A Population-Based Cross-Sectional Study Comparing Depression and Health Service Deficits Between Rural and Nonrural U.S. Military Veterans

Abstract

With involvement in two wars over the past decade, there has been a documented increase in depression prevalence and suicide incidence among U.S. military veterans. Because higher proportions of veterans come from rural communities, access to care may be an issue when behavioral health care is needed. Although the Veterans Administration has expanded health services in rural areas, this has not always resulted in increased service utilization. This study examined the prevalence of depression and associated health service deficits (HSDs) for rural versus nonrural U.S. military veterans. Using bivariate and multivariate techniques, 2006 Behavioral Risk Factor Surveillance System data were analyzed. Bivariate analysis revealed that rural veterans had greater odds of having at least one HSD, being currently depressed as measured by the Personal Health Questionnaire-8, and having lifetime depression. Logistic regression analysis confirmed that rural veterans had higher odds of both current and lifetime depression than nonrural veterans when controlling for socioeconomic status and race/ethnicity. Additionally, logistic regression analysis also revealed that rural veterans with current depression had higher odds of being Hispanic or Other/Multiracial than Caucasian, not employed for wages than employed for wages, <65 years of age, and reported having at least one HSD.

Suicide Attempt Characteristics Among Veterans and Active-Duty Service Members Receiving Mental Health Services: A Pooled Data Analysis

“…For example, veterans are more likely to have chronic pain and long-term health conditions requiring polypharmacy (Im et al, 2015), conferring both additional suicide risk and increased access to suicide means. Veterans are also more likely to be socially isolated and use alcohol and drugs in contexts where an overdose may not be detected (Dittrich et al, 2015). Illicit drugs and alcohol might be used very socially in the military setting, and service members may have fewer opportunities to overdose without being discovered by others.…”

A Systematic Review of Factors Impacting Suicide Risk Among Rural Adults in the United States

“…The vast majority (n = 25) of included studies were cross‐sectional designs, 3,20–43 followed by noncomparative qualitative study designs 44–48 (n = 5), 3 cohort studies (n = 2 retrospective cohort 49,50 ; n = 1 nonconcurrent cohort 51 ), and 1 case‐control 52 study (see Table 2).…”

“…Rural individuals with substance abuse history were twice as likely to die by suicide (OR = 2.3, 95% CI: 1.0‐5.3) 21 . Other individual level factors identified included past suicide exposure, 20,24 behavioral health care use, 20,24,33 financial difficulties, 20,21,24,48 and attitudinal barriers to care 27 …”

“…Moderate RoB study findings included lack of providers 32 and stigma of seeking help for mental health 27 . A large cross‐sectional survey identified rural residents as more likely to experience a health service deficit, more likely not to have had a past year exam, and have no identified primary care provider 33 . A small survey of rural women identified accessibility and availability as barriers to mental health care 39 .…”

A Population-Based, Cross-Sectional Study Examining Health Services Deficits of US Veterans Using 2014 Behavioral Risk Factor Surveillance System Data: Is Rural Residency an Independent Risk Factor after Controlling for Multiple Covariates?

“…An earlier study [ 4 ], analyzing Behavioral Risk Factor Surveillance System (BRFSS) data, examined depression and HSDs in rural compared to non-rural adult populations and found that rural residency was an independent risk factor for greater HSDs in adults with depression. [ 8 ] In 2014, a study was published examining the prevalence of HSDs in depressed (determined by a standardized and validated measure) US veterans [ 11 ]. Rural residency was found to be an independent risk factor for greater odds of having a HSD in rural veterans.…”