Academic paper titleA Qualitative Study of Determinants of PTSD Treatment Initiation in Veterans  

Sayer, Nina A., Greta Friedemann-Sanchez, Michele Spoont, Maureen Murdoch, Louise E. Parker, Christine Chiros, and Robert Rosenheck. “A qualitative study of determinants of PTSD treatment initiation in veterans.” Psychiatry: Interpersonal and Biological Processes 72, no. 3 (2009): 238-255.  
Synopsis of paperTo identify barriers and facilitators affecting treatment (Tx) initiation for PTSD among U.S. veterans  

Results organised as:
(i) Barriers to PTSD treatment initiation
(ii) Facilitators to PTSD treatment initiation
(iii) Determinants of PTSD treatment initiation  
Prominent experiences identified (i) Barriers to Tx initiation

1. Avoidance of trauma related feelings or memories  

2. Values & priorities that conflict with Tx seeking  

3. Pride in self reliance  

4. Focus on job and family functioning  

5. Tx discouraging beliefs, such as  
a. Providers will not understand trauma
b. Tx unlikely to help
c. Tx = loss of autonomy
d. Tx is for the weak, crazy, incompetent
e. Tx is only for extreme problems 

6. Healthcare system concerns  
a. Providers cannot be confided in
b. Providers won’t have the resources 
c. Providers are only relevant to previous war veterans, or with severe disabilities
d. Providers do not have military related PTSD expertise 

7. Knowledge barriers – Lack of knowledge on PTSD, services for it, and that they can be diagnosed as PTSD   

8. Access barriers  
a. Enrolment process
b. Perceived lack of eligibility
c. Time and expenses
d. Distance from service 

9. Socio-cultural environments that invalidate trauma
a. Societal rejection
b. Negative homecoming experience
c. Social network discouraging help seeking 
d. Withdrawal from social network  

(ii) Facilitators of Tx initiation

1. Recognition of PTSD, accepting diagnosis and availability of help  

2. Tx encouraging beliefs, such as  
a. Getting help is socially accepted
b. Other people’s opinions do not matter
c. Tx is helpful
d. System and those who encourage Tx are trustworthy

3. Good system infrastructure   
a. Initiatives that raise PTSD awareness, reduce its stigma, and improve access to help
b. Veteran officers promoting help-seeking
c. Primary care providers promoting help-seeking

4. Social network facilitation    
a. Encouragement from spouse, partners, family, others
b. Encouragement from other veterans
c. Encouragement from employers

(iii) Determinants of Treatment initiation         

1. Individual level
a. Recognising and accepting need for Tx
b. Response to trauma and socio-cultural environment
c.  Avoidance vs facing feelings memories, social networks
d. Individual characteristics 
e. Values, priorities, beliefs about Tx, PTSD, and healthcare system
f. Recognition of resources

2. Social network level
a. Behaviour of social circle 
b. Socio-cultural environments
c. Cultural Norms regarding engagement w trauma (i.e. acceptance vs stigma)

3. Healthcare system level
a. Knowledge of HCPs
b. Behaviours of HCPs
c. Initiatives available to increase awareness of PTSD, reducing its stigma and improving resource access
d. Enrolment procedures ease 
What do these prominent experiences mean?(i) Barriers to Tx initiation

Patients will likely be carrying many beliefs that can discourage them from seeking help
a. Find out what belief categories they hold
b. Advocate for Treatment-encouraging beliefs  

(ii) Facilitators to Tx initiation
Systems and social environments are critical in facilitating help-seeking behaviour – Reflect “Am I contributing to this conducive system or social connection?”  

(iii) Determinants of Tx initiation  
Impactful anecdotes(i)
On pride of self-reliance:
“…I don’t want to talk to a therapist for help reasons–I just want the information, and try