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November 6, 2008

Major Depressive Episode and Treatment for Depression among Veterans Aged 21 to 39

In Brief
  • An estimated 9.3 percent of veterans aged 21 to 39 (312,000 persons) experienced at least one major depressive episode (MDE) in the past year
  • Among veterans aged 21 to 39 with past year MDE, over half (51.7 percent) reported severe impairment in at least one of four role domains (i.e., home management, work, close relationships with others, and social life), and nearly one quarter (23.5 percent) reported very severe impairment in at least one of the domains
  • More than half (59.6 percent) of veterans aged 21 to 39 who experienced past year MDE received treatment for depression in the past year

Recent research indicates that an estimated 25 to 30 percent of the veterans of the wars in Iraq and Afghanistan have reported symptoms of a mental disorder or cognitive condition.1,2 Untreated mental health problems can result in long-term negative consequences for the affected individuals, their families, their communities, and our Nation as a whole.

The National Survey on Drug Use and Health (NSDUH) includes questions about military veteran status, major depressive episode (MDE),3 and treatment for depression. This issue of The NSDUH Report examines data from veterans aged 21 to 39, an age group that includes veterans with relatively recent service. The report provides data on the prevalence of past year MDE, levels of impairment resulting from MDE as measured by the Sheehan Disability Scale (SDS),4 average number of days of the inability to carry out normal activities due to MDE, and past year treatment for MDE. It should be noted that the NSDUH does not collect data to determine whether or not veterans served in combat or in which conflicts they served. All findings presented in this report are based on combined 2004 to 2007 NSDUH data.

What Percentage of Veterans Aged 21 to 39 Experienced Past Year MDE?

An annual average of 9.3 percent of veterans in this age group (an estimated 312,000 persons) experienced at least one MDE in the past year. The rate of past year MDE was higher among veterans aged 21 to 25 and those aged 26 to 29 (12.1 and 13.4 percent, respectively) than among veterans aged 30 to 34 and those aged 35 to 39 (7.5 and 8.3 percent, respectively) (Figure 1).

Figure 1. Percentages of Past Year Major Depressive Episode (MDE) among Veterans Aged 21 to 39, by Age Group: 2004 to 2007
This figure is a vertical bar graph comparing percentages of past year major depressive episode (MDE) among veterans aged 21 to 39, by age group: 2004 to 2007. Accessible table located below this figure.

Figure 1 Table. Percentages of Past Year Major Depressive Episode (MDE) among Veterans Aged 21 to 39, by Age Group: 2004 to 2007
Age Group Percent
Aged 21 to 25 12.1%
Aged 26 to 29 13.4%
Aged 30 to 34   7.5%
Aged 35 to 39   8.3%
Source: SAMHSA, 2004-2007 NSDUHs.

Female veterans were twice as likely as their male counterparts to have experienced past year MDE (16.6 vs. 8.0 percent). Rates for past year MDE were similar among black, white, and Hispanic veterans aged 21 to 39 (9.6, 9.2, and 8.5 percent, respectively).

How Did Past Year MDE Affect Veterans?

Almost all (99.2 percent) veterans aged 21 to 39 with past year MDE reported having experienced some level of resulting impairment in one or more of the role domains of home management, work, close relationships with others, and social life (Figure 2). Over half (51.7 percent) reported severe impairment in at least one of these role domains, and nearly one quarter (23.5 percent) reported very severe impairment in at least one of the domains.

Figure 2. Overall Severity of Role Impairment* among Veterans Aged 21 to 39 Who Experienced Past Year Major Depressive Episode (MDE)**: 2004 to 2007
This figure is a vertical bar graph comparing overall severity of role impairment* among veterans aged 21 to 39 who experienced past year major depressive episode (MDE)**: 2004 to 2007. Accessible table located below this figure.

Figure 2 Table. Overall Severity of Role Impairment* among Veterans Aged 21 to 39 Who Experienced Past Year Major Depressive Episode (MDE)**: 2004 to 2007
Severity Percent
None   0.8%
Mild   0.7%
Moderate 23.4%
Severe 51.7%
Very Severe 23.5%
Source: SAMHSA, 2004-2007 NSDUHs.

