Stigma: A Barrier to Care for Citizen Soldiers

By Joseph Jacob

Citizen soldiers (that is, the National Guard and Reserves), like their active duty counterparts, are prone to PTSD and other mental health conditions. Other mental health concerns that may also occur in citizen soldiers, either independently or co-morbidly, include “clinical depression, sleep dysregulation and nightmares, self-medication, substance use and abuse, and suicide thoughts, acts, and occasional tragic deaths by suicide” (Greden et al.). These psychological conditions are a product of the traumas and stresses that these soldiers encounter during their service.

Upon returning from service, soldiers with mental illnesses are reluctant to reaching out for care (Greden et al.). According to a study, a significant barrier was the “inexorable stigma” associated with seeking out treatment (Greden et al.). These soldiers are also challenged by additional barriers or stressors that hinder them from pursuing treatment (Greden et al.). A few examples of these barriers include financial issues, relationship troubles, and separation from military support (Greden et al.).

The same study, using Michigan Army National Guards (MI ARNG) as a prototype for civilian soldiers, looked into the psychological effects of their service (Greden et al.). Of the sample population with a reported mental concerns, only 47 percent pursued help or treatment (Greden et al.). The following table are some of the reasons why individuals from this group restrained from seeking out help:

Retrieved from:
Retrieved from:

Clearly, the stigma of their condition played a significant role in deterring these individuals from seeking care (Greden et al.). The study also proposed a peer-to-peer program called Buddy-to-Buddy which essentially tailors mental health care to those returning from service (Greden et al.). The program trains peer soldiers, who are not too distant in military rank, to periodically “check in” on soldiers returning from service (Greden et al.). It permits and facilitates a level of comfort in talking about potential problems these returning soldiers may have, without having them feel disconnected from the listener. The peers are supportive and are more likely to recognize the hardships these returning soldiers face. Upon recognizing any signs, these peer soldiers help returning troops get care (Greden et al.). Furthermore, civilian clinicians are also educated on treating soldiers and being sensitive to their experiences and past (Greden et al.). Coming from similar roles in their service, these peer soldiers are able to relate to the returning soldiers in a way that is difficult with civilian clinicians and/or mental health advisors. The program seems promising as its purpose is to break down barriers such as stigmas.

This program has certainly met previously unmet needs of soldiers (Greden et al.). According to the study, having someone who can relate to the experiences and traumas that one may face during their service may be a key way to break down the stigma of these illnesses (Greden et al.). They can facilitate conversations and could promote an environment of comfort for soldiers—an environment that may not be possible in a civilian clinical setting. More peer-to-peer programs throughout the nation could benefit returning troops and could bring an increase in the amount of soldiers with these mental health concerns who seek treatment for their condition.



Greden, John F., Marcia Valenstein, Jane Spinner, Adrian Blow, Lisa A. Gorman, Gregory W. Dalack, Sheila Marcus, and Michelle Kees. “Buddy-to-Buddy, a Citizen Soldier Peer Support Program to Counteract Stigma, PTSD, Depression, and Suicide.” Annals of the New York Academy of Sciences 1208.1 (2010): 90-97. Web.

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