Figure 1
PRISMA flow diagram.
Table 1
Table of Characteristics.
| NO | AUTHOR (YEAR) | TYPE OF STUDY | N | STUDY/PARTICIPANT CHARACTERISTICS |
|---|---|---|---|---|
| 1 | Claridge (2017) | Semi-structured interviews. Grounded theory and Discourse analysis. | 5 | English, recruited via the National Health Service, male, age M 24 (SD NR), all had mental health difficulties, aged = < 24 when accessing care, Caucasian, Army, non-officers, deployments NR. Explored masculine relevant discourse as a barrier in the context of help-seeking. |
| 2 | Hamilton, Poza, Hines, & Washington (2012) | Three focus groups. Grounded theory | 29 | USA, recruited from homeless shelters, drop-in centres, transitional housing projects, substance abuse programmes, the county jail, soup lines and a direct outreach programme. Female, homeless, age M 48 (range 36), African American 46%, Caucasian 33%, Associate degree 59%, disabled 65%, Army 69%, high risk alcohol users 24%, deployments captured in sample (without frequencies) were described as Vietnam ‘era’, post-Vietnam, Gulf War ‘era’ and 9/11 ‘era’, accessed mental health service 59%. Explored the barriers to psychosocial support for homeless female veterans. |
| 3 | Huck (2014) | Semi-structured interviews. Thematic and narrative analysis. | 16 | English, recruited via the National Health Service and the Charity Veteran Service, aged 20–69 (M + SD NR), all had mental health difficulty, PTSD n = 14, comorbidity n = 8, Caucasian n = 14, non-officers, deployment tours NR but all had deployed on between 1–6 separate tours. Explored the experiences of help-seeking, specifically as barriers and enablers, in UK veterans. |
| 4 | Kiernan, Moran, & Hill (2016) | Semi-structured interviews. Framework analysis. | 19 | English, recruited as part of a larger study, age M 45.05 (SD 7.32), males n = 18, Army n = 14, deployment tours NR but number that had deployed was n = 11, all had history of alcohol issues. Explored the difficulty and/or reluctance to help-seek for alcohol misuse in UK veterans. |
| 5 | Mellotte, Murphy, Rafferty, & Greenberg (2017) | Semi-structured interviews. Grounded theory. | 17 | England, recruited via the National Health Service and the Charity Veteran Service, age M 51 (range 36), Caucasian n = 16, Army n = 15, non-officers, deployment tours NR, all had accessed mental health services, clinically significant levels of depression 80% and anxiety 71%, screened likely for PTSD 47% and likely for alcohol issues 59%. Explored barriers and enablers to pathways to care for UK veterans. |
| 6 | Sayer et al., (2009) | Semi-structured interviews. Grounded theory. | 44 | USA, recruited through the VA, age M 42 (SD 15.99), Caucasian n = 41, male n = 30, Vietnam, Afghanistan, and Iraq veterans all claiming for PTSD related disability. Explored determinants of PTSD treatment initiation of US veterans. |
[i] Note: * Veteran Affairs. Veteran may be recruited through the VA (as the VA may hold veteran records), but not all veterans use VA services. VA affiliation does not necessarily equate to VA service use. NR = not reported.
Table 2
Themes of Enablers and Barriers to HS.
| ENABLERS | |
|---|---|
| Military culture Culturised norms | Taking control to find a solution |
| Severity of problems | Reaching a crisis point, i.e., ‘rock bottom’ Having a mental health diagnosis, i.e., PTSD Noticing the difficulties have become unmanageable |
| The system | If healthcare professionals have military experience or knowledge Peer-led support services Satisfaction with support services |
| Relationships and support | The loss of a relationship Social network offering practical and emotional support Peer-led encouragement |
| BARRIERS | |
| Military culture – culturised norms | Normalising beliefs and behaviours around healthcare Stigmatising beliefs of self and others towards mental health and HS ‘Cracking on with it’ – taking control and being self-reliant Normalising excessive alcohol use |
| Severity of problems | Lack of education or knowledge surrounding problem severity |
| The system | Access to support services Lack of information, knowledge, and education Veterans are different from civilians, i.e., are misunderstood Dissatisfaction with support services Lack of trust in the System |
| Relationships and support | Lack of relationships |
Figure 2
The HS processes for veterans.