The Awareness of PTSD in Military Personnel among Clinical Social Workers and Psychologists in Health-Care Centers ()
1. Introduction
Military personnel and their families are subjected to a variety of pressures and social issues that are not applicable to the general population, putting them in a unique and challenging situation. Some military personnel suffer from combat-related physical injuries, resulting in disability or causing them to leave the service early, which in turn has an economic and social impact on their families. Some service members, on the other hand, return from war with psychological wounds and injuries such as post-traumatic stress disorder (PTSD). According to the National Center for PTSD in the United States, PTSD affects 11 - 20 out of every 100 veterans who served in Iraq. PTSD affects 12% of Gulf War veterans, while 30% of Vietnam War veterans have been diagnosed with the disorder National Center for PTSD (2018).
In comparison with the statistics above, the number of Saudi personnel with PTSD is still unclear or undetermined, raising concerns about the awareness among Saudi veterans and their families of PTSD symptoms. On a larger scale, the lack of data about PTSD raises concerns about the availability of practical and feasible PTSD information in Saudi society, particularly among practitioners in health-care centers.
Clinical social workers and psychologists are usually trained to provide professional systemic intervention, advocacy, and counseling, and they must receive qualification to do so (Faust, 2008). Because they may encounter military personnel suffering from PTSD during their work, they need a thorough understanding of the condition. Clinical social workers and psychologists must know whether their patients are veterans and whether their symptoms are related to their military experience. Thus, the researcher believes that clinical social workers and psychologists must improve their understanding of PTSD in military service members and become familiar with their specific health demands to interact with them effectively and address their needs.
To summarize, the study’s main goals are to 1) Determine which factor (self-development, education, or organizational development) is most important in raising awareness among the study sample; 2) Determine whether there is a difference in awareness between individuals who have completed an abroad qualification and those who have not completed an abroad qualification; 3) Determine how well Saudi Arabian clinical social workers and psychologists understand PTSD in military personnel.
Before going any further, it is important to mention that Saudi Arabia provides free health care to all citizens. More specifically, according to data from the Health Ministry statistical yearbook in 2018 (Health Ministry, 2018), there are roughly 47 governmental hospitals, including military hospitals, that are only for personnel of the military sector and their families. Physical, psychological, and social health-care services in all areas are provided by military hospitals. Because clinical social work and psychology are integral parts of the treatment plan, they are some of the most important services in hospitals. Treating the patients’ social difficulties is just as vital as treating their health complications. Furthermore, with the south of Saudi Arabia currently an active combat zone adding to the possibility of soldiers suffering from post-traumatic stress disorder, PTSD awareness today is more important than ever.
1.1. PTSD Knowledge among Health-Care Professionals
As a result, clinical social workers and psychologists need to improve their knowledge of PTSD symptoms among veterans and seek educational preparation to understand the needs of service members (Cooper et al., 2016), keeping in mind the delicateness of their past or current situation as armed forces personnel (Kiernan et al., 2016). According to Finnegan et al. (2017) military members and their families require social care practitioners who are familiar with their unique status and condition and who have the ability to address these concerns in a manner that veterans and their families understand. As a result, the veterans’ reluctance to seek professional help is primarily due the practitioners’ unfamiliarity with the needs of veterans. Finnegan et al. (2017) found that veterans do not reveal information about their combat experiences to clinicians because the veterans feel clinicians do not understand. Mansfield et al. (2005) alsofound that veterans are reluctant to seek help because they perceive numerous barriers to doing so, and they do not trust health-care professionals. Furthermore, according to Kiernan et al. (2016) despite a growing awareness of the potential barriers to care for veterans, and a developing understanding of their specific needs, veterans are not sufficiently included in health-care education. Furthermore, both Engward & Fleuty (2019) and Kiernan et al. (2016) stated that health service policymakers, councilors, and practitioners struggle to truly understand the unique experiences and challenges of the veteran’s life and are unclear on the course of treatment or guidance suitable for veterans and their families. Subsequently, these uncertainties become major barriers for veterans in accessing health care. Thus, a growing body of literature (Engward & Fleuty, 2019; Finnegan et al., 2017; Kiernan et al., 2016) suggests that to make a significant difference in the care of veterans and their families, to address the social health care knowledge gap, and to raise awareness about the needs and experience of the veteran community, a culture of understanding regarding veteran health care must be established through graduate and even undergraduate education. Fundamental curriculum elements, for example, must be based on empirical evidence; must include a systematic and structured educational portfolio, pilot schemes, and other educational initiatives; and must provide training courses that include veterans’ health as a core component of their curricula (Finnegan et al., 2017).
