title: Differences in Depression Care for Men and Women among Veterans with and without Psychiatric Comorbidities.
abstract: Depression is common among primary care patients, affecting more women than men. Women veterans are an extreme but growing minority among patients seeking care from the Department of Veterans Affairs (VA), an organization historically designed to serve men. Little is known about gender differences in depression care quality within the VA primary care population.
  
  
  
  This works assesses the gender differences in depression care among veterans using longitudinal electronic measures.
  
  
  
  We undertook a cross-sectional study of all veteran VA primary care users with a new episode of depression from federal fiscal year 2010, covering nine geographically diverse regions. We assessed the quality of depression care based on receipt of minimally appropriate depression treatment within 1 year of a new episode of depression and on receipt of depression-related follow-up visits within 180 days. Minimally appropriate treatment and follow-up were operationalized as meeting or exceeding a minimally appropriate threshold for care, based on national quality measures and expert panel consensus. Regression models were used to produce predicted probabilities for each process outcome accounting for the presence or absence of other psychiatric comorbidities. All models were adjusted for model covariates and clinic clusters (404 sites).
  
  
  
  In 2010, 110,603 veterans with a primary care visit had a new episode of depression; 10,094 (9%) were women. In multivariate analyses, women had modest yet significantly higher rates of minimally appropriate depression treatment than men, whether patients had depression only (79% of women vs. 76% of men; p < .001) or depression along with other psychiatric comorbidities (92% of women vs. 91% or men; p < .001). There were no significant gender differences for rate of receipt of follow-up for depression at 180 days. Interactions between gender and other psychiatric comorbidities were not significant.
  
  
  
  Our findings suggest that the VA is achieving comparable depression care between genders at minimally appropriate thresholds.
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California. Electronic address: Christine.Lam@va.gov.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Lam
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Cathy
authors.initials: C
authors.lastname: Sherbourne
authors.affiliation: Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California; Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, California.
authors.forename: Lillian
authors.initials: L
authors.lastname: Gelberg
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Lee
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California.
authors.forename: Alexis K
authors.initials: AK
authors.lastname: Huynh
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California.
authors.forename: Karen
authors.initials: K
authors.lastname: Chu
authors.affiliation: Mental Health Services, Department of Veterans Affairs, Washington, DC; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Strauss
authors.affiliation: VA HSR&D Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, Michigan.
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Metzger
authors.affiliation: VA HSR&D Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Post
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California; RAND Corporation, Santa Monica, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Farmer
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care; D012737:Sex Factors; D014481:United States; D014728:Veterans / Q000523:psychology