Veteran Depression: Risks, Signs & Treatment Options

Depression is often a debilitating condition that can negatively impact one’s life and wellbeing.¹ For veterans, there may be increased risk of depression and other mental health disorders following their time in military service.¹ Veteran depression and mental health continue to be of the utmost concern for military families and professionals.¹

If you or someone you care about is a veteran struggling with depression, you should know that veteran depression help is available. Learning about depression and its signs, risk factors, causes, and VA healthcare services and treatments, may ensure you get the help you need.

What Is Depression?

Depression is everyday term for clinical depression or major depressive disorder (MDD).² It is a mental health disorder that can cause low mood and other symptoms that affect how you feel and can interfere with your ability to function.²

Aside from clinical depression or MDD, there are also other types of depressive disorders, which can cause signs and symptoms of depression.² This includes seasonal depression/ seasonal affective disorder (SAD) and depression with psychotic symptoms.²

Depression in veterans can co-occur with many physical and mental health issues, including substance misuse, traumatic brain injury, PTSD (posttraumatic stress disorder), suicidality, and heart disease.^{3, 4, 5} MDD and PTSD are psychiatric disorders that commonly co-occur in veterans, with about half of veterans having both PTSD and MDD.⁵

Signs of Depression in Veterans

The signs and symptoms of depression can vary from person to person. Not everyone will manifest symptoms in the same way, and many individual factors and biological traits can play a role in the way you might be affected by depression.²

For example, men with depression often display higher rates of anger, aggression, substance misuse, and risk taking than women who are depressed.⁶ Older adults tend to have less obvious signs and may appear more sad or tearful than younger people.²

Common signs of depression include:^{1, 2}

• Feeling frequently sad, low, empty, or anxious.
• Loss of interest in activities you once enjoyed.
• Feeling angry or aggressive for no clear reason.
• Irritability, frustration, or restlessness.
• Insomnia (inability to sleep) or hypersomnia (sleeping too much).
• Weight changes.
• Inability to concentrate.
• Fatigue, a lack of energy, or feeling “slow”.
• Unexplained aches and pains, stomach complaints, headaches, cramps, or digestive problems that don’t appear to have a clear cause.
• Feeling worthless or guilty.
• Thoughts of self-harm or suicide.

Risk Factors and Causes of Depression

Researchers believe that depression is caused by several risk factors including genetic, biological, environmental, and psychological influences.⁷ Veteran depression and depression in the general population may develop because of these factors:^{3, 7}

• Family history of depression.
• Major changes in life.
• Stress.
• Trauma.
• Specific physical illnesses like anemia, or taking certain medications, such as steroids or narcotics.

In addition, veteran depression and anxiety can also be impacted by different factors. which are specific to their work. One study explains that the overall work environment for military members can serve as a “catalyst” for depression; however, it can also be affected by other factors, such as:¹

• Being separated from family.
• Experiencing the stress of combat.
• Physical injury.
• Experiencing or witnessing harm in others.

Statistics on Depression in Veterans

Different studies have had varying results regarding veteran depression statistics. These results may depend on the specific parameters of the study, such as the era being examined or individual factors.³ However there are several studies that have found veterans to be vulnerable to depression.

• The VA reports that 1 in 3 veterans who visit their doctor present with symptoms of depression and 1 out of 8-10 veterans have MDD.³
• A study in JAMA Psychiatry found that veterans had nearly 5 times the rate of depression than civilians.⁸
• Some research indicates that around 14% to 16% of U.S. military members who were deployed to Afghanistan and Iraq have developed PTSD or depression.¹
• One study reports that veteran depression rates increased at military medical facilities from an 11.4% baseline to 15% after being deployed to Iraq or Afghanistan.¹
• Research also indicates that around 9% of all appointments in the VA health network are related to depression.¹
• One VA study that examined depression in veterans vs. nonveterans found that veterans actually experienced slightly lower, but not statistically relevant, rates of depression when compared to nonveterans. Eleven percent of veterans were found to have depression vs. 12.8% in nonveterans.³ This study also found that Vietnam veterans had twice the level of depression as World War II or Korean War Veteran, but the reasons for this were not entirely clear.³
• Another study of 4,461,208 veterans found that depression was their most prevalent mental health disorder, with rates of 13.5%, compared to 9.3% with PTSD, 8.3% with substance use disorders (SUD), and 4.8% with anxiety disorders. Out of those with depression, 33.2% had PTSD, 19.4% had an anxiety disorder, and 23.2% had an SUD.⁹
• In 2019, around 6,000 male veterans aged 18-25 experienced MDD with serious impairment (with no valid reported results for females), while 575,000 male veterans and 213,000 female veterans aged 26 and older experienced the same disorder.¹⁰

Veteran Depression and Substance Misuse

As mentioned above, substance misuse/addiction frequently co-occurs in veterans with depression and/or other mental health disorders.⁹ The VA reports that veterans with PTSD may be more likely to cope with their symptoms through substance use, known as self-medication.¹¹

