Stigma and Barriers to Care, Online Mental Health Tools, and Suicidality in California's Veterans

Veterans have a higher national suicide rate than non-veterans (31.6 versus 18.0 per 100,000). Psychotherapy and other treatments are effective at reducing suicidality, yet stigma and barriers to care reduce willingness to seek help. For veterans who do seek help, they are often undertreated leaving them still in need of help. Online mental health tools (OMHTs) provide another option for obtaining help; however, there is limited research regarding the relationship between stigma and barriers to care, OMHT use, and suicidality. We hypothesized that stigma and barriers are related to higher likelihood of OMHT use and OMHT use is related to lower likelihood of suicidality.

The California Health Interview Survey is a population-based state health survey that collects data over a 2-year cycle via web and phone interviews. The sample was 4,435 veterans (91% male, 75% White, and average age 67 years old). The study was institutional review board exempt because data storage and analyses were done at the Data Access Center at University of California-Los Angeles.

Logistic regressions showed endorsing stigma and barriers indicated a higher likelihood of using OMHTs. Additionally, use of OMHTs was unexpectedly associated with greater suicidality.

Findings reinforce the need for research aimed at identifying ways to reduce stigma and barriers toward seeking help. Online mental health tools are a viable option for individuals experiencing stigma and barriers and for individuals who previously experienced suicidality.