Depression in Elder Veterans Courtney Horton Valdosta State University Fall 2017

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Introduction The purpose of this presentation is to focus on depression in older/elder veterans. This topic is important because treatment options may vary given civilian/veteran status (Hundt, Barrera, Robinson, & Cully, 2014). Social workers who work with veterans my need knowledge on this subject for effective treatment plans in depression. Recognizing differences among various populations makes social workers better-equipped for whatever may be thrown their way. This topic relates to social work because depression in elder veterans is and issue of an individual or group in a given environment. This subject can be viewed in the Person In Environment (PIE) perspective which would entail that veterans may have depression from previously serving in the military and what they have experienced during that time, or possibly from transitioning back to a more civilian- based lifestyle.

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Main Issues It is important to know there is a lack of evidence that supports depression is worse or different from that of non-veterans or civilians. CBT may not be effective when treating depression in veterans. However, there is not a lot of evidence to support this. Psychological factors could impact veterans’ effective depression treatment options. Hence, CBT has previously shown to be an effective treatment plan in civilians while it may not be as affective for depressed veterans (Hundt et al. 2014). In one study conducted by Boakye, Buchanan, Jing, Stringer, Geneus, Scherrer, and Wang (2017), depression and mental distress was measured in veterans and non- veterans among different service eras. Lifetime depression and mental distress was lower in veterans than non-veterans during the WWII and Korean War eras. However, depression and mental distress was higher in veterans during the Vietnam era. This research emphasizes how important time eras may be when implementing treatment plans for depressed veterans (Boakye et al. 2017). According to Braden, Overholser, Fisher, and Ridley (2015), psychological assessments of veterans do not focus enough on underlying factors for increased suicide. Many veterans who denied suicidal thoughts eventually committed suicide. They found that veterans’ definitions of life meaning was significantly linked with ideas/views on suicide (Braden et al. 2015).

Main Issues Cont. Schmied, Larson, Highfill-McRoy, and Thomsen (2016), emphasized the importance in focusing on the relationship between psychiatric health and stressful life events in veterans. They found that symptoms of PTSD and depression predicted future stressful events. Substance abuse among veterans was also linked with depression. Shockingly, noncombat stress displayed more prevalent effects on veterans’ mental health that exposure to combat. If an individual veteran showed higher impulsivity, she or he was more susceptible for stress, PTSD, substance abuse, and depression. Schmied et al. (2016) argues that prior to and after military service these individuals should go through interventions for response preparations in regards to stress, coping mechanisms, and prevention on substance abuse (Schmied et al. 2016). Gould, Huh, Brunskill, McConnel, and Tenover (2015) used one or more psychotherapy sessions, pre and post treatment, in elder veterans. They found that veterans with disabilities had higher anxiety and depression symptoms (Gould et al. 2015). Hyer and Stanger (1999) looked at veterans from WWII and Korean war eras and found through self-reports that depression impacts health status and social support. PTSD impacted adjustment and health status in veterans more so than depression. However, depression impacts heart rate and social support in veterans more than PTSD. Hyer et al. (1999), suggests that it is important to consider depression when discussing PTSD in veterans (Hyer et al. 1999)

Relation to HBSE One The topic of depression in elder veterans relates to Human Behavior in the Social Environment (HBSE) because: 1) A strengths-based lens can be used when assessing and treating veterans with depression. 2) Elder veterans can be assessed from the PIE (Person In Environment) lens. 3) Depression and veterans/military service could very well be intertwingled.

