{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T18:05:18Z","timestamp":1789236318798,"version":"build-2803163510"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"9-10","license":[{"start":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T00:00:00Z","timestamp":1684195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,29]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Mental health treatment is a service for military service members who have experienced psychological injury or trauma. Unfortunately, the stigma associated with treatment can prevent many service members from seeking and receiving treatment designed to help them recover. Previous studies have examined the impacts of stigma among military personnel as well as civilians; however, stigma among service members currently receiving mental health treatment is unknown. The purpose of this study is to understand the relationships between stigma, demographic variables, and mental health symptoms in a sample of active duty service members receiving mental health services in a partial hospitalization program.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>This cross-sectional, correlational study collected data from participants in the Psychiatric Continuity Services clinic at Walter Reed National Military Medical Center, which offers a four-week partial hospitalization program specializing in trauma recovery for active duty service members of all branches. The data from behavioral health assessments were gathered over a 6-month timespan, including the Behavior and Symptom Identification Scale-24, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item scale, and Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Stigma was measured using the Military Stigma Scale (MSS). The demographic data collected included military rank and ethnicity. Pearson correlations, t-tests, and linear regression were used to further explore the relationships between the MSS scores, demographic covariates, and behavioral health measures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In unadjusted linear regression models, non-white ethnicity and higher behavioral health assessment intake measures were associated with higher MSS scores. However, after adjusting for gender, military rank, race, and all mental health questionnaires, only Post-traumatic Stress Disorder Checklist for DSM-5 intake scores remained associated with MSS scores. No relationship between gender or military rank and average stigma score was observed in either the unadjusted or adjusted regression models. One-way analysis of variance detected a statistically significant difference between the white\/Caucasian group and Asian\/Pacific Islander group and a near significant difference between white\/Caucasian group and black\/African American group. The rates of stigma were higher in non-whites than whites.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In this active duty military cohort, greater mental health stigma was associated with greater severity of mental health symptoms, especially post-traumatic stress symptoms. Some evidence found that ethnicity may also play a role in stigma score differences, particularly in the Asian\/Pacific Islander group. Service providers could consider assessing mental health stigma to meet the clinical needs of their patients within the context of their willingness to obtain and adhere to treatment. Anti-stigma efforts to reduce stigma and its impacts on mental health are discussed. Additional research investigating the effect stigma has on treatment outcomes would help guide the relative importance of assessing stigma, in addition to other behavioral health realms.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad159","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T18:28:37Z","timestamp":1684261717000},"page":"e3152-e3159","source":"Crossref","is-referenced-by-count":8,"title":["Mental Health Stigma in Active Duty Service Members Receiving Mental Health Services"],"prefix":"10.1093","volume":"188","author":[{"given":"Jennifer K","family":"Zumwalde","sequence":"first","affiliation":[{"name":"Recreational Therapist, Psychiatric Continuity Services, Directorate of Behavioral Health, Walter Reed National Military Medical Center , Bethesda, MD 20889-5611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent L","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Professor, Recreation Therapy Degree Program, School of Applied Health and Human Sciences, University of North Carolina Wilmington , Wilmington, NC 28403-5625, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen M","family":"Young","sequence":"additional","affiliation":[{"name":"Former Service Chief of Psychiatric Continuity Services Clinic, Directorate of Behavioral Health, Walter Reed National Military Medical Center , Bethesda, MD 20889-5611, USA"},{"name":"Currently the Clinical Manager, Psychiatry Department, Acadia Hospital , Bangor, ME 0440, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,5,16]]},"reference":[{"issue":"7","key":"2023083018192765500_R1","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1037\/0003-066X.59.7.614","article-title":"How stigma interferes with mental health care","volume":"59","author":"Corrigan","year":"2004","journal-title":"Am Psychol"},{"issue":"11","key":"2023083018192765500_R2","doi-asserted-by":"publisher","first-page":"1880","DOI":"10.1017\/S0033291717000356","article-title":"Stigma-related barriers and facilitators to help seeking for mental health issues in the armed forces: a systematic review and thematic synthesis of qualitative literature","volume":"47","author":"Coleman","year":"2017","journal-title":"Psychol Med"},{"issue":"9","key":"2023083018192765500_R3","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1002\/jclp.21889","article-title":"Development and initial testing of a measure of public and self-stigma in the military","volume":"68","author":"Skoop","year":"2012","journal-title":"J Clin Psychol"},{"issue":"5\u20136","key":"2023083018192765500_R4","doi-asserted-by":"publisher","first-page":"e598","DOI":"10.1093\/milmed\/usab283","article-title":"Systematic review of the military career impact of mental health evaluation and treatment","volume":"187","author":"Heyman","year":"2022","journal-title":"Mil Med"},{"key":"2023083018192765500_R5","article-title":"Department of Defense: Mental health evaluations of members of the military services","volume-title":"(DoD Instruction 6490.04)","year":"2013"},{"key":"2023083018192765500_R6","article-title":"Office of the Director of National Intelligence: Security Executive Avent Directive-4 (SEAD-4) National Adjuicative Guidelines"},{"key":"2023083018192765500_R7","doi-asserted-by":"publisher","first-page":"e232","DOI":"10.1093\/milmed\/usx051","article-title":"Military personnel who seek health and mental health services outside the military","volume":"183","author":"Waitzkin","year":"2018","journal-title":"Mil Med"},{"issue":"10","key":"2023083018192765500_R8","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.7205\/MILMED-D-11-00286","article-title":"Perceived stigma and barriers to mental health care in marines attending the combat operational stress control program","volume":"177","author":"Momen","year":"2012","journal-title":"Mil Med"},{"issue":"1","key":"2023083018192765500_R9","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1080\/08995605.2011.534415","article-title":"Stigma, negative attitudes about treatment, and utilization of mental health care among soldiers","volume":"23","author":"Kim","year":"2011","journal-title":"Mil Psychol"},{"issue":"2","key":"2023083018192765500_R10","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1037\/prj0000120","article-title":"The role of different stigma perceptions in treatment seeking and dropout among active duty military personnel","volume":"38","author":"Britt","year":"2015","journal-title":"Psychiatr Rehabil J"},{"issue":"3","key":"2023083018192765500_R11","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1037\/a0032225","article-title":"Does cynicism play a role in failure to obtain needed care? 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