1.2. Perceived Barriers that Prevent Veterans with PTSD from Seeking Social Care
To pave the way for PTSD veterans to seek professional help, it is critical to address the perceived barriers that could prevent them from doing so, such as stigma, the military culture of toxic masculinity, the lack of PTSD awareness, and the lack of access to health care. Scambler (2009) defined stigma as a social process marked by exclusion and blame as the result of a person’s impression or reasonable expectation of an undesirable social judgment about them based on an enduring element of identity bestowed by a health problem or health-related condition. Furthermore, both Stana et al. (2017) and Iversen et al. (2011) suggested that stigma related to the pursuit of mental health treatment may be more distressing among military personnel than for most civilians. The greatest obstacle to care provision across the military force’s population, according to Iversen et al. (2011), is the stigma associated with seeking help for mental health concerns. Both Major & O’Brien (2005) and Stana et al. (2017) agreed that admitting to mental illness could be construed as malingering, which could put a veteran’s military career and reputation in jeopardy. Mansfield et al. (2005) highlighted the viewpoint that for male military service members, seeking help would threaten their ability to function independently. Nevertheless, it could be argued that feeling stigmatized has much to do with the masculinity of military culture, as Stana et al. (2017) has explained. That is, veterans seek to match perceived social norms commonly associated with men because masculinity is defined as invulnerability and stoicism in conduct. To clarify this concept, a soldier who is coping with military stressors is classified as a real man, and there is no room inside military culture to admit weakness or difficulty (Green et al., 2010). In contrast, Caddick et al. (2015) believed that in PTSD treatment settings, services that promote male health may be recognized and supported when masculinity is not seen as an issue. Furthermore, Caddick et al. (2015) stated that veterans can be involved in relationships and narrative systems that support and value these new masculine orientations. A lack of PTSD understanding among veterans, in addition to stigmatization and the military culture’s barriers due to toxic masculinity, may hinder veterans from seeking professional care and raise the risk of PTSD symptoms.
It may be difficult for soldiers to speak about some especially distressing events such as warfare, according to Green et al. (2010), and this may delay the recognition and treatment of mental health concerns. Another point of view is that veterans may not consider their situation serious enough to require expert assistance (Mansfield et al., 2005). One study found that postponing a diagnosis of PTSD among veterans makes treatment more difficult (Hermes et al., 2015). Furthermore, according to Hermes et al. (2015), the period following a traumatic event and prior to the onset of symptoms and an understanding of their context can be lengthy and psychologically significant. As a result, Engward & Fleuty (2019) suggested that more education and encouragement for veterans and their families may be required to improve the awareness of why veteran status is crucial for care. Finally, according to Mansfield et al. (2005), financial constraints, a lack of insurance, a lack of transportation, a lack of awareness about the types of assistance available, and a lack of trust in care providers can all discourage people from seeking assistance.
