and that this stigmatization stems from any mental issues that have been brought on by their service (Schuy et al., 2019). A large portion of the literature on stigma and supportive behavior in the military community used a cross-sectional approach to gathering data, which has the drawbacks of being less impartial and making it challenging to conclude cause and effect. The design of this study, using a self-reporting approach, aims to get objective and reliable results on the connection between stigma and working in the military, as well as perceived barriers to seeking medical help.
From the perspective of the impact of stigma on racial and ethnic minorities, it is well pronounced. Thus, the non-White group sees people with mental illnesses as more threatening than the White group does, and they report a stronger desire for isolation of people with mental issues than the Whites (Eylem et al., 2020). For Asian Americans, similar studies demonstrated greater prevalence for public and self-stigma forms than White Americans (Chaudhry & Chen, 2019).
Public stigma occurred due to either a lack of understanding about psychiatric illness or the existence of culturally specific religious views, such as the emphasis placed on employment for Asian Americans, and cultural biases of being powerful and self-sufficient for Black Americans (Eylem et al., 2020). Chinese Americans are found to be more likely to support social stigmas and social exclusion against individuals who have a mental illness due to the cultural potential ramifications of mental illness for the bloodline (Eylem et al., 2020). Due to historical and present discrimination, structural stigma often manifests as service hurdles for Asian Americans and Latinx Americans who are immigrants (Eylem et al., 2020). Thus, minority groups are found to be more affected by all kinds of stigmas than the majority groups.
Methods
Data Collection
I plan to preregister the above objectives and predictions (as well as other exploratory questions) in the Open Science Framework. 50-100 undergraduate veteran students will be recruited using the University of Nevada, Reno SONA system, and a random sample of 50-100 will be recruited through surveys through the Reno Veterans Health Administration. At the end of the survey, participants will have a chance to opt in for a follow-up: among them, those who score the highest ratings in perceived stigmas for mental health will be invited.
All participants will be rewarded with a $5 Amazon gift card to facilitate data collection. Given the estimated sample size of 100-200, $400 will be given out. Twenty participants who participate in a follow-up interview will be guaranteed a $15 Amazon gift card. I will use a one-way ANOVA to compare stigmas within minority groups and non-minorities and test the above predictions under the supervision of Dr. Paul Kwon. All study procedures will receive IRB approval before data collection begins.
Anticipated Results
Early findings indicated that racial minority participants experienced a greater impact from mental health stigma than non-minority participants during military service and following separation.
Conclusions/Discussion
The research has shown a link between the stigmatization of health-related mental conditions and a person’s belonging to minority groups and military service. Internalized stigma, anticipated stigma, public stigma, and structural stigma are the types of stigma that are perceived as barriers to receiving care. In the military, the stigmas are often the result of camaraderies and brotherhood that reign in the units where people are not ready to rely on a person with mental issues and therefore try to isolate them. In minority groups, stigmatization predominantly occurs due to specific religious views held within the minority groups.
Public stigma, in both cases, comes from the lack of understanding of the problem by society and its unwillingness to help individuals with mental issues adapt to everyday life. To reduce stigmas associated with seeking treatment, there should be available mental health resources within the military community for minority as well as majority groups. The elaboration of such a health system could become the topic for further research and investigation.
References
Meyer, J. F., Wattenberg, M. S., Kosman, K. A., Budd, M. A., Duffy, M. J., Agrawal, A.,… & Bradley, J. C. (2023). Stigma and Barriers to Care for Mental Health Treatment for Military and Veteran Populations. In Veteran and Military Mental Health: A Clinical Manual (pp. 45-85). Cham: Springer International Publishing.
Fox AB, Smith BN, Vogt D (2018). How and when does mental illness stigma impact treatment seeking? longitudinal examination of relationships between anticipated and internalized stigma, symptom severity, and mental health service use. Psychiatry Research, 268, pp. 15–20. Web.
Williston SK, Bramande EA, Vogt DS, et al (2020). An examination of the roles of mental health literacy, treatment-seeking stigma, and perceived need for care in female veterans’ service use. Psychiatric Services, 71(2), pp. 144-150. Web.
Schuy K, Brants L, Dors S, et al (2019). Psychological stigma costs as barriers to healthcare use in former soldiers of the German armed forces: a qualitative analysis. Military Psychology, 31(4), 279-291. Web.
Krill Williston S, Roemer L, Vogt DS (2019). Cultural and service factors related to mental health beliefs among post-9/11 veterans. International Journal of Social Psychiatry, 65(4), pp. 313-321. Web.
Rafferty LA, Wessely S, Stevelink SAM, et al (2019). The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment. European journal of psychotraumatology, 10(1), 1700613. Web.
Cheney AM, Koenig CJ, Miller CJ, et al. Veteran-centered barriers to VA mental healthcare services use (2018). BMC health services research, 18(1), 1-14. Web.
Eylem, O., De Wit, L., Van Straten, A., Steubl, L., Melissourgaki, Z., Danışman, G. T.,… & Cuijpers, P. (2020). Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis. BMC Public health, 20(1), 1-20. Web.
Chaudhry, T. & Chen, S. (2019) Mental illness stigmas in South Asian Americans: A cross-cultural investigation. Asian American Journal of Psychology, 10(2), 154–16. Web.
Appendix
Budget
Table 1 – Budget
Justification
All participants will get a $5 Amazon gift card as an incentive to aid with data gathering. A total of $400 will be awarded considering the 100–200 person sample size that is anticipated. There will be 20 respondents who will get a $15 Amazon gift card if they take part in a follow-up interview.