FAC T SHEET FOR PROVIDERS

A Health Campaign of Uniformed Services University, www.usuhs.edu, and theCenter for the Study of Traumatic Stress, Bethesda, Maryland, www.CSTSonline.org

Depression in Primary Care:
A Military Health Care Perspective
Our nation’s war on terror affects
increased expectations of family andDuetoconcerns
aroundstigmaand
the health of our military and theirfriends, the sadness of not having a loved
families. Deployment, redeployment,
one present, or having to say goodbye
one’s career, primary care is often
single parenting, long absences, andsoon after a holiday reunion.
thesettingofchoiceforservice
losses sustained from injury or death are
Primary care providers play anmembers and families to address
stressors that impact our community’s
important role in early detection andphysical and mental health. While many
intervention of mental disorders, whichmental health issues.
service members and their families arecan often prevent and mitigate long-term
resilient, other service members (andhealth consequences. Due to concerns
their families) may experience mental health problems thataround stigma and one’s career, primary care is often therequire medical attention.
setting of choice for service members and families to address
Depression, one of the most common and treatablemental health issues. This Courage to Care Fact Sheetmental disorders, often presents itself during a primary
addresses the impact of depression on our military and theircare visit. This can be in the form of unexplained fatigue
families, and the importance of the primary care setting forand vague aches and pains. Depression can also result from
helping in its early identification and intervention.
or be exacerbated by the stress of preparing for holidays,MILITARY UNIQUE ISSUES FORCONSIDERATIONSUGGESTIONS FOR MENTAL HEALTHOUTREACH IN PRIMARY CARE

Primary care settings should be alert to thefollowing:

Observe
The signs of depression are often obvious. It is important
to observe changes in demeanor and in mood of patientswith whom one is familiar. Depression can also manifest
in fatigue, problems with concentration and sleep, andweight loss. Unexplained pains and headaches may also besymptoms that warrant exploration.

■ Upon return from duty, a mental health screen called

the PDHA (post-deployment health assessment) isadministered; the PDHRA (post-deployment healthreassessment) is administered 90–180 days after
returning home.

■ The need for mental health services has been found to

be greater for those who have deployed to Iraq versus
those who have deployed to Afghanistan or otherlocations.

■ Barriers to care include the availability of mental

health resources (particularly to family members)
at more remote military posts and the availability toreservists and National Guard Soldiers who may be inlocations where there are no military posts.

Ask
Screening can be simple, quick and to the point. “Howhave you been feeling lately?” can be an excellent lead in tofacilitate discussion. For first time patients, questions suchas “What brings you here today?” followed by “Are thesesymptoms or feelings you have experienced in the past?”
can open up dialogue. Always remember — “Safety first.”
Inquiring about thoughts of suicide is always important.
Continued

Listen
There may be a sense of, “I can handle it on my own,” ora sense of shame about having feelings that could indicate
depression. Being there and listening can be of the greatest
assistance. Help-seeking begins with self-awareness and asense of safety, which can be facilitated by your presenceand interest.
Reinforce
Treatment is effective. The majority of individuals whoseek and receive treatment will get better. Depression
also affects one’s family. Taking care of one’s self protects
the health and cohesion of one’s family. Adherence toprescribed medication is important. As with many healthissues (such as hypertension and diabetes), medication
adherence is a challenge. A primary care visit can be aSuicide Alert
Anyone who expresses suicidal intentions should betaken very seriously. Over 90% of people who die bysuicide have clinical depression or another diagnosable
mental disorder, and substance abuse is often a factor.
Although women attempt suicide more than men, fourtimes as many men die as a result of suicide and 73% of
all suicide deaths are white males. If a patient expresses
suicidal intentions, assist the patient and/or their family
member to seek professional mental health servicesimmediately or to go to a local emergency room.
Signs of Depression and Possible Suicide Risk
■ Talking About Dying — any mention of dying,

disappearing, jumping, shooting onesself or othertypes of self-harm.

■ Recent Loss — death, divorce, separation, broken

relationship, loss of job, money, status, selfconfidence, self-esteem, loss of religious faith, loss ofinterest in friends, sex, hobbies, activities previouslyenjoyed.

“teachable moment” to reinforce the progress a patient has
made and the benefits to self and family of adhering totreatment.
AssureAssure patients that “depression does not meandischarge.” Explain to service members that many onactive duty might be in treatment for depression andcontinue to work effectively. A diagnosis of depression
does not necessarily require medications; mild tomoderate depression can be treated with a variety ofnonpharmacological approaches. The earlier one receives
help for depression the less likely it will develop into a more
serious problem, that could affect one’s job, health, andrelationships.

■ Change in Personality — sad, withdrawn, irritable,anxious, tired, indecisive, apathetic.

■ Change in Behavior – inability to concentrate on

school, work, routine tasks.

■ Change in Sleep Patterns — insomnia, often withearly waking or oversleeping, nightmares.

■ Change in Eating Habits — loss of appetite andweight, or overeating.

■ Diminished Sexual Interest — impotence, menstrualabnormalities (often missed periods).

■ Fear of Losing Control — going crazy, harming self orothers.

■ Low Self Esteem — feeling worthless, shame,overwhelming guilt, self-hatred, “everyone would bebetter off without me”.

■ No Hope for the Future — believing things will neverget better; that nothing will ever change.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org