Increasing awareness of PTSD as a treatable disorder may encourage veterans to seek professional help. PTSD-related depression, according to Olenick et al. (2015), is a treatable illness with an 80 - 90 percent success rate, with eight out of ten veterans effectively treated. According to Olenick et al. (2015), there are several social resources for increasing PTSD care among veterans, such as rehabilitation care, which includes vocational programs and physical, social, and mental therapy. Moreover, several researchers (Green et al., 2010; Johnson et al., 2013; Kintzle, et al. 2018; Olenick et al., 2015; Stana et al., 2017) have found that family or group therapy, stress reduction, guided imagery therapy, cognitive behavioral therapy, and social support are the most effective non-pharmaceutical treatments for PTSD. Both Caddick et al. (2015) and Bowler et al. (2010) have claimed that an expanding number of outdoor activities, such as horseback riding, fly fishing, horticulture, walking, water sports, and narrative setting can have positive benefits on a veteran’s physical and mental health.
1.3. Psychological and Social Problems Related to PTSD
Several studies (Johnson et al., 2013; Olenick, 2015; Semaan et al., 2016) noted a variety of physiological and social challenges that veterans face as a result of PTSD. One issue is that veterans are more likely to experience PTSD-induced psychiatric symptoms such as depression, negative thoughts and sensations, mistrust, suicide, and social alienation. Furthermore, Kintzle et al. (2018) emphasized that those veterans who had been exposed to combat have more intense pain and, as a result, more intense PTSD and depression symptoms than veterans who had not been exposed to combat. In accordance with Kintzle et al. (2018), Olenick et al. (2015) mentioned that 8% of nonmilitary men versus 36% of male veterans have been linked to depression symptoms. Even though veterans are more likely to be diagnosed with depression, Olenick claims that they are less likely to commit suicide than nonveterans, which he attributes to better understanding and acceptance of PTSD. Moreover, the transition of veterans to civilian life is a major social complication, according to Finnegan et al. (2017), Kintzle et al. (2018), and Semaan et al. (2016). The veteran transition experience can be complicated after they are deployed to a war zone and witness a horrific event, and there is a stark difference in normative structures and values between military and civilian society. Veterans may suffer from PTSD, become homeless, get divorced, or change careers after returning home, according to Engward & Fleuty (2019), and Semaan et al. (2016). In the United States today, there are 19.6 million veterans, and 22 veterans commit suicide every day. Semaan et al. (2016), Olenick et al. (2015), and Johnson et al. (2013) indicated that homelessness as a result of veteran’s transition to civilian life is a serious societal problem. Almost 50,000 veterans are homeless (Semaan et al., 2016), with more than 51% having disabilities and 50% suffering from a serious mental illness such as traumatic brain injury (TBI) or PTSD (Olenick et al., 2015). To sum up, Engward & Fleuty (2019), Kiernan et al. (2016), Finnegan et al. (2017), and Cooper et al. (2016) have recommended that to ensure that appropriate care and support is offered to veterans, studies of the potential health needs of veterans and their families should become integral elements of educational training for health-care professionals. Lastly, a culture should be developed to permeate a military emphasis throughout the health-care fields in universities (Engward & Fleuty, 2019). Thus, it was predicted the significant role of veteran PTSD awareness among the healthcare professionals.
1.4. Research Key Terms
1.4.1. Post-Traumatic Stress Disorder among Veterans
It is necessary here to clarify exactly what is meant by PTSD. According to Shiromani (2009), PTSD is defined as a reaction to a major threat of damage or death, followed by feelings of great anxiety, helplessness, or horror. PTSD’s effect on interpersonal relationships, emotional health, physical health, and societal effects all add to the condition’s overall expenses. Furthermore, in the current article, PTSD among Saudi military members is described in terms of veterans with PTSD. Military service members and civilians may be exposed to several potentially traumatic events during war or conflict, according to the National Center for PTSD (2020). As a result of this exposure, they are more prone to acquire PTSD or other mental health difficulties.
1.4.2. Awareness among Health-Care Practitioners
Although the term “awareness” is commonly used in the literature, health-care professionals such as clinical social workers and psychologists have yet to agree on a formal definition of PTSD awareness. PTSD awareness could be defined as a branch of general mental health awareness that has resulted in the creation of dedicated services to assist military personnel coping with emotional, social, and psychological issues related to PTSD. Such awareness may also help caregivers learn how to detect and treat patients who have been exposed to war and combat zones.
