Army spouses' mental health treatment engagement: The role of barriers to care.

Introduction: Military spouses are exposed to unique stressors that could put them at greater risk for developing mental health issues requiring mental health services. This study examines the impact of barriers to mental health care on army spouses' treatment engagement, controlling for socio-demographic variables and mental health symptoms. Methods: This study is a secondary analysis of survey data collected in 2012 from 327 U.S. Army spouses from a previously deployed army unit. Results: Factor analysis of a barriers-to-care scale revealed four sub-scales: 1) perceived stigma, 2) practical barriers to care, 3) self-management, and 4) attitudes toward care. Using multivariable logistic regression, among army spouses with at least mild mental health symptoms, being employed full- or part-time (OR = 0.13, 95% CI, 0.02-0.82), having at least one child (OR = 0.09, 95% CI, 0.01-0.61), and endorsing psychological barriers to care (OR = 0.82, 95% CI, 0.72-0.95) were associated with lower likelihood of using mental health services, while reporting more practical barriers (OR = 2.06, 95% CI, 1.36-3.14) was associated with a greater likelihood. Discussion: Preliminary results show army spouses experiencing at least mild mental health symptoms may struggle to get care if they have at least one child or if they are employed full- or part-time. Those who report more stigma about mental health care may be less likely to seek care. The counterintuitive association between practical barriers, such as difficulty with scheduling an appointment, and being in treatment, may reflect that those in care are more likely to experience these issues.