Care from Mental Health Providers Preferred to PCPs
By Annette M. Boyle
LOS ANGELES — Recent research uncovered some good news and bad news when it comes to female veterans and depression: Women experience depression at much higher rates than men but also are more likely to receive adequate care and report symptom improvement.
The study, published in Women’s Health Issues, found that 20% of women veterans screened positive for probable major depression in a primary care setting compared to only 12% of men, a 66% increase in prevalence, according to the study team from the VA Greater Los Angeles Healthcare System.1
In addition, women veterans more frequently experienced significant psychological comorbidities, with 48% of those with depression also screening positive for posttraumatic stress disorder (PTSD) and 65% indicating they had general anxiety. By contrast, 38% of men with depression had likely PTSD. Men with that diagnosis had similar rates of generalized anxiety but higher rates of alcohol misuse, 23.8% vs. 15.2%.
“The trend in the data indicates that women are more likely to present with both depression and anxiety disorders, and we know from previous studies that there is also high comorbidity with physical conditions,” explained lead author Teri D. Davis, PhD, Health Services scientist at the VA and psychology instructor at California State University, Fullerton. Consequently, Davis pointed out, “women veterans are likely to have a very complex clinical presentation which requires sophisticated and long-term treatment.”
Despite this complexity, more women veterans appear to be getting the care they need. The researchers found that 57% of the women initially identified with depression received adequate depression care, compared to 39% of men. Adequate care was considered four or more mental health specialist visits in the six months following the positive screen or having taken a selective serotonin reuptake inhibitor (SSRI) or bupropion for at least 26 days in the last month or for more than 25 days per month in three consecutive months during the six-month follow-up period. More to the point, a higher percentage of women reported improvement in the symptoms of depression seven months after screening—46% vs. 39%.
One reason for the better outcomes could lie with women veterans’ preferences for care. “Women are more likely to go to mental health providers and may prefer nonprescribers for depression care. There is some indication they want therapy with medication,” to address their depression and change their behaviors, Davis told U.S. Medicine.
Not surprisingly, then, the women in the study were twice as likely to have had at least four visits with a mental health specialist in the prior six months than the men, 30.4% vs. 14.5%. They also were more than 50% more likely to have had any contact with a mental health specialist during the follow-up period (67.4% vs. 43.4%) and twice as likely to have ever had contact with a mental health specialist (73.3% vs. 35.4%).
While implantable devices have shown promise in reducing rehospitalization for heart failure (HF), VA researchers sought to determine if options that are less expensive and non-invasive would have comparable results. Legislation to prevent VA from outsourcing creation of its drug formulary and to require more input from medical professions is being considered in Congress.
While implantable devices have shown promise in reducing rehospitalization for heart failure (HF), VA researchers sought to determine if options that are less expensive and non-invasive would have comparable results.
Legislation to prevent VA from outsourcing creation of its drug formulary and to require more input from medical professions is being considered in Congress.