Female Iraq and Afghanistan veterans were more likely to be diagnosed with depression than their male counterparts, who were more likely to be diagnosed with posttraumatic stress disorder, a retrospective study of U.S. veterans has shown.

These were among the significant gender differences between the male and female veterans identified in the study, which looked at sociodemographic and mental health characteristics among 329,049 Iraq and Afghanistan war veterans who went to a Veterans Affairs health care facility at least once between April 2002 and March 2008, the first time they had used the facilities since the start of the two wars (Am. J. Public Health 2010;100:2450-6).

"Gender differences are important to consider as the VA and the Department of Defense continue to expand and strengthen programs to evaluate and provide health care for a new generation of returning veterans," wrote the authors of the study, Shira Maguen, Ph.D., and her associates at the San Francisco VA Medical Center.

Of the total population studied, 12% were female and 53% were active duty, 28% of the women and 33% of the men had had multiple deployments, and 54% of the women and 69% of the men were white. Most (65% of the women and 63% of the men) were in the Army. Diagnoses were made by trained professionals and were based on DSM-IV criteria. At VA facilities, all veterans are screened for mental health disorders.

Depression diagnoses were significantly more common among the female veterans than among the males (23% vs. 17%). The rate of eating disorders also was higher among the female veterans (0.6% vs. 0.1%), as was the rate of anxiety disorders (12% vs. 10%), differences that were statistically but not clinically significant, the authors said.

Among the male veterans, diagnoses of posttraumatic stress disorder (PTSD) were significantly more common than among the female veterans (22% vs. 17%), as were substance use diagnoses (3% vs. 2%).

The authors identified significant interactions between gender and other variables, including age, marital status, branch and rank, and being diagnosed with PTSD and with depression.

Among both female and male veterans, a significant correlation was found between being diagnosed with PTSD and being divorced, separated, or widowed, compared with being married; being an Army vet, versus being a Navy or Air Force veteran; being in active duty service, compared with being in the Reserves; and having served multiple deployments, as opposed to one deployment. Women who were older than aged 30 years were at a significantly greater risk of being diagnosed with PTSD than were men, "for whom older age seemed to be a protective factor," the authors noted.

In addition, women were significantly more likely to be diagnosed with PTSD if they had never been married, were in the Reserves or National Guard, were in the Navy or Air Force, or were an officer.

A diagnosis of depression was significantly more likely among white female and male veterans; and among those who were divorced, separated, or widowed; as well as among those who had served in the Army, had been in active duty, or were enlisted. Women who were older than aged 30 years also were significantly more likely to be diagnosed with depression, as were women older than 40.

Being black was a protective factor for a depression diagnosis in both men and women, the authors said, referring to evidence suggesting that ethnic and racial minorities have stronger social support networks than whites and return home to more supportive communities than whites. This finding points to the "importance of determining level of social support in relationships, among families, and in veterans’ communities and of focusing on community reintegration for recently returned veterans," they wrote.

The authors described age as "the most pronounced gender difference" that was correlated with PTSD and depression, with older women at a greater risk for being diagnosed with PTSD and depression than younger women. However, younger men were at a greater risk of being diagnosed with PTSD than older men, which the authors speculated could be related to difficulties older women with more established family and community ties have when deploying and reintegrating into those communities when they return home.

These results "contribute to a better understanding of the characteristics of women seeking VA health care as well as how these characteristics may differentially be associated with mental health outcomes," they noted.

The results cannot be generalized to all military personnel from the two wars, or veterans of other wars, which were among the study’s limitations, they said. Previous studies of gender differences in mental health outcomes among Iraq and Afghanistan war veterans have had mixed results.

No disclosures were listed for the authors. The study was funded by a Department of Defense Concept Award Grant and a VA Health Services Research and Development Career Development Award.

Age, Gender Linked to Mental Health Diagnoses Among Recent Vets