1.4.3. Population and Sampling
The first stage in the sampling process is to clearly define the target population. Population commonly refers to the number of people living in a particular country (Taherdoost, 2016: p. 19). This study focuses on clinical social workers and psychologists who have already worked or volunteered in health-care organizations, third-party sectors, or social-psychological practices. The sample for this study was selected using the nonprobability sampling strategies of judgmental and snowball sampling because of the study’s descriptive nature and limited resources. Unlike random sampling, judgmental sampling, commonly known as purposive sampling according to Taherdoost (2016), is the selection of people based on the information available about them as well as specified study goals. Snowball sampling, according to Babbie (2007), is often employed in field research, and it involves asking each person interviewed to suggest additional potential participants, a procedure that is appropriate when members of a special population are difficult to locate (p. 205). In addition, participants must have worked in health care anywhere in Saudi Arabia, and have a bachelor’s, master’s, or doctoral degree in sociology, social work, or psychology.
2. Method
The current study is based on quantitative investigation, using a descriptive research design. The descriptive approach is defined as a technique for gathering facts and interpreting how the facts relate to the topic being investigated (Babbie, 2007). Descriptive research tries to characterize the research problem, population, or condition to comprehend its existence rather than to explore why it occurred in the first place. So far, the study’s main goals are to 1) Determine which factor (self-development, education, or organizational development) is most important in raising awareness among the study sample. 2) Determine whether there is a difference in awareness between individuals who have completed an abroad qualification and those who have not completed an abroad qualification. 3) Determine how well Saudi Arabian clinical social workers and psychologists understand PTSD in military personnel.
2.1. Measurement Instrument
In this study, the survey questionnaire is used as an instrument. The chosen instrument is typically used for descriptive reasons, such as in studies where people are the unit of analysis. Also, employing a questionnaire to collect data is useful for analysis (Babbie, 2007). The knowledge questionnaire was built based on the information from related literature reviews, as well as from known PTSD symptoms, and covers facts about PTSD among military personnel that health-care professionals are expected to know. The self-report instrument tool has three categories written in Arabic (because the participants were Arabic speakers) then translated to English for statistical use. The first category contains sociodemographic information: gender, nationality, age, level of education, major, whether the participant has ever received a qualification from one of the aboard countries (A degree or certificate from a country other than Saudi Arabia)without specifying the most recent degree, the number of years of experience as a clinical social worker or psychologist, organization affiliation, whether the participant is full- or part-time or a volunteer, and the total number of military personnel with PTSD they have seen during their years practicing health care. The second category is for specifying resources such as education, training provided by the organization about the problems facing military personnel in general, and conversations with military personnel with PTSD themselves. It contains seven items and uses the three-point Likert scale of agreement (agree = 3, neutral = 2, disagree = 1). The final category measures the level of knowledge of PTSD in military personnel and was developed by the researcher after gaining appropriate information from reviewing relevant literature that uses the Mental Health Literacy Scale (MHLS). The literature includes studies by O’Connor & Casey (2015), Spagnolo et al. (2018), Chao et al. (2020), as well as books about the most common PTSD symptoms among veterans. This measure contains 19 items and uses the three-point Likert scale of frequency (always = 3, often = 2, never = 1). The scale includes questions about PTSD symptoms that a practitioner should be aware of while consulting patients.
2.2. Validity and Reliability
The questionnaire was sent to six professors in the Social Studies Department at King Saud University for criterion validation to ensure the validity of the assessment tools and content. The academics were picked based on their research interests (two are statisticians, two are criminal sociologists, one is a social-psychologist, and the last is a sociologist of development).