As with depression, SUDs in veterans may be linked to different risk factors, which are specific to military members, such as deployment, combat exposure, and post-deployment civilian/reintegration challenges.¹²

If you have a co-occurring disorder, you should know that depression and substance misuse/addiction can be treated together. Research on integrated treatment, which addresses both disorders simultaneously, shows that substance use often decreases significantly with these interventions.¹²

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that integrated treatment can help reduce substance use, improve mental health outcomes and functioning, enhance a person’s quality of life, and increase the likelihood of successful treatment and recovery for both disorders.¹³

Integrated treatment for depression and SUDs should be covered by VA benefits if you are a member of the VA healthcare program. It should also be covered by Medicare, Medicaid, and private insurance.^{14, 15, 16}

Your exact benefits may vary, so it’s advisable to consult your insurance provider and specific plan details. The Affordable Care Act (ACA) requires that Marketplace health insurance plans cover mental health and substance use disorders as essential health benefits.^{17, 18}

Treatment for Veterans with Depression

Different treatments can help veterans with depression or co-occurring disorders to recover and even very severe depression can be treatable.³ People may receive different types of therapy, such as behavioral therapies, psychotherapy, medication, or a combination of these.^{2, 3}

Mental health and substance abuse treatments may take place at varying intensity levels and in different settings, such as inpatient or outpatient facilities.¹⁶ The setting and types of therapies will vary based on each person’s needs. Individualized treatment may contribute to more positive outcomes.¹⁹

Evidence-based therapies can be an important component of your treatment plan. Evidence-based means that these therapies are proven to be effective in helping people recover from mental health conditions and improving their overall wellbeing.²⁰ Therapies you may receive include:²¹

• Acceptance and Commitment Therapy (ACT), which is designed to help you feel better by helping you figure out what’s most important in your life so you can make healthier choices and achieve your goals.
• Cognitive-Behavioral Therapy for Depression (CBT-D), which helps you examine and replace negative or unhelpful thoughts and behaviors with those that are healthier and realistic.
• Interpersonal Psychotherapy for Depression (IPT-D), which is a relationship-focused therapy designed to help you look at relationship issues that may contribute to or cause your depression.

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VA Services for Depression

You can receive different mental health services and treatments at many VA medical centers.²⁰ Services can include:^{16, 22}

• Medication, including medication for depression as well as co-occurring problems like anxiety or insomnia.
• Psychotherapy and behavioral therapies.
• Short-term inpatient care.
• Outpatient care.
• Residential care.

Does the VA Give Disability for Depression?

VA disability benefits for depression depends on the level of impairment you experience.²³ The disability rating can range from 100, meaning total impairment, all the way to 0, when a person has a formal diagnosis but doesn’t experience symptoms that interfere with their daily functioning.²³

One study reports that that 18% of veterans with depression had a disability rating of ≥70%. However, another study found that 47% of those studied with depression had a combined disability rating of 70% or higher.²⁴

There are different ways you can apply for VA healthcare:²⁵

• Apply online.
• Mail in the Application for Health Benefits (VA Form 10-10EZ) to the Health Eligibility Center: 2957 Clairmont Rd., Suite 200, Atlanta, GA 30329.
• Call the toll-free hotline at 877-222-8387, Monday through Friday, 8:00 am to 8:00 p.m. ET to get help with your application.
• In person at your local VA affairs medical center or clinic.

Tips on Coping with Veteran Depression

Coping with depression isn’t easy, but there are steps you can take to help yourself feel better, such as:^{2, 26, 27}

• Staying active and exercising regularly.
• Eating a healthy, well-balanced diet.
• Practicing mindfulness meditation and stress management.
• Connecting with others on a regular basis.
• Maintaining realistic expectations and realizing that it takes time for depression to improve.
• Participating in self-help support groups; the VA offers specific groups for veterans with PTSD or who have experienced trauma.
• Make an appointment to speak to a VA counselor. You can also access the VA’s telehealth services to speak to someone if you’re not able to go to a VA center. You can send a message to set up appointments through their website, va.gov.
• Contact the Veterans Crisis Line at 1-800-273-8255 (Press 1). You can also chat with someone online through their website or text 838255 to talk to someone right away.
• Check out the VA App Store, which offers different apps to with mental health symptoms and stress.
• Visit the Veteran Training website, which offers a variety of courses designed to address different mental health concerns.

How to Help a Veteran with Depression

If you know a veteran who is struggling with depression, you can provide support and assistance in several ways. Strategies to consider can include:²⁸

• Encouraging contact with friends and family to build a support network.
• Taking part in physical activity with them like riding a bike or taking a walk.
• Offering to take them to the VA and help schedule appointments.
• Being mindful of when they pull away and need space, and offer help when they’re ready.
• Seeking help for yourself. It’s not easy to care for someone with depression, PTSD, and other mental health disorders. You might check out the VA’s Caregiver Support program to find resources that can help.