Mental Health Service Utilization in Depressed Canadian Armed Forces Personnel

Abstract

The proportion of depressed Canadian Armed Forces personnel who seek professional care and who access specialty mental health care is higher than in most other populations. However, an important minority of patients are not accessing health services. Efforts to further increase mental health service utilization in the Canadian military should continue to target beliefs about the effectiveness of mental health care.

Incidence of major depression diagnoses in the Canadian Armed Forces: longitudinal analysis of clinical and health administrative data

“…Several factors may account for this difference. First, CAF personnel suffering from major depression may be more likely to seek care than their American counterparts, and may, therefore, be more likely to receive a formal diagnosis; previous studies have found that 75% of depressed Canadian soldiers access mental health care in a 12-month period [11], compared to less than 50% in the US military [20][21][22]. This apparent difference in care-seeking propensity may be partly explained by the substantial difference in age composition between the two militaries; on average, CAF personnel are older than their American counterparts [23,24], and older age is associated with higher mental health service use in depressed patients [25].…”

“…As recommended in current guidelines [13], we also sought to assess the validity of our case definition. Data source agreement is an accepted method for assessing the quality of case definitions in health administrative data research [18], and a large cross-sectional survey recently estimated that 6.0% of Regular Force personnel with major depression used mental health services in the previous year [11]. In an effort to assess the quality of data used in the current study, we identified all individuals who were serving in the Regular Force on the last day of our study period (i.e., December 31st 2017), and used our case definition to determine whether they had any clinical encounters for major depression at any point from January to December 2017.…”

“…In an effort to assess the quality of data used in the current study, we identified all individuals who were serving in the Regular Force on the last day of our study period (i.e., December 31st 2017), and used our case definition to determine whether they had any clinical encounters for major depression at any point from January to December 2017. We qualitatively compared the sex and age distribution of patients with past-year clinical encounters for major depression to the results of the aforementioned survey [11].…”

“…These surveys have provided valuable information on the prevalence of major depression across different military organizations [1,3,8]. They have also shed new light on the occupational factors associated with major depression in military personnel [9] and on stigma perceptions [10] and care-seeking behaviors [11] related to this condition. However, cross-sectional surveys cannot provide information on the rate of major depression incidence.…”

“…However, current guidelines recommend assessing the quality of such data, when they are used for epidemiological research [13]. As a secondary objective, we, therefore, assessed the quality of our data by comparing our results to those of a recent crosssectional study of self-reported mental health service utilization in a large representative sample CAF personnel with major depression [11]. This cross-sectional survey and our current study both measured similar outcomes in the same population; close agreement between their results would, therefore, support the validity of data used in the current study.…”