The purpose of the current study was first to examine the content and prevalence of, as well as associations among, mental health-related beliefs, mental health literacy, military-related cultural factors (unit social support, exaggerated self-reliance, and emotional control), and lifetime treatment utilization in a community sample of 134 veterans who have served in the US military since 2001. Correlational results indicated that only exaggerated self-reliance was positively related to negative beliefs about treatments (r=.20, p<.01) and treatment-seeking (r=. 42 , p<.01), but not other dimensions of stigma. In addition, both emotional control and self-reliance were inversely related to social distance stigma (EC: r=-.20, p <.05), (SR: r=-.34 , p<.01). Further, psychological distress was positively related to negative beliefs about mental health treatments, treatment-seeking, and concerns about anticipated stigma, but not negative beliefs about mental health problems, or social distance stigma. No relations were found between unit social support and mental health-related beliefs. No relations were found between mental health-related beliefs and lifetime care utilization among a subsample (n=84) of participants experiencing current distress consistent with mild clinical symptoms or above.

The second aim of this study was to test whether negative mental health-related beliefs, including both explicit negative beliefs and implicit bias, could be modified through a brief web-based culturally sensitive intervention in an experimental setting. Recruiting from the correlational study sample, veterans who endorsed high negative beliefs about mental health and consented to the follow-up study (n= 14) were randomly assigned to observe a series of either the Make the Connection video interventions developed by the Department of Veteran's Affairs or a series of videos about general healthcare issues (such as nutrition, the importance of wearing sunscreen, etc.) and then completed measures of explicit and implicit bias and mental health literacy. Measures of explicit bias and mental health literacy were repeated at a one-month follow-up. Analyses were significantly underpowered, and results indicated no significant differences across groups. Effect sizes demonstrated medium to large effects of the treatment condition on negative beliefs about mental health problems and concerns about anticipated stigma from friends and coworkers, but no effect on implicit bias, social distance stigma, or behavioral stigma. Clinical implications, future directions, and limitations are discussed.