Mental health help-seeking beliefs and behaviours in the Australian Defence Force: Intersections with e-mental health and self-management

Abstract

One in five Australian Defence Force (ADF) members are estimated to experience a mental disorder every 12 months, and one in two will experience a 12-month disorder in the first five years after leaving full-time service. Yet, half of those with a mental disorder will not receive professional care. The Australian Government is looking towards innovative solutions to address this hidden unmet need. Technology-based mental health resources, e-mental health, are assumed to improve access to mental health care, but there is limited empirical evidence of the impact of these services from a population health perspective. The aims of this thesis were to identify barriers to mental health help-seeking in the ADF community and examine the role of e-mental health resources in help-seeking and self-managed mental health.

Data for this thesis were drawn from a cross-sectional survey investigating the mental, social and physical health of 11,587 full-time serving and recently transitioned ADF members. Andersen's Behavioural Model of Health Service Use (Andersen, Davidson, & Baumeister, 2014) was used to examine predisposing, need and enabling factors associated with 12-month mental health service use. Reach of e-mental health resources was assessed across multiple technology modalities (information websites, telephone helplines, social media, internet interventions and smartphone apps) and then examined in relation to concurrent professional service use. Lastly, self-reliance and self-management strategies were examined in a sub-sample of participants who had a mental health concern but received no assistance (n=1,539).

Gaps in mental health service use were found for males in the ADF, individuals who had transitioned out of the ADF, and Army and Navy service members. A lack of perceived need, self-stigma, negative attitudes to care and resilience were identified as important barriers to mental health help-seeking. These barriers persisted for more conventional e-mental health modalities such as websites and telephone helplines. Use of websites, helplines and smartphone apps were significantly associated with seeking professional help, but social media and internet intervention use were not. Preferential use of online resources over professional care was more common among those with moderate symptoms and was associated with lower perceived need, higher self-stigma and resilience. Similarly, high self-reliance was associated with lower depressive symptoms, greater perceived functioning (regardless of reported disability), greater resilience and higher self-stigma.

Whilst e-mental health has been suggested to lessen gaps in mental health services, this thesis demonstrates that the impact of current e-mental health resources provided by Australian Defence and veteran agencies may be modest. Resources with the strongest evidence base are least used, and technologies in which Defence and DVA have minimal engagement are being used by groups at greater risk of mental ill-health in this community. The study highlights the importance of addressing self-stigma and perceived conflict between resilient identity and help-seeking behaviour. Future work needs to identify opportunities for increasing personal agency in military mental health services, to engage individuals across the spectrum of mental health need. Diversification of e-mental health resources will be critical for reaching at-risk groups and is a key consideration for future implementation activities and research.