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Best Practices According to the Department of Veterans Affairs, 11% of veterans who are over the age of 65, suffer from depression. This percentage is more than double in the civilian elder population. Dr. Rebecca Crabb, and clinical psychologist at the VA Geriatric Research Education and Clinical Center notes that diagnosing depression in elder veterans can be difficult. She describes depression in older people differently than that of younger people stating that symptoms can be different among the two populations. These symptoms include: anxiety, memory loss, fatigue, pain, irritability, hopelessness and helplessness. At times, depression and dementia can look the same. Younger veterans (18-44) and older veterans (65+) are at greater risk for suicide. Depression looks different in older veterans because they may find difficulty in lack of activities throughout the day. They may also deal with isolation, loss of family members or someone close, and/or financial strain. Dementia could also be causing increased depression 40% of veterans who have been diagnosed with depression have also been diagnosed with PTSD. Information received from: N.A., N.D., One in ten older vets is depressed. U.S. Department of Veterans Affairs. Retrieved from https://www.va.gov/health/NewsFeatures/20110624a.asp

Best Practices Cont. Antidepressants can be affective. Psychotherapy can also be affective. Exercises of present and past experiences can help older veterans with problem-solving and involvement in activities that are important to them. The VA encourages looking back on past experiences and talking about overcoming difficulties. They also feel that this stabilizes veterans “life-long strengths. (Encouraging strengths-based perspective is something social workers constantly implement in their practices.) When a caregiver is involved with therapy it helps as well because the caregiver can help with at-home tasks and challenges. 2/3s of veterans stop taking their antidepressant medication and many do not seek help due to mental health stigmas. The VA is implementing Primary Care Behavioral Health teams for veterans so that they can report depression or receive treatment in their primary care facility rather than a mental health facility. Depression is a common disorder among veterans and that is why it is so important to research and have knowledge on this topic. Information received from: N.A., N.D., One in ten older vets is depressed. U.S. Department of Veterans Affairs. Retrieved from https://www.va.gov/health/NewsFeatures/20110624a.asp

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Summary It is important that social workers have knowledge on depression in elder veterans because it is a common issue among this population. The more knowledge on a population, environment, and how those two interact the better a social worker will be prepared when they come across various clients. Pyschotherapy seems to be more affective than medication. It seems as if an older/depressed veteran would rather talk about issues and past experiences which is something that social workers no doubt acquire skills in throughout practice. More research should be conducted in this area because literature focused primarily on links and causations, not on possible treatment options and implementing them. Shmied et al. (2016) suggests that service members receive treatment involving interventions that would entail prevention of depression. More research should be conducted in greater elder veteran populations because many of the populations in these studies were small. More research should be conducted in prevention plans as well.

References Boakye, E. A., Buchanan, P., Jing, W., Stringer, L., Geneus, C., Scherrer, J. F., & Wang, J. (2017). Self reported lifetime depression and current mental distress among veterans across service eras. Military Medicine, 182(3/4), e1691-e1696. doi:10.7205/MILMED-D-16-00119 Braden, A., Overholser, J., Fisher, L., & Ridley, J. (2015). Life meaning is associated with suicidal Ideation among depressed veterans. Death Studies, 39(1), 24-29. doi:10.1080/07481187.2013.871604 Gould, C. E., Huh, J. T., Brunskill, S. R., McConnell, K., & Tenover, J. L. (2015). Disability and treatment outcomes for anxiety and depression in older veterans. Clinical Gerontologist, 38(4), 268-282. doi:10.1080/07317115.2015.1032463 Hundt, N. E., Barrera, T. L., Robinson, A., & Cully, J. A. (2014). A systematic review of cognitive behavioral therapy for depression in veterans. Military Medicine, 179(9), 942-949. doi:10.7205/MILMED-D-14-00128 Hyer, L., & Stanger, E. (1999). The interaction of posttraumatic stress disorder and depression among older combat veterans. Journal of Clinical Psychology, 55(9), 1073-1083 Schmied, E. A., Larson, G. E., Highfill-McRoy, R. M., & Thomsen, C. J. (2016). Reciprocal relationships between stressors and mental health problems in military veterans. Journal of Social & Clinical Psychology, 35(9), 705-721. doi:10.1521/jscp.2016.35.9.705 N.A., N.D., One in ten older vets is depressed. U.S. Department of Veterans Affairs. Retrieved from https://www.va.gov/health/NewsFeatures/20110624a.asp