Enablers and barriers to military veterans seeking help for mental health and alcohol difficulties: A system review of the quantitative evidence

The paper examines enablers and barriers influencing military veterans’ help-seeking for mental health and alcohol difficulties. It aims to identify correlates and predictors of help-seeking (HS) across a range of mental health problems, extending beyond a sole focus on stigma and including alcohol/substance-related factors.

Prior quantitative systematic reviews capturing veteran populations have primarily focused on predictors of help-seeking among those with PTSD, often emphasizing enablers and not factoring a wider range of mental health difficulties, including alcohol or substances. Findings across studies indicated mixed relationships between stigma and HS: multiple studies reported no link, some reported a positive association with intentions to seek help (stigma not acting as a barrier), and few reported a negative association (stigma acting as a barrier). Veteran-specific barriers were not consistently discussed in earlier reviews.

Systematic search strategy: Medical Subject Headings (MESH) were used in databases that support them. Terms were truncated (e.g., disorder*) and wildcards used (e.g., utili?ation) to capture variant spellings. Topic synonyms were combined with OR (e.g., military OR armed forces OR veterans OR war veterans); all enabler/barrier terms were linked with OR; all help-seeking terms with OR; all mental health and alcohol terms with OR. MESH headings were linked with the alternative term sets using OR, and finally all concept groups were combined with AND. Quality appraisal: Each methodological/reporting element listed under each header received a score of 1, summed to produce an overall quality score per study. Notes: In one quantitative review, 51 studies were identified; participant information was not reported and was unavailable due to an inactive link to online resources.

- Social support, perceived need, greater PTSD symptom severity, and having an episode of care were main predictors of help-seeking and continued service use among veterans. - Stigma showed mixed associations with HS: 9 studies found no link; 4 studies found a positive association with intentions to seek help (attitudes would not be a barrier); 1 study found a negative association (attitudes would be a barrier). Individuals with high anticipated stigma still expressed interest in seeking help. - Alcohol use acted as a barrier to HS by providing perceived relief of mental health symptoms, thereby reducing perceived need to seek help. - Veteran-specific barriers were not discussed in detail.

Findings indicate that relational and clinical factors—such as social support, perceived need, PTSD symptom severity, and prior engagement with care—are key drivers of help-seeking among veterans. The mixed evidence on stigma suggests that while stigma can be a barrier for some, it is not uniformly deterrent; many veterans with anticipated stigma still intend to seek care. Alcohol’s role in symptom relief can lower perceived need for formal services, hindering HS. These insights help refine intervention targets toward enhancing social support, increasing problem recognition, and addressing alcohol-related coping, rather than focusing solely on stigma reduction.

The review synthesizes quantitative evidence on enablers and barriers to veterans’ help-seeking for mental health and alcohol difficulties, highlighting social support, perceived need, symptom severity, and care engagement as central enablers, with alcohol-related coping as a notable barrier. Given the heterogeneous impact of stigma, multifaceted strategies beyond stigma reduction are warranted. Future research should systematically examine veteran-specific barriers and better integrate alcohol/substance factors across diverse veteran populations.

Participant information for one quantitative review (51 studies) was not reported and supporting online resources were inactive. Prior reviews were primarily focused on PTSD and enablers, with limited coverage of broader mental health conditions and alcohol/substance issues. Veteran-specific barriers were not consistently discussed.