Impact of Stigma on Veteran Treatment Seeking for Depression

Abstract

The Veterans Health Administration (VHA) mandates annual depression screening in primary care; however, veterans often delay seeking treatment after screening positive, which can increase the severity and impact of depression. This mixed-methods study examined the association between stigma and treatment utilization among veterans (N = 271) in primary care with a positive depression screen. A subsample of veterans (n = 23) participated in a semistructured interview to qualitatively explore the social and cultural contexts of treatment utilization for depression. Treatment utilization data based on Healthcare Effectiveness Data and Information Set (HEDIS) guidelines were obtained by chart review 3 months following the positive screen date. Logistic regression indicated a lack of evidence that stigma was associated with treatment utilization. However, grounded thematic analysis suggested that stigma negatively influenced perceptions of depression and treatment utilization for some veterans. Four themes emerged: (1) depression is weakness; (2) depression is an unwanted label; (3) depression is normal; and (4) overcoming stigma. Evidence from interviews suggests that stigma may play a larger role in decisions about treatment seeking, which was not quantitatively evident. Addressing the psychosocial ramifications of stigma for depression may help minimize treatment lapses and maximize treatment seeking among veterans who screen positive for depression in primary care.

Keywords:

• Depression
• Primary care
• Veterans
• Treatment utilization
• Stigma

Notes

Note: ^a n = 263 for race, n = 269 for age, gender, and education, and n = 270 for marital status.

^b HEDIS guidelines include (1) optimal practitioner contact or three or more outpatient mental health follow-up encounters within the 12-week acute treatment phase of depression and (2) effective medication coverage or continuity of antidepressant medication treatment during 84 of the 114 days following the index antidepressant prescription date.

Note: *p < .05; **p < .001; ***p < .0001.