Date of Award

January 2015

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Cynthia Brandt

Subject Area(s)

Mental health, Medicine, Women's studies

Abstract

The Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans utilizing Veterans Affairs (VA) services are medically and psychosocially complex, diverse, and rapidly growing. A significant portion of women Veterans seek out mental health services and they are more likely to be diagnosed with major depression than men, however the majority of prior studies informing Veteran mental health services have been done with predominantly male study populations (16,18,19). Our objectives were 1) to identify characteristics associated with a major depression diagnosis among OEF/OIF/OND men and women Veterans after stratifying by gender and 2) to identify gender differences in the nature of depressive symptoms among these Veterans. We identified 493,747 OEF/OIF/OND personnel—via the VA OEF/OIF/OND roster—who were discharged from the U.S. military from 2001-2010, utilized VA health care services, and met study criteria. Descriptive statistics and multivariable logistic regression models were used to determine how selected demographic characteristics and medical conditions were associated with a major depression diagnosis among women and men. Also, a PHQ-9 in the baseline Women Veterans Cohort Study (WVCS) survey of 644 male and women OEF/OIF/OND Veterans in the Midwest and Northeast U.S. was used to assess depressive symptoms. Among the 493,747 Veterans studied, 5.6% had a major depression diagnosis (8.7% of women vs. 5.1% of men). Hispanic ethnicity (OR=1.26 (1.14, 1.40) was associated with a depression diagnosis in women while older age (OR=1.06 (1.04, 1.09)) and “Other” race/ethnicity (OR=1.14 (1.05, 1.25) was associated with a depression diagnosis in men. Black race was no longer a protective factor for women when the cohort was stratified by gender (OR=0.94 (0.90, 0.97)!OR=1.03 (0.95, 1.11)). Unmarried status was protective against a depression diagnosis in both men (OR=0.94 (0.90, 0.97) and women (OR=0.92 (0.86, 0.94)). All comorbid conditions—psychiatric illnesses, alcohol abuse, substance abuse, hypertension, and unspecified joint or back disorders—were associated with a depression diagnosis in both men and women and having another psychiatric illness was the strongest correlate in both groups. Military service-connected disability was associated with depression in both men and women, but there was a stronger correlation between service-connected disability rating and a depression diagnosis in women. Depressive symptoms were prevalent among this cohort, the most frequent of which was fatigue. Women were more likely to endorse appetite changes while men were more likely to endorse suicidal ideation. It can be concluded that there are differences between women and men OEF/OIF/OND Veterans with major depression. Further research disentangling the intersection of gender and depression in this medically and psychosocially complex population of Veterans is needed.!As the women Veteran population utilizing VA care continues to grow, increasing our understanding of major depression and its risk factors, symptomology, and its comorbidities is crucial to improving overall health outcomes.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 07/29/2018.

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