Beyond stigma: Understanding the “inclined abstainers” in military behavioral health-care utilization

ABSTRACT

Low treatment utilization in Soldiers with combat-related Posttraumatic Stress Disorder (PTSD) is an ongoing issue. The critical concern is to better understand factors which prohibit a Soldier with PTSD who wants help from seeking treatment (an “inclined abstainer”). A total of 537 Active Duty Soldiers on a US Army post completed a brief survey comprising psychometrically validated measures of stigma, behavioral health treatment beliefs, resilience, PTSD symptoms, and treatment intentions. Health-care records were prospectively tracked for 12 months to determine the relation between survey answers and treatment utilization. Sixty-three percent of those who acknowledged having a mental health-related problem did not seek help within a one-year period. Greater severity of PTSD symptoms was associated with an increased likelihood of behavioral health engagement. Soldiers that were classified as “inclined abstainers” were also more likely to endorse negative beliefs about psychotherapy and report higher levels of resilience as compared to “inclined actors.” These results suggest that a treatment model of PTSD emphasizing self-efficacy and self-reliance, while addressing negative beliefs about psychotherapy, may help promote engagement of behavioral health services among Active Duty Soldiers.     

‘To Take the Sword is to Draw the Sword without the Authority of the Prince’: Obedience,Duty and Romans 13 During the 1549 Rebellions in England

ABSTRACT

The motivations behind the 1549 rebellions were born of socio-economic and religious concerns. However, some contemporary commentators identified another underlying factor: a failure to observe the precepts of Romans 13. The text demands that all subjects must obey the higher powers for fear of God’s wrath, and that rulers have a reciprocal duty to protect their subjects from evil. In their response to the rebellions, Thomas Cranmer, Robert Crowley, and Thomas Lever, amongst others, provided an exegesis of Romans 13 that refused to place the blame for the uprising at the door of the rebels alone. Instead, they recognized that the temporal and spiritual ministers were likewise guilty of failing to observe their divinely ordained duties. As a result, what these interpreters revealed was that all classes of society shared a responsibility for the rebellions of 1549 because all had equally failed to observe the commands of Romans 13.