Hitting the wall: The impact of barriers to care and cumulative trauma exposure on PTSD among Northern Ireland Veterans

Abstract: The Northern Ireland (NI) population has high rates of trauma exposure and posttraumatic stress disorder (PTSD) but many barriers prevent people from seeking help/care, which can worsen mental health conditions. For Veterans, these barriers can include a lack of access to or availability of services, a lack of trust in the mental health system, and stigma - negative beliefs about themselves if they were to seek help. Additionally, many UK Armed Forces veterans in Northern Ireland choose not to disclose Veteran status because of security concerns. The Armed Forces Covenant promises available, accessible, and guaranteed care to service members and Veterans, but the covenant is not in place in Northern Ireland, leaving NI Veterans in need without support and relying on charity organizations. This study explored the relationship among trauma exposure, PTSD, and barriers to care among NI Veterans. Analysis showed that an increased number of traumatic event exposures and increased barriers to care predicted a higher amount of PTSD symptoms and distress, meaning the more trauma a Veteran witnessed or experienced and the more barriers preventing them from seeking care, the worse their mental health was likely to be. Introduction: Seeking treatment for posttraumatic stress disorder (PTSD) distress can be complicated by a variety of internal and external factors that prevent an individual from seeking care and treatment while distress worsens. This is especially true for hidden populations with an extensive trauma history, such as UK Armed Forces Veterans residing in Northern Ireland. This study aimed to determine the contribution of barriers to care and cumulative trauma exposure to the severity of PTSD symptomatology, the extent of that contribution, and whether variance existed in the specific types of barriers. Methods: Data from 657 Veterans residing in Northern Ireland (90.6% male) taken from the Northern Ireland Veterans Health and Wellbeing Study were used in a series of regression models to explore the relationships among cumulative trauma exposure, barriers to care, specific barrier types, and PTSD symptomatology. Results: Overall barriers to care and cumulative trauma exposure predicted PTSD (beta = 0.385), as did, to a lesser degree, logistical barriers (beta = 0.348), trust barriers (beta = 0.258), and stigmatic barriers (beta = 0.298). Discussion: The accumulation of multiple trauma exposures and experiences is strongly associated with PTSD symptomatology, with barriers to care having a significant impact on distress. Overall barriers, specific subtypes of barriers, and trauma contributed to PTSD in this population of UK Armed Forces Veterans residing in Northern Ireland. Introduction : La quete d'un traitement pour la detresse liee au trouble de stress posttraumatique (TSPT) peut etre compliquee par une variete de facteurs internes et externes empechant de trouver les soins et le traitement requis alors meme que la detresse s'aggrave. C'est le cas en particulier de populations cachees ayant une lourde histoire traumatique, comme celle des veteran(e)s des Forces armees britanniques vivant en Irlande du Nord. Cette etude cherche a determiner la contribution particuliere des obstacles aux soins et d'une exposition cumulee aux traumatismes a la gravite des symptomes de TSPT, ainsi que l'etendue de cette contribution et l'existence d'une variance dans les types specifiques d'obstacles. Methode : Les donnees de 657 veteran(e)s residant en Irlande du Nord (des hommes, a 90,6 %), tirees de l'etude sur la sante et le bienetre des veteran(e)s d'Irlande du Nord, ont ete employees dans une serie de modeles de regression dans le but d'explorer les relations entre l'exposition cumulative aux traumatismes, les obstacles aux soins, les types d'obstacles particuliers et la symptomatologie du TSPT. Resultats : Dans l'ensemble, les obstacles aux soins et l'exposition cumulative aux traumatismes predisent le TSPT (beta = 0,385), tout comme le font, dans une moindre mesure, les obstacles logistiques (beta = 0,348), les obstacles lies a la confiance (beta = 0,258) et les obstacles lies a la stigmatisation (beta = 0,298). Discussion : Le cumul d'expositions et d'experiences traumatiques multiples est fortement associe a la symptomatologie du TSPT et les obstacles aux soins ont un effet significatif sur la detresse. Les obstacles pris dans leur ensemble, les sous-types particuliers d'obstacles et les traumatismes contribuent au TSPT dans la population etudiee.

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