The surveys were subsequently pilot tested on a group of sixteen people (eight clinical social workers and eight psychologists) who worked at either the King Fahad National Guard Hospital in Jeddah, the Erada Complex for Mental Health, or the King Abdullah Specialist Children Hospital in Riyadh. The purpose of this pilot testing was to locate items that were unclear or perplexing. The average time it took to answer the scale was less than 15 minutes. The internal consistency of the questionnaires was evaluated with Cronbach’s alpha correlation. The Cronbach’s alpha for the level of knowledge of PTSD in military personnel on a scale of 19 items was .952 and was regarded as satisfactory, See the following Table 1.
2.3. Data Collection
The research took place in Saudi Arabia during September-November of 2021. In addition to purposive sampling, snowball sample recruiting strategies were used to ensure that the population of clinical social workers and psychologists in health-care organizations, practices, and third-party sectors was representative. Through the official researcher email at King Saud University, the questionnaires were also distributed to the heads of clinical social worker and psychological departments at several hospitals around Saudi Arabia. Lastly, no personally identifiable information such as names, addresses, or email addresses was ever requested or saved.
2.4. Data Analysis
This section will show, analyze, and discuss the data and outcomes obtained from the questionnaire and will demonstrate how the tool’s output is efficient and purposeful, meeting its goals in accepting or rejecting the study’s hypotheses through the analysis that follows.
The survey was done using an online Google Form that was only accessible to the researcher and to no one else. In the first week of November 2021, the responses were downloaded into the Statistical Program for the Social Sciences— Version (28.0; 190) for analysis.
The descriptive statistics frequencies and percentages were calculated for sociodemographic data, such as gender, level of education, and years of experience, as shown in Table 2. The approximate number of military personnel with PTSD seen by the participants during their years of experience is shown in Table 3, using range and mean.
For the second category, which includes the resources of knowledge of PTSD, mean, standard deviation, and a one-sample test were used. A one-way ANOVA
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Table 2. The sample’s demographic characteristics.
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Table 3. Significance of coefficients
analysis was performed to determine the effect of education, self-development, and organizational development on the level of awareness.
Finally, standard deviation, mean, and a one-sample T test were used for the 19 item measure (described above) of PTSD symptoms that practitioners should be aware of while consulting patients.
3. Result
3.1. Sociodemographic Characteristics
The N = 144 clinical social workers and psychologists who worked or volunteered in health-care centers or third-party sectors made up the total sample for this study. For the responses, there is no missing data.
The sample’s demographic characteristics in Table 2 suggest that more than half of the sample is female (72.2%), and the bulk of the sample is Saudi (99.3%). Only 6.3% have a PhD, whereas 64.6% have a bachelor’s degree, and 27.8% have a master’s degree. Over half the participants (54.2%) have a social work degree, followed by degrees in sociology (23.6%) and psychology (23.6%) with 4.2% having degrees with a different focus. In addition, just 11.1% of the participants have acquired aboard certification (United States, United Kingdom, Sudan, Egypt, Jordan, Bahrain, or Kuwait). Nearly half the participants (43.8%) have 5 or fewer years of experience as social workers or psychologists, while 32.6% have more than 11 years of experience. Almost two-thirds of the participants (65.3%) worked for a government health-care organization, with the remaining 34.8% working for private or charitable organizations. Of the 144 respondents, 81.9% have a full-time job, 9.0% work part time, and 9.0% volunteer.
Finally, the approximate number of military people with PTSD seen by the participants during their experience years is shown in Table 3.
3.2. Sources for Information on PTSD in the Military
The following Table 4, Table 5 will address one of the fundamental issues in this research paper: Which component is more essential in raising awareness within the study sample: self-development, education, or organizational development?
Using a one-sample T test statistical analysis, we can explain the differences in sources for information on PTSD in the military:
As can be seen in the table above, there was a statistically significant difference in the study sample of respondents, where sig = 0.001 was less than 0.05, and the T statistic was 3.289 with a degree of freedom of 143.
