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Major Depressive Disorder Has Affected Nearly Half of Female OIF/OEF Veterans

by U.S. Medicine

June 6, 2014
More VA Screening Needed with Increase in Women Vets By Annette M. Boyle DURHAM, NC – In the general population and among veterans, women suffer from depression at a substantially higher rate than men, and the mood disorder often occurs concurrently with other mental health conditions. As the number of women in uniform increases, screening for depression takes on even greater importance, both to successfully treat the illness itself and to resolve underlying mental health issues.
A photo illustration produced by the U.S. Navy supporting the Suicide Prevention program urging sailors to speak up and seek guidance. Sailors throughout the fleet are encouraged to work together as commands, units, installations or other groups to recognize suicidal tendencies and behavior and act to prevent it.  Navy photo illustration by Mass Communication Specialist Seaman Johans Chavarro

A photo illustration produced by the U.S. Navy supporting the Suicide Prevention program urging sailors to speak up and seek guidance. Sailors throughout the fleet are encouraged to work together as commands, units, installations or other groups to recognize suicidal tendencies and behavior and act to prevent it. Navy photo illustration by Mass Communication Specialist Seaman Johans Chavarro

Currently, women account for 20% of new military recruits and 10% of veterans. As today’s recruits leave the service, the proportion of women veterans will continue to rise, with the VA estimating that that nearly 1 in 5 veterans will be female within the next 25 years. The VA’s commitment to providing comprehensive, gender-sensitive mental healthcare for women veterans recognizes that “compared to male veterans, women veterans are more likely to have certain mental health conditions, such as depression and anxiety, as well as co-occurring mental and physical health problems” and experience higher rates of intimate partner violence and military sexual trauma, according to a feature article promoted by the VA last month. In addition, the VA acknowledges that “addressing women’s reproductive mental health concerns, such as postpartum depression or the effects of medication on a woman and her baby, requires specific knowledge and services.” Research published recently in the Journal of Affective Disorders, meanwhile, provides greater insight into the differences in the experience of major depression and comorbid disorders between younger women veterans and their male counterparts.
JCurryHeadshot

John Curry, PhD

John Curry, PhD, and his colleagues at the VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC) analyzed data from 1,700 veterans who had served during the operations in Iraq and Afghanistan. The data was originally collected as part of the MIRECC multi-site registry. The participants included 346 women and 1,354 men.1 The researchers found  nearly half of the women (46.5%) and slightly more than one-third of men (36.3%) experienced major depressive disorder during their lifetimes (MDD-L). The proportion of women and men who had ever been diagnosed with major depression in this group was significantly higher than in other studies, perhaps because it did not draw exclusively from patients in a primary care setting. In the National Comorbidity Survey Replication, 18% of all American adults ages 18 to 64 had experienced major depressive disorder — 22.1% of women and 14.4% of men met the criteria for diagnosis. “Some of the participants were seeking mental health services rather than primary care,” Curry noted, which “could explain why the rates of lifetime MDD were higher than they would be in a primary care clinic.” In addition, the data reflects the number of veterans who had experienced MDD at any point in their lives rather than only those with current depression.DepVetsFig1 The higher rates might also reflect deeper probing during the data gathering stage as “all participants took part in an extensive, structured, comprehensive psychiatric diagnostic interview, and so they were systematically asked about past and present symptoms in a way that would not be done in a primary care visit,” Curry told U.S. Medicine. Because MDD and other mental health issues commonly co-occur, the researchers sought to determine whether the onset of depression and common comorbid conditions occurred at different rates or sequences in men and women. In the study, men and women with MDD-L had similar, high rates of PTSD (66.4% for men and 60.9% for women). Women were almost twice as likely to have experienced a non-PTSD anxiety disorder in their lifetimes and were about six times more likely to have had an eating disorder than men. Men were far more likely to have had alcohol use disorders. The researchers also analyzed the data to try to determine whether depression occurred first or developed subsequent to other conditions such as post-traumatic stress disorder, substance use disorders, anxiety and eating disorders. “Our final hypothesis, that there would be more women than men for whom MDD-L preceded comorbid disorders, was not supported, nor was the age of onset for depression younger for women veterans,” concluded the authors. In fact, “those other diagnoses were more likely to occur first in about three-quarters of the women,” Curry noted. As the VA develops mental health services designed to address the particular needs of women, the results of this study provide valuable insights. Anxiety disorders, experienced by 30% of women, can complicate the treatment of depression, noted Curry and colleagues. Further, while women were less likely than male veterans to have alcohol use disorder, it still affected nearly one-third of female veterans.DepVetsFig2 Perhaps as important as the differences found between men and women veterans in the frequency and onset of depression and mental health comorbidities are the areas of similarity. In the general population, depression occurs at higher rates in women starting in adolescence. In this study, the researchers “expected that there would be a higher percentage of women veterans reporting MDD-L that preceded comorbid lifetime disorders. Instead, we found that primary onset MDD-L was in every instance less common than non-primary onset MDD-L,” and “there were no gender differences in onset sequences, nor was there a gender difference in age of onset of first depressive episode.” Overall, the first depressive episode occurred at about age 28. “As the number of women in military service and thus veteran status increases, it will be critical to screen for and recognize MDD among women veterans,” the authors concluded. Further, as depression most commonly occurs after development of other mental health conditions, providers who diagnose depression in women veterans should assess for other likely conditions, such as PTSD, anxiety and eating disorders to improve the likelihood of successful treatment of both depression and comorbid conditions, they advised.DepVetsFig3 Military healthcare providers can play an important role in improving and maintaining mental health of forces long after they leave active duty, the researchers noted, explaining, “Identifying primary-onset conditions early, perhaps during military service, will aid in the reduction of symptoms and the speed of treatment effectiveness post-military service.” 1Curry JF, Aubuchon-Endsley N, Brancu M, Runnals JJ; VA Mid-Atlantic Mirecc Women Veterans Research Workgroup; VA Mid-Atlantic Mirecc Registry Workgroup, Fairbank JA. Lifetime major depression and comorbid disorders among current-era women veterans. J Affect Disord. 2014 Jan;152-154:434-40.

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