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Mental health stigma and military spouses

Spouses of active duty service members may hold a more stigmatized view of mental health care due to exposure to military culture

Cite this
Minnocci, M. K., & Thorp, S. R. (2020, December 15). Mental health stigma and military spouses. The Couple and Family Psychologist. http://www.apadivisions.org/division-43/publications/blog/practice/military-spouses

serviceman holding hands with spouse

Mental health stigma (MHS) consists of discriminatory attitudes that deny an individual full social acceptance through public or internalized prejudices (Goffman, 1963). MHS is associated with poorer utilization of mental health care (MHC), including therapy or the use of prescribed medication for a mental condition (Link & Phelan, 2001). In military populations, common concerns about seeking MHC by military personnel are that unit leadership would treat them differently, they would be seen as weak, and peers would have less confidence in them (Sharp et al., 2015). Despite efforts to reduce MHS, stigma remains a barrier to care in the military. Although mental health problems are highly prevalent, many service members do not engage in MHC (Britt et al., 2008).

Stigma can extend to anyone associated with a member of a stigmatized group. Spouses of active duty service members may hold a more stigmatized view of MHC due to exposure to military culture. Military spouses often indicate feeling social pressure to “bear the rank” of their spouse and fulfill social requirements (Harrell, 2001). Military spouses often experience high rates of marital discord and dissatisfaction. Frequent relocations and separations, adapting to foreign countries, a serving spouse’s potential exposure to trauma, and other stressors may impact the resilience of the marital union (US Chamber Foundation, 2017). Military spouses have reported that military life negatively impacted employment opportunities, and indeed unemployment is greater for military spouses compared to civilian spouses. Employment is affected by frequent relocations, the challenges of child-rearing while an active duty spouse is deployed, the inhibition of educational goals, and perceived duties to the military (US Chamber Foundation, 2017). Limits to occupational opportunities may lead to financial constraints that further limit utilization of MHC (US Chamber Foundation, 2017). Spouses may also face difficulties obtaining childcare, reliable transportation, or time off work to accommodate MHC (Britt et al., 2008). Individuals may fear being seen by someone they know at a mental health clinic or fear that their treatment utilization will go on their permanent record and hurt the occupational mobility of their spouse.

Over 1.2 million individuals are actively serving in the United States Armed Forces, and their families benefit from providers with an understanding of the unique barriers to care they experience (Meyer & Wynn, 2018). There are many strategies for reducing MHS. Graduate programs in psychology can include courses on military culture, MHS, and trauma to guide future practitioner’s interventions with military spouses. The American Psychological Association (APA) can promote continuing education courses and internship experiences with military content. The Department of Defense and the U.S. Department of Veterans Affairs National Center for PTSD offer strategies for reducing stigma (e.g., the Defender’s Edge program, reviewed by Bryan & Morrow, 2011; the AboutFace program), but these are focused on military personnel and veterans rather than spouses. Practitioners can describe the stressors of military spouses on websites and brochures, and clinicians can normalize stressors in initial sessions to reduce the perceived sense of “otherness” experienced by some individuals with mental illness.

Another tool to use to help address MHS is providing services via telehealth. Telehealth is defined as the provision of health care through remote means (e.g., telephone, smartphone, video call platforms), and videoconferencing psychotherapy in particular has worked well for veterans and military families (Price, Noulas, Wen, & Spray, 2019), though there may be technological challenges (Thorp, Fidler, Moreno, Floto, & Agha, 2012). Telehealth services could allow a military spouse to receive appropriate care while remaining at their residence, providing childcare, and accessing specialists located elsewhere. This approach enables individuals to access care without worries about being judged by acquaintances in mental health waiting rooms.

There is limited scientific research comparing stigma between military and civilian samples. We know even less about military spouses and MHS, and how stigma may impact MHC utilization in military couples. Increased research on military spouses and their unique stressors can guide public policy, encourage changes within institutions, and provide inclusive care for an underserved population.

References

Britt, T. W., Greene-Shortridge, T. M., Brink, S., Nguyen, Q. B., Rath, J., Cox, A. L., . . . Castro, C. A. (2008). Perceived stigma and barriers to care for psychological treatment: Implications for reactions to stressors in different contexts. Journal of Social and Clinical Psychology, 27(4), 317-335. doi:10.1521/jscp.2008.27.4.317

Bryan, C. J., & Morrow, C. E. (2011). Circumventing mental health stigma by embracing the warrior culture: Lessons learned from the Defender's Edge program. Professional Psychology: Research and Practice, 42(1), 16-23. doi:10.1037/a0022290

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice Hall.

Harrell, M. C. (2001). Army officers' spouses: have the white gloves been mothballed? Armed Forces & Society28(1), 55-75. doi:10.1177/0095327X0102800104

Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology27(1), 363-385. Retrieved from https://www.annualreviews.org/doi/abs/10.1146/annurev.soc.27.1.363

Meyer, E. G., & Wynn, G. H. (2018). The importance of US military cultural competence. In Military and veteran mental health (pp. 15-33). Springer, New York, NY. doi:10.1007/978-1-4939-7438-2_2

Nichols, L. O., & Martindale-Adams, J. (2016). Telephone support during overseas deployment for military spouses formerly: Telephone support during deployment for OEF/OIF spouses. VA Medical Center Memphis, United States. Retrieved from https://apps.dtic.mil/dtic/tr/fulltext/u2/1012142.pdf

Price, L. E., Noulas, P., Wen, I., & Spray, A. (2019). A portal to healing: Treating military families and veterans through telehealth. Journal of Clinical Psychology75(2), 271-281. doi:10.1002/jclp.22720

Sharp, M. L., Fear, N. T., Rona, R. J., Wessely, S., Greenberg, N., Jones, N., & Goodwin, L. (2015). Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiologic reviews, 37(1), 144-162. doi:10.1093/epirev/mxu012

Thorp, S. R., Fidler, J., Moreno, L., Floto, E., & Agha, Z. (2012). Lessons learned from studies of psychotherapy for PTSD via video teleconferencing. Psychological Services, 9, 197-199. doi:10.1037/a0027057.

US Chamber Foundation. (2017). Military spouses in the workplace. Retrieved from https://www.uschamberfoundation.org/sites/default/files/Military%20Spouses%20in%20the%20Workplace.pdf

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