Regression analysis was used to represent the effect of education on awareness levels:
The value of correlation R equal to 0.455 in Table 6 indicates that there was a positive relationship between education and awareness. In addition, as seen in the R square column, education explains 20.7 % of the change in the level of awareness.
The level of significance (sig) in the Table 7 above is 0.000, which is less than 0.05, indicating that the regression model is significant.
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Table 4. Arithmetic means and standard deviations of the study variables.
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Table 5. The differences in (sources for information on PTSD in the military) using one-sample T Test.
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Table 6. The effect of education on the level of awareness.
a. Predictors: (Constant), Education.
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Table 7. The effect of education on the level of awareness.
The importance of the education variable is shown by the value of the educational significance level, sig = 0.000, which is less than 0.05 in the Table 8 above. Therefore, the regression model will be as follows:
One-way ANOVA (Table 9) can be used to explain the difference between self-development and level of awareness:
The significance of F (P-value) is 0.000 in Table 9, which is significant because it is less than the criterion value of 0.05. As a result, there was a substantial difference in the means in the sample score (agree, neutral, disagree) when compared to the level of awareness. Using the following multiple comparisons (Table 10) with a less significant difference (LSD) technique, the difference score can be found:
There is a considerable difference between all sample scores, disagree and neutral, disagree and agree, neutral and agree, as seen in the table above. This is explained in the sig column because all the results have a sig less than 0.05.
Regression analysis was used to explain the impact of organizational development on awareness levels on the Table 11 below.
As can be observed in the R square column, the degree of correlation R = 0.237 indicates that there is a positive association between organizational development and level of awareness, and the result reveals that organizational development explains the change in the level of awareness by 5.6%.
Table 12 explains the effect of organizational development on awareness level:
The level of significance, sig = 0.004, which is less than 0.05, indicates that the regression model is significant, as seen in the Table 12 below.
As seen in the Table 13 below, the organizational development significance level, sig = 0.004, which is less than 0.05, shows that the organizational development variable is significant. Therefore, the regression model will be as follows:
3.3. The Differences in the Level of Awareness between Those Who Obtained a Qualification from Inside or Outside Saudi Arabia
The study’s second main research question was whether there were any variations in awareness between participants who had completed an abroad qualification and those who had not, and was expressed as the following hypothesis, shown on Table 14:
- Alternative Hypothesis (1): Those who received qualifications from within or from outside Saudi Arabia have different levels of knowledge.
- Null Hypothesis (1): There are no differences in the level of awareness between participants who earned a qualification from Saudi Arabia (from within or outside the country).
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Table 8. Significant of the Coefficientsa.
a. Dependent Variable: A level of Awareness.
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Table 9. The difference between self-development alternative.
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Table 10. The differences between developments alternative.
a. Predictors: (Constant), organizational development.
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Table 12. The effect of the development on the level of awareness.
a. Dependent Variable: a level of Awareness; b. Predictors: (Constant), organizational development.
The independent-samples T test (Table 15) explains the variations in the level of awareness between individuals who received a qualification from within or from outside Saudi Arabia:
The Levin’s test for equal variance reveal that sig = 0.084, which is greater than 0.05, indicating that the variance is homogeneous, implying that the findings of the first row, which are presumed to represent equal variances, will be accepted. Furthermore, the T value is 0.404 with a degree of freedom (df) of 142 and a level of significance of 0.687, which is a value greater than 0.05, indicating that there are no statistically significant differences in levels of awareness based on where the qualification was obtained (inside or outside Saudi Arabia). As a result, the null hypothesis will be accepted, and the alternative hypothesis will be rejected.
3.4. Knowledge Level of PTSD in the Military
How well do Saudi Arabian professional social workers and psychologists understand PTSD in military personnel? That is the concluding question in this study report.
The following (Table 16) shows arithmetic means and standard deviations of the research variables, which will be used to answer the question:
A one-sample T test was used to explain differences in PTSD knowledge level in the military (Table 17).
