Depression prevalence and geographic distribution in United States military women: results from the 2017 Service Women’s Action Network needs assessment

Abstract

Introduction:To better understand depression in United States (US) servicewomen, needs assessment data from the Service Women’s Action Network (SWAN) were collected and analyzed, with comparison samples drawn from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS). The purpose of the present study was threefold. First, an assessment of the spatial distribution of depression in the United States among military women was made using geographic information systems. Second, the authors sought to determine differences in the prevalence of undiagnosed mental health concerns and diagnosed depression in women by military service status. Third, the authors sought to identify risk factors for depression among military women. Methods: Frequencies and percentages for all demographic, geographic, and outcome variables were calculated by military service status and data source. Differences among three groups – non-Veteran respondents of the BRFSS, Veteran respondents of the BRFSS, and SWAN member Veterans – were analyzed with the Chi-square test of independence. Estimates of the state-level prevalence of undiagnosed mental health concerns and diagnosed depression among military women who responded to either the 2016 BRFSS or the 2017 SWAN needs assessment were calculated and represented with state-boundary choropleth maps in Quantum GIS (QGIS). Results: A multinomial logistic regression model, adjusted for educational attainment, race, ethnicity, employment status, US region, and rurality, showed that military women and women Veterans were more likely to have undiagnosed mental health concerns and diagnosed depression, χ2 28 = 4,891.91, p < 0.001, Nagelkerke’s R2 = 0.03. Spatial analysis indicated that respondents living in the South were more likely to have diagnosed depression or undiagnosed mental health symptoms in both the BRFSS and SWAN needs assessment samples. Discussion: Primary findings from this study suggest that given the regional variation in depression among women Veterans, future studies should work to examine the role of the region in mental health for servicewomen in the United States, looking at available services and cultural differences. Recommendations include targeted programming for women Veterans.