Page 15 Complete Your CE Test Online - Click Here Major depression and suicide Veterans, depression, and suicide As previously noted, depression and PTSD are the most common mental health problems faced by returning troops. Depression is common in the general population as well as in veterans. In any given year, nearly 1 in 10 adult Americans has some type of depression. Depression and PTSD often occur together. Research results indicate that depression is nearly three to five times more likely to occur in persons with PTSD than in persons without PTSD (National Center for PTSD, 2015). EBP alert! Since research shows that depression and PTSD often co-exist, nurses must be sure to screen for both depression and PTSD when assessing veterans’ health. Depression is diagnosed more often in women than in men and often occurs concurrently with other mental health problems (Boyle, 2014; Durkin, 2013). As the number of women serving in the armed services increases, so will the potential for depression among female veterans. To date, women account for 20% of new military recruits and 10% of veterans. The VA estimates that nearly one in five veterans will be female within the next 25 years. Therefore, it is likely that health care facilities will see a rise in certain mental health conditions, such as depression and anxiety, as well as intimate partner violence and military sexual trauma as this population continues to rise (Boyle, 2014). However, even though depression is diagnosed more often in women than in men, male veterans are also at considerable risk for depression (Boyle, 2014;, 2015a). Suicide is a significant concern in depressed individuals. The incidence of suicide is higher in depressed persons than in persons with other diagnoses (Durkin, 2013). Statistical findings regarding suicide and veterans include the following information (, 2015a): ● ● Results from recent research studies show that suicide rates among veterans are much higher than previously believed. There may be as many as 5,000 to 8,000 suicides annually (22 per day) among veterans. ● ● More active duty personnel died by their own hands than in combat in 2012. Studies have also focused not only on incidence of suicide in veterans in general, but according to age as well. Information published in the January 9, 2014, edition of Stars and Stripes described a dramatic increase in the number of young veterans that committed suicide from 2009 to 2011, the latest time period for which statistics are available. Male veterans under the age of 30 had a 44% increase in the rate of suicides. There was an 11% increase in the rate of suicide in female veterans. That means that about two young veterans take their lives every day, most often just a few years after leaving the service (Shane, 2014). Nursing consideration: Of the 22 veteran suicides a day, only about five veterans were registered into the health system (Shane, 2014). Nurses must work to facilitate the entry of veterans into the appropriate healthcare system. The challenge, according to Jan Kemp, the VA’s National Mental Health director for Suicide Prevention, is expanding the outreach to veterans and persuading them that mental health interventions really do work. In an effort to help more veterans, the VA has increased the number of mental health personnel available, including suicide hotline staff (Shane, 2014). It is not just younger veterans who are taking their own lives at an alarming rate. Suicide in older veterans is also a significant problem. In recent years, much of the research regarding suicide and mental health problems has been conducted on veterans of the wars in Iraq and Afghanistan; however, according to a VA study, nearly seven in ten veterans who have committed suicide were over the age of 50 (Jordan, 2018). Although older veterans share many of the risk factors of younger veterans, including depression, PTSD, and combat experience, other factors may influence the decision to commit suicide in older veterans, proposes Dr. Tom Berger, executive director of the Vietnam Veterans of America (VVA) Veterans Health Council. Recent research suggests the following factors specific to older veterans play a role in suicide among this population (Jordan, 2018): ● ● Older veterans have reached an age where the structure of their lives is changing. After returning from combat, many veterans deal with their stressors by hard work and focusing on their families. As they reach retirement age and children leave home, the work and people they have focused on are no longer present in the same way, but the stressors and memories of the traumatic event(s) remain. ● ● Korean War veterans may have even more intense problems since they would have reached their 40s before PTSD was acknowledged as a significant problem for veterans. ● ● Injuries to limbs, migraine headaches, or other conditions that cause chronic pain all increase the risk of suicide if depression is also present. ● ● As veterans age, they may become more representative of the general population. In the general population, older people account for a higher percentage of suicides. Nursing consideration: Critical to the treatment of depression and PTSD is recognizing that service members and veterans represent a subgroup within the general population. Treatment needs to factor in the military culture and experiences specific to veterans (Jordan, 2018). Definition of depression Major depression, also known as unipolar disorder, is a syndrome of an ongoing, persistent, sad, dysphoric mood. This mood is accompanied by sleep and appetite disturbances, lethargy, and a marked inability to experience pleasure (anhedonia). Major depression can adversely impact the ability to effectively function at work, home, and in social settings (Durkin, 2013). Suicide is the most serious consequence of depression. Feelings of guilt, worthlessness, and hopelessness are so overpowering that affected persons feel life is no longer worth living and/or the only way to stop these overwhelming feelings is to take one’s life. Nearly twice as many women as men attempt suicide. However, men are more likely to succeed in their attempts at suicide (Durkin, 2013). Nursing consideration: All persons who suffer from depression should be assessed for suicidal ideation. Nurses must be sure to include such evaluation during the assessment process. There are several forms of depression in addition to major depression that may affect veterans. These include the following forms (Durkin, 2013; National Institute of Mental Health, 2016). ● ● Persistent depressive disorder: This is a depressed mood that lasts for at least two years. To be diagnosed with persistent depressive disorder, the person must have episodes of major depression along with periods of less severe symptoms. However, symptoms must last for at least two years. ● ● Psychotic depression: Psychotic depression occurs when a person is affected by severe depression plus some form of psychosis, such as delusions or hallucinations. ● ● Postpartum depression: About 10% to 15% of women experience postpartum depression, which is a serious form of depression that develops after a woman gives birth. Hormonal and physical changes combined with the responsibilities of caring for a newborn can be overwhelming, thus triggering depression that can interfere with her ability to care for her baby,her interpersonal relationships ,and ability to function effectively at home and/or work. ● ● Seasonal affective disorder (SAD): SAD is characterized by the onset of depression during winter months when there is less natural light. This type of depression usually lifts during spring and summer months. A milder, chronic form of depression is referred to as dysthymic disorder. This disorder is characterized by a chronic dysphoric mood