Military veterans face disproportionately high rates of mental health problems and alcohol misuse. Understanding the factors that either facilitate or hinder their help-seeking behaviors is crucial for developing effective interventions and improving access to care. This study addresses a critical gap in knowledge by systematically reviewing quantitative research on this topic. The purpose is to identify common themes across studies and provide a comprehensive overview of the enablers and barriers veterans experience when seeking help for mental health and alcohol-related difficulties. The importance of this research lies in its potential to inform the development of targeted interventions and policies aimed at improving the mental health and well-being of veterans. The review focuses on identifying both individual-level factors (e.g., stigma, perceived need, self-efficacy) and system-level factors (e.g., accessibility, availability of services) that affect help-seeking behaviors. Understanding these factors is essential for creating a supportive environment where veterans feel comfortable seeking and receiving appropriate care.

The study builds upon previous systematic reviews focusing on help-seeking barriers and enablers among veterans. It aims to provide a more comprehensive analysis by considering a wider range of mental health difficulties, including alcohol-related problems, and by integrating both enabler and barrier perspectives. The review incorporates studies utilizing diverse methodologies and diverse outcome measures, to identify patterns across different populations and contexts. The review meticulously examined existing literature to establish a comprehensive understanding of the current state of knowledge regarding help-seeking behaviors amongst military veterans facing mental health challenges and alcohol issues. This review's focus goes beyond merely identifying barriers, addressing a gap in existing research that predominantly focuses on barriers rather than enablers.

The researchers conducted a systematic review of quantitative studies. Their search strategy involved using multiple databases, employing MESH headings, and utilizing word truncation and wildcards to maximize the scope of the search. The search terms included keywords related to military veterans, help-seeking behaviors, mental health conditions (including PTSD, depression, anxiety), and alcohol problems. The 'OR' and 'AND' Boolean operators were employed to combine search terms effectively. The databases were systematically searched, and studies were screened based on pre-defined inclusion and exclusion criteria. Data extraction focused on participant characteristics, study methodologies, and findings related to help-seeking enablers and barriers. A quality assessment of included studies was conducted using a standardized scoring system. The review included a total of 51 quantitative studies. The methodology section details the databases searched, search terms used, inclusion/exclusion criteria, data extraction process, and quality assessment methods. Specific details regarding the scoring system used for assessing study quality are also included. The selection of studies included those considering a wide range of mental health difficulties and was not limited to a particular condition such as PTSD. A comprehensive list of questionnaires used within the selected studies is also provided, including details of their purpose and measurement scales, which were relevant to the analysis.

The review identified several key enablers and barriers to help-seeking among military veterans. Social support emerged as a significant enabler, with stronger social networks positively correlating with help-seeking behavior. Perceived need for treatment also emerged as an important predictor, suggesting that individuals who recognize their need for assistance are more likely to seek help. Greater PTSD symptom severity was surprisingly found to be a predictor of help-seeking, implying that veterans with more severe symptoms might be more motivated to seek professional assistance. A history of prior care use also positively predicted ongoing engagement with mental health services. Regarding barriers, alcohol use was identified as a significant factor, indicating that veterans might use alcohol as a coping mechanism that reduces the perceived need to seek help for mental health issues. While many studies investigated stigma, results were mixed, with some finding no association between stigma and help-seeking, and others finding a positive or negative association (depending on the type of stigma measured). It was noted that high levels of anticipated stigma did not preclude veterans from demonstrating an interest in accessing help. The review did not focus specifically on veteran-specific barriers, though veteran-specific enablers were identified. The findings highlight the complex interplay of individual, social, and systemic factors influencing veterans' decisions to seek mental health and alcohol-related help.

The findings of this systematic review underscore the importance of addressing both individual-level and system-level factors to enhance help-seeking among military veterans. Interventions should aim to strengthen social support networks, increase awareness of the need for treatment, and address alcohol misuse as a potential barrier. Furthermore, while stigma may play a role, the inconsistent findings suggest that stigma reduction strategies might need a nuanced approach, taking into account different dimensions of stigma and their varying impact on help-seeking behaviors. Future research should focus on understanding how these factors interact and influence veterans’ decisions to seek care in specific contexts. The inconsistent findings regarding the role of stigma warrant further investigation to clarify its complex relationship with help-seeking behavior. The study's focus on quantitative evidence provides valuable insights into the patterns and predictors of help-seeking, but qualitative research is necessary to gain a deeper understanding of the lived experiences of veterans and the contextual factors influencing their help-seeking decisions.

This systematic review provides a comprehensive overview of quantitative evidence on enablers and barriers to help-seeking for mental health and alcohol issues among military veterans. Social support, perceived need, PTSD symptom severity, and prior care use are key enablers. Alcohol use acts as a significant barrier. Findings regarding stigma are mixed. Future research should explore the interplay of these factors and investigate culturally-sensitive interventions tailored to enhance veteran help-seeking behaviors. The study emphasizes the importance of multi-faceted approaches that address both individual needs and systemic barriers.

The reliance on quantitative studies limits the depth of understanding of the lived experiences of veterans. The review is limited by the available quantitative literature, and the heterogeneity of study designs and measures may affect the generalizability of the findings. The inconsistent findings on the role of stigma highlight the need for further research using more nuanced measures of stigma to gain a clearer understanding of its impact. The review does not extensively analyze veteran-specific barriers, limiting a deeper examination of this aspect.