As indicated in the table above, there was a statistically significant difference in the respondent’s research sample, where sig = 0.000, which is less than 0.05, because the mean difference was 7.82639, and the t statistic was 8.846 with a degree of freedom of 143.
4. Discussion
This study identified the level of awareness of PTSD in Saudi Arabian military personnel among clinical social workers and psychologists, as well as the most important sources for PTSD awareness. This research reveals three key findings.
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Table 16. The arithmetic means and standard deviations of the research variables
To begin with, the findings of this study show a significant difference (t = 3.289, sig = 0.001) between the sources of information about PTSD among military people. Education as a source for knowledge of PTSD was shown to have a substantial link with the level of awareness among the sample (R = 0.4555, 20.7%), followed by self-development (P-value = 0.000), and finally organizational development (R = 0.237, 5.6%).
Surprisingly, these findings contradict those of Kiernan et al. (2016), who claimed that veterans’ needs are not well addressed in health-care education, potentially preventing veterans from seeking care. However, the current study’s findings, particularly the most beneficial influence on the level of awareness among health-care practitioners, have never been described before.
This study did not discover a significant difference between those who earned qualifications abroad and those who obtained qualifications locally, contrary to expectations. According to the current study, there were no statistically significant differences in levels of awareness based on whether the qualification was acquired inside or outside Saudi Arabia (sig = 0.687). This finding was surprising and may be due to the unification of social studies and psychology curricula in universities. Nonetheless, until recently, there was no reliable evidence that education in the social sciences about PTSD among military personnel was insufficient.
Another significant finding was that the level of awareness among study samples differed significantly (sig = 0.000, mean = 7.82639). Participants who claimed that “they sometimes can detect the symptoms of PTSD among military members” had a mean = 2.09 and std = 0.614, while participants who stated that “they never use the PTSD scale” had a mean = 1.62 and std = 0.737. These two findings differ from previous study findings, which showed a strong correlation between education, self-development, and organizational development; however, they are broadly consistent with earlier studies (Engward & Fleuty, 2019; Kiernan et al., 2016), which found that health service policymakers, councilors, and practitioners struggle to truly understand the unique experiences and challenges of the veteran’s life and are unclear on the course of treatment. Whenever these findings are compared to the rest of the scale’s results in Table 16, it is possible that the study instrument is a source of self-reporting bias.
One expected finding, as indicated in Table 3, is that nearly half the participants reported seeing no military patients with PTSD over their experience years, which might be justified in two ways based on two different aspects. First, this study endorses the findings of Iversen et al. (2011), Major & O’Brien (2005), and Stana et al. (2017), who claimed that stigma is one of the perceived barriers to seeking social care among PTSD veterans. These findings furthermore support the results of (Finnegan et al., 2017) who found that veterans do not inform clinicians about their combat experiences because the clinicians “do not understand,” and also support the findings of Mansfield et al. (2005), who suggested that veterans are hesitant to seek help because they do not trust health-care professionals. The second justification is that, as shown in Table 16, most professional social workers and psychologists do not use the PTSD scale when diagnosing their patients, making it difficult to detect PTSD symptoms and leaving the number of positive cases with PTSD unknown.
5. Conclusion
The focus of this research was to find the most essential component in boosting PTSD awareness among clinical social workers and psychologists. The current study also aimed to see whether there is a difference in awareness between those who have finished an abroad qualification and those who have not. Finally, the current research aimed to assess the level of PTSD awareness among clinical social workers and psychologists in the health-care field.
This study has found that generally there is a significant relationship between the study variables (education, self-development, and organizational development) and the level of PTSD awareness among the study sample. The most obvious finding to emerge from this study is that there is an equality of awareness among those who earned qualifications abroad and those who obtained qualifications locally. Finally, this study has shown that there are significant differences in the levels of overall awareness among the study sample.
