A qualitative study of determinants of PTSD treatment initiation in veterans

Nina A Sayer, Greta Friedemann-Sanchez, Michele Spoont, Maureen M Nelson, Louise E. Parker, Christine Chiros, Robert Rosenheck

Research output: Contribution to journalArticlepeer-review

163 Scopus citations


Although there are effective treatments for Posttraumatic Stress Disorder (PTSD), many PTSD sufferers wait years to decades before seeking professional help, if they seek it at all. An understanding of factors affecting treatment initiation for PTSD can inform strategies to promote help-seeking. We conducted a qualitative study to identify determinants of PTSD treatment initiation among 44 U.S. military veterans from the Vietnam and Afghanistan/Iraq wars; half were and half were not receiving treatment. Participants described barriers to and facilitators of treatment initiation within themselves, the post-trauma socio-cultural environment, the health care and disability systems, and their social networks. Lack of knowledge about PTSD was a barrier that occurred at both the societal and individual levels. Another important barrier theme was the enduring effect of experiencing an invalidating socio-cultural environment following trauma exposure. In some cases, system and social network facilitation led to treatment initiation despite individual-level barriers, such as beliefs and values that conflicted with help-seeking. Our findings expand the dominant model of service utilization by explicit incorporation of factors outside the individual into a conceptual framework of PTSD treatment initiation. Finally, we offer suggestions regarding the direction of future research and the development of interventions to promote timely help-seeking for PTSD.

Original languageEnglish (US)
Pages (from-to)238-255
Number of pages18
Issue number3
StatePublished - Sep 2009

Bibliographical note

Funding Information:
Outcomes Research, Veterans Affairs Medical Center in Minneapolis Minnesota and with University of Minnesota, Twin Cities Campus. Greta Friedemann-Sanchez, PhD, is also affiliated with the University of Minnesota. Louise E. Parker, PhD, is an independent consultant in Cambridge, Massachusetts. Christine Chiros, PhD, is affiliated with the VA Medical Center, Mental and Behavioral Health Section, in Minneapolis. Robert Rosenheck, MD, is with the Northeast Program Evaluation Center (NEPEC), Connecticut VA Healthcare System, in West Haven, Connecticut. This research was supported by the U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (HSR&D) (Grant no. DHI 05-111). The content of this report presents the findings and conclusions of the authors and does not necessarily represent the VA or HSR&D.

Copyright 2012 Elsevier B.V., All rights reserved.

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