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Center for Care Delivery and Outcomes Research

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Social Determinant Influences on Veterans’ Views of PTSD and Treatment


Michele Spoont, PhD, and her colleagues in CCDOR and at Purdue University have been working on a mixed-methods study exploring how  social determinants of health among Veterans with PTSD influence their mental health treatment beliefs, treatment preferences, and views of PTSD.

Social Determinant influences on Veterans’ views of PTSD and Treatment

Background:   In prior research, we found racial, ethnic, and gender disparities in receipt of mental health treatment, persistence in  treatment, and clinical outcomes among Veterans with PTSD.  Of the many factors contributing to these disparities, little is known about how social factors and other social determinants of health might influence Veterans’ perceptions of PTSD, mental health treatment, and treatment preferences.
Methods:  We conducted a mixed-methods study to examine whether Veterans’ social networks, prior treatment experiences, cultural backgrounds, mental health stigma beliefs, experiences of discrimination, and neighborhood characteristics influence their views of PTSD and mental health treatment. We recruited Veterans recently diagnosed with PTSD who had no mental health care in the prior year and who were making or recently made a decision about mental health treatment. Sampling was purposively stratified by administrative race and ethnicity designations so that we could recruit a multi-ethnic sample of African American/Black, Asian American, Latinx, and non-Latinx White Veterans with approximately equal numbers of men and women in each group.  Phone interviews were done with 164 Veteran participants.  Interviewees were sent a follow-up survey which was returned by 120 Veterans (RR=73%).  Neighborhood characteristics associated with Veterans’ zip codes were pulled from several national databases (e.g., American Community Survey).

Findings: Analyses are ongoing. Whether female Veterans disclose information about traumatic experiences or mental health issues depends on factors that are consistent with Communication Privacy Management theory: culture, gender, context, risk/benefit assessments, and motivations. Preliminary analyses also found that Veterans are highly selective about which members of their social networks they discuss mental health issues. Composition of the mental health-relevant portion of Veterans’ social networks is associated with perceived social isolation. Nearly all social network members with whom Veterans discuss mental health concerns encourage them to seek treatment.


1.  Wilson SR, Hintz EA, MacDermid Wadsworth SM, Topp DB, Southwell KH, Spoont M. (2019). Female U.S. Military Veterans’ (Non)Disclosure of Mental Health Issues with Family and Friends: Privacy Rules and Boundary Management, Health Communication, DOI: 10.1080/10410236.2019.1693128. [Epub ahead of print].

2.  Spoont M. Racial/Ethnic Disparities in PTSD Treatment. Paper presented via webinar for VA National Center for PTSD Mentoring Program Conference Call on July 1, 2020.

3.  Spoont M, MacDermid-Wadsworth S, Meis L, Topp D, Polusny G.  Who in US Veterans’ Social Networks Encourage or Discourage them to Pursue Mental Health Treatment for PTSD? Paper presented at the 34th Annual Meeting of the International Society for Traumatic Stress Studies (ISTSS), November 9, 2018, Washington, DC.

4.  Wilson SR, Hintz E, MacDermid Wadsworth S, Topp D, Spoont M. Reasons U.S. Military Veterans Conceal and Reveal Mental Health Issues with Families: A Communication Privacy Management Theory Analysis.  Paper presented at the 68th Annual International Communication Association Conference. May 24-28, 2018. Prague, Czech Republic.