6. Limitations
As with any study, the research results need to be assessed in light of the data’s strengths and weaknesses. In terms of limitations, the data collection instrument is an online self-report questionnaire. According to de Leeuw (2008), online self-report surveys have various drawbacks, including an increased likelihood of prematurely terminating the survey and of distraction due to multitasking. Furthermore, the participants’ honesty regarding their knowledge and experience, as well as the number of military individuals treated by the participants, may have influenced the level of knowledge of PTSD in military personnel.
As far as the researcher knows, there is no specific scale to measure the level of knowledge of PTSD in military personnel. The researcher developed the scale after gathering relevant information from literature reviews that used the Mental Health Literacy Scale, including studies from O’Connor & Casey (2015), Spagnolo et al. (2018), and Chao et al. (2020). Because of the study’s modest sample size of N = 144, caution should be exercised. The findings of this generated scale may not be reliable, and the scale must be further tested.
These findings have certain limitations in terms of generalizability. The current study only included clinical social workers and psychologists who worked or volunteered in health-care organizations, facilities, or third-party sectors, implying that the findings may not be applicable to all Saudi social workers and psychologists. Because almost 99% of the participants were Saudi, the sample was nationally representative of Saudi clinical social workers and psychologists. However, non-Saudi participants would be omitted.
The study was restricted by the lack of formal data on the number of Saudi military members diagnosed with PTSD during the Yemen War; this lack is likely due to security reasons given that the war is still ongoing.
In addition, the study aimed to investigate how education affected participants who have a degree in sociology, social work, psychology, or a related major such as family and marriage consulting. As a result, the researcher discovered that unrelated majors such as computer science, nursing, and pharmacology, which account for 4.2% of the total sample, may have influenced the validity of the comparison with other study factors such as self-development and organizational development, as well as the effect of education on awareness levels.
Moreover, several questions about the psychological and social issues that Saudi military soldiers experienced after being deployed from the Yemen combat zone remain unaddressed. Future research should be able to further evaluate the perceived barriers to obtaining social support among Saudi military members suffering from PTSD, according to the findings.
More research is needed to investigate the roles of education and organizations in improving PTSD awareness by using an interview research approach or a mixed method (quantitative and qualitative) approach to gain knowledge. Because access to participants is restricted, government organizations, private sector partnerships, and local community participation are all needed to assist social research and remove any barriers that may occur during data collection.
Despite these limitations, the study features several positive aspects. The current study is expected to contribute to a growing body of knowledge about PTSD among health-care professionals, particularly social workers and psychologists.
More importantly, the researcher believes this is the first time a scale for the level of understanding of PTSD in military people has been developed with outstanding validity and reliability (Cronbach’s Alpha = 0.950). Similarly, one of the study’s significant characteristics is that it considers PTSD among Saudi military members as a research topic in the social studies.
The current findings also contribute to our understanding of the critical function of education in boosting PTSD awareness among military personnel. According to the current study’s findings, 63.2% of the sample agreed that they had knowledge of the social problems that military personnel face after returning from a war through their education, and 54.9% agreed that they had gained knowledge through their education about PTSD that military personnel developed after a war.
Finally, during the years of experience at the organization, 73.5% of the sample disagreed that their workplace provides awareness courses or trainings on the problems facing the military after the war, and 72.2% of the sample disagreed that their workplace offers specialized courses in PTSD caused by military service.
These findings were unexpected, and they suggest that colleges and health institutions should teach their students how to connect more effectively with PTSD patients, especially in the fields of social work and psychology. Finally, these recommendations are in line with the suggestions of Engward & Fleuty (2019), Kiernan et al. (2016), Finnegan et al. (2017), and Cooper et al. (2016), which recommend that to ensure that veterans receive appropriate care and support, the potential health needs of veterans and their families should become an integral part of professional education and training in health care. These findings also recommend creating a culture in which knowledge of the military pervades all aspects of health care in institutions.
Acknowledgments
Dr. Theeb Aldosary, the chair of the Social Studies department, Art collage, at King Saud University, was contributed to guide the researcher in this work.
Funding
This research received no external funding.