Impact of Stigma on Veteran Treatment Seeking for Depression

Abstract

The Veterans Health Administration (VHA) mandates annual depression screening in primary care; however, veterans often delay seeking treatment after screening positive, which can increase the severity and impact of depression. This mixed-methods study examined the association between stigma and treatment utilization among veterans (N = 271) in primary care with a positive depression screen. A subsample of veterans (n = 23) participated in a semistructured interview to qualitatively explore the social and cultural contexts of treatment utilization for depression. Treatment utilization data based on Healthcare Effectiveness Data and Information Set (HEDIS) guidelines were obtained by chart review 3 months following the positive screen date. Logistic regression indicated a lack of evidence that stigma was associated with treatment utilization. However, grounded thematic analysis suggested that stigma negatively influenced perceptions of depression and treatment utilization for some veterans. Four themes emerged: (1) depression is weakness; (2) depression is an unwanted label; (3) depression is normal; and (4) overcoming stigma. Evidence from interviews suggests that stigma may play a larger role in decisions about treatment seeking, which was not quantitatively evident. Addressing the psychosocial ramifications of stigma for depression may help minimize treatment lapses and maximize treatment seeking among veterans who screen positive for depression in primary care.