Severe or very severe impairment in role functioning was reported by 55.4 percent of these veterans for home management, 41.3 percent for ability to work, 50.4 percent for close relationships with others, and 57.7 percent for social life.

Overall, those veterans with past year MDE who reported any impairment in any domain of role functioning were unable to carry out normal activities on an average of 57.4 days in the past year; those who reported a very severe impairment were unable to carry out normal activities on an average of 120.0 days in the past year.

How Many Were Treated for Depression and What Type of Treatment Did They Receive?

More than half (59.6 percent) of veterans aged 21 to 39 who experienced past year MDE received treatment for depression in the past year. Among those who received treatment for depression, 74.0 percent saw or talked to a medical doctor or other health professional about depression and used prescription medication for depression, 20.9 percent saw or talked to a medical doctor or other health professional about depression but did not use a prescription medication for depression, and 5.1 percent used prescription medication for depression but did not see or talk with a medical doctor or other professional about depression in the past year (Figure 3).5

Figure 3. Percentages of Type of Treatment Received for Depression in the Past Year among Veterans Aged 21 to 39 Who Experienced Past Year MDE and Who Received Treatment for Depression in the Past Year: 2004 to 2007
This figure is a pie graph comparing percentages of type of treatment received for depression in the past year among veterans aged 21 to 39 who experienced past year MDE and who received treatment for depression in the past year: 2004 to 2007. Accessible table located below this figure.

Figure 3 Table. Percentages of Type of Treatment Received for Depression in the Past Year among Veterans Aged 21 to 39 Who Experienced Past Year MDE and Who Received Treatment for Depression in the Past Year: 2004 to 2007
Treatment Received Percent
Used Prescription Medication Only but Did Not See or Talk with a Medical Doctor or Other Professional about Depression   5.1%
Saw or Talked to a Medical Doctor or Other Professional Only 20.9%
Saw or Talked to a Medical Doctor or Other Professional and Used Prescription Medication 74.0%
Source: SAMHSA, 2004-2007 NSDUHs.

Discussion

With the recent combat deployments in Iraq and Afghanistan, treating the mental health care needs of veterans will be a continuing challenge for the mental health care system for years to come. Identifying and understanding the mental health service needs of service men and women, including the need for appropriate medical and therapeutic services, are a critical part of facilitating veterans' successful re-entry into civilian life and to reducing the long-term negative consequences of depression and other mental and emotional problems for veterans, their families, and their communities.

End Notes
1 Seal, K. H., Bertenthal, D., Miner, C. R., Sen, S., & Marmar, C. (2007). Bringing the war back home: Mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Archives of Internal Medicine, 167, 476-482.
2 Tanielian, T., & Jaycox, L. H. (Eds.). (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery (MG-720-CCF). Santa Monica, CA: Rand Corporation. [Available at http://www.rand.org/multi/military/veterans/]
3 The National Survey on Drug Use and Health (NSDUH) defines lifetime and past year major depressive episode (MDE) using the diagnostic criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which specifies a period of 2 weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. In assessing MDE, no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders.
4 The Sheehan Disability Scale (SDS) measures the impact of MDE on a person's life. The SDS asks adults aged 18 or older to give a rating of 0 to 10 (with 10 being the highest) for the level of impairment caused by the disorder in each of four role domains: (1) home management, (2) work, (3) close relationships with others, and (4) social life. Respondents with unknown severity of SDS role impairment data or for whom particular activities were not applicable were excluded.
5 Information to fully determine how these individuals could have taken prescription medication without seeing a doctor or health professional was not collected. It is possible that this group includes persons who last saw or spoke to a doctor or other professional about depression more than a year ago yet took prescription medication for MDE during the past year.

Figure Notes
*  See End Note 4.
** Due to rounding, percentages do not total 100 percent.

Suggested Citation
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (November 6, 2008). The NSDUH Report - -  Major Depressive Episode and Treatment for Depression among Veterans Aged 21 to 39. Rockville, MD.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The data used in this report are based on information obtained from 3,143 veterans aged 21 to 39 interviewed from 2004 to 2007. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Office of Applied Studies (OAS), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information on the NSDUH is available in the following publication:

Office of Applied Studies. (2008). Results from the 2007 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 08-4343, NSDUH Series H-34). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Also available online: http://oas.samhsa.gov.

The NSDUH Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available online: http://oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.

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