Predictors of help-seeking in the context of mental health and alcohol issues, for hidden veterans in Northern Ireland

Background - It is suspected that Northern Ireland (NI) veterans have higher rates of poor mental health due to exacerbated trauma exposure. However, security issues create the tendency to self-marginalise, therefore, help-seeking (HS) for poor mental health is likely reduced.
Aims - This study examined the predictors of actual HS behaviour, as these findings have implications for veteran care within NI.
Methods – Logistic regression was conducted on data from 603 participants. HS was defined as ever/currently having medication or therapy, with predictors being mental health comorbidities (alcohol, anxiety, depression, PTSD, C_PTSD, dissociation), attitudes towards mental health and transition. Analysis was adjusted for military and demographic factors.
Results – The main predictor of medication use was mental health comorbidity, with higher levels of comorbidity having a greater effect on current use. ‘High comorbid all disorders’ was the most salient predictor (OR4.37 ‘ever’; OR9.64 ‘current), followed by anxiety/depression (OR3.61 ‘ever’; OR4.71 ‘current’) and PTSD with moderate depression/alcohol (OR3.86 ‘current’). Being female (OR3.35) and deployment outside NI (OR2.07) predicted historic medication use. Poor transition, shorter length of service, positive attitudes and mental health diagnosis since discharge had positive but smaller effects on HS via medication. Therapy use was only predicted by transition (OR2.32), length of service (OR.96), attitudes (OR.47) and diagnosis since discharge (OR.13). Current therapy engagement was disregarded from analysis due to lack of variation in responses (not in therapy >90%).
Discussion – Therapy and medication use had differing predictors, which is likely due to support service issues and the need to self-marginalise. NI veterans will HS mainly via medication, possibly because medication is free in NI and veterans do not have to disclose their military service within their medical records. Other factors likely drove historic therapy use; it is unclear if therapy was engaged in outside NI where support access is easier. A heavy reliance on social or peer support could act as a proxy for current therapy engagement. Social or informal support also allows veterans to remain hidden.