Main Article Content
Cross-sectional study, antidepressant, major depressive episodes, drug utilization, Canadian Forces
Major depression affects a significant proportion of individuals including those serving in the military; but, there is less information on the pharmacological treatment they receive.
We assessed the prevalence and determinants of past year antidepressant use among regular and reservist members of the Canadian Forces who have experienced major depressive episodes in the past 12 months.
The 2002 Canadian Community Health Survey Cycle 1.2 Canadian Forces Supplement (CCHS1.2-CFS) surveyed 8441 active members of the Canadian Forces. Individuals who reported experiencing major depressive episodes (MDE) in the past 12 months, according to the definition of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), were examined with data from the CCHS1.2-CFS. Regression models assessed sociodemographic determinants and service factors of antidepressant use employing appropriate weights and bootstrapping variance estimation methods.
Overall, 7.4% of members of the Canadian Forces experienced MDE in the past 12 months, and of those only 32.1% reported to have taken an antidepressant. Significant predictors of antidepressant use were marital status i.e. married/common law (OR=3.6, 95%CI 2.0-6.4), widowed/separated/divorced (OR=4.0, 95%CI 2.0-8.4), and being in both combat and peacekeeping missions (OR=2.2, 95%CI 1.3-3.8).
Findings highlight the characteristics that predispose individuals in the Canadian Forces with MDE to use antidepressant, and serves as a baseline to determine the effectiveness of ongoing programs for diagnosis, treatment and prevention of major depression. Continued research involving the Canadian Forces will foster better understanding of mental health outcomes and effective interventions to improve care.
2. Prigerson HG, Maciejewski PK, Rosenheck RA. Population attributable fractions of psychiatric disorders and behavioral outcomes associated with combat exposure among US men. Am J Public Health 2002 Jan;92(1):59-63.
3. Charatan F. One in five US soldiers have depression or post-traumatic stress disorder, study finds. BMJ 2008 Apr 26;336(7650):913.
4. Erbes C, Westermeyer J, Engdahl B, et al. Posttraumatic stress disorder and service utilization in a sample of service members from Iraq and Afghanistan. Mil Med 2007 Apr;172(4):359-63.
5. Grieger TA, Cozza SJ, Ursano RJ, et al. Posttraumatic stress disorder and depression in battle-injured soldiers. Am J Psychiatry 2006 Oct;163(10):1777-83; quiz 1860.
6. Hoge CW, Castro CA, Messer SC, et al. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004 Jul 1;351(1):13-22.
7. Levy BS, Sidel VW. Health Effects of Combat: A Life-Course Perspective. Annu Rev Public Health 2008 Oct 16.
8. Luchins DJ. Social disadvantage and the mental health of military personnel returning from Iraq and Afghanistan. Adm Policy Ment Health 2008 Jul;35(4):270-1.
9. Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA 2007 Nov 14;298(18): 2141-8.
10. Sareen J, Belik SL, Afifi TO, et al. Canadian military personnel's population attributable fractions of mental disorders and mental health service use associated with combat and peacekeeping operations. Am J Public Health 2008 Dec;98(12):2191-8.
11. Sareen J, Cox BJ, Afifi TO, et al. Combat and peacekeeping operations in relation to prevalence of mental disorders and perceived need for mental health care: findings from a large representative sample of military personnel. Arch Gen Psychiatry 2007 Jul;64(7):843-52.
12. Patten SB, Wang JL, Williams JV, et al. Descriptive epidemiology of major depression in Canada. Can J Psychiatry 2006 Feb;51(2):84-90.
13. Lam RW, Kennedy SH, Grigoriadis S, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy. J Affect Disord 2009 Oct;117 Suppl 1:S26-43.
14. Gutschi LM, Vaillancourt R, Boddam R. Antidepressant usage in the Canadian Forces. Mil Med 2006 Feb;171(2):107-11.
15. Canadian Community Health Survey - Mental Health and Well-being - Canadian Forces. Available at: http://www.statcan.gc.ca/cgibin/ imdb/p2SV.pl?Function=getSurvey&SDDS= 5084&lang=en&db=imdb&adm=8&dis=2 (Accessed May 4, 2010).
16. Canadian Community Health Survey Supplement, Cycle 1.2 Mental Health and Wellbeing. Available at: http://www.statcan.gc.ca/imdbbmdi/ instrument/5084_Q1_V1-eng.pdf (Accessed May 4, 2010).
17. SAS 9.1.3 Documentation. Available at: http://support.sas.com/documentation/onlinedoc/ 91pdf/index_913.html (Accessed May 4, 2010).
18. Lapierre CB, Schwegler AF, Labauve BJ. Posttraumatic stress and depression symptoms in soldiers returning from combat operations in Iraq and Afghanistan. J Trauma Stress 2007 Dec;20(6): 933-43.
19. Riddle MS, Sanders JW, Jones JJ, et al. Selfreported combat stress indicators among troops deployed to Iraq and Afghanistan: an epidemiological study. Compr Psychiatry 2008 Jul-Aug;49(4): 340-5.
20. Beck CA, Patten SB, Williams JV, et al. Antidepressant utilization in Canada. Soc Psychiatry Psychiatr Epidemiol 2005 Oct;40(10):799-807.
21. Dohrenwend BP, Turner JB, Turse NA, et al. The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science 2006 Aug 18;313(5789):979-82.
22. Chief of the Defence Staff Launches Canadian Forces Mental Health Awareness Campaign. Available at: http://www.reuters.com/article/pressRelease/idU S181559+25-Jun-2009+MW20090625 (Accessed May 4, 2010).