Connecting Veterans to Depression Treatment: The Importance of Social contexts and Accessibility.

Rodrigues S, Bokhour B, Mueller N, Dell N, Osei-Bonsu PE, Eisen S, Elwy R. Connecting Veterans to Depression Treatment: The Importance of Social contexts and Accessibility. Poster session presented at: American Public Health Association Annual Meeting and Exposition; 2014 Nov 17; New Orleans, LA.

Background: The Department of Veterans Affairs mandates annual depression screening in primary care; however, many Veterans delay seeking treatment after screening positive, which can increase the severity and impact of depression. Objectives: To explore Veteran perceptions of depression and determine the facilitators and barriers of seeking care. Research Design: Qualitative, semi-structured interviews following participation in a larger survey study. Subjects: Veterans (N = 23) who screened positive for a new episode of depression at three primary care clinics in the Northeast region of the United States. Measures: Semi-structured interviews were conducted to elicit stories about depression while exploring the social and cultural underpinnings of depression that contribute to barriers and facilitators of seeking care. Grounded thematic analysis was conducted to identify key themes of Veterans' understanding of depression and treatment. Results: Context and access were identified as two key themes in Veterans' decisions to seek care. Context involved social aspects, like isolation, that made treatment seeking difficult and contributed to depression. Access involved barriers, like transportation difficulties, that threatened continuity of care once Veterans connected to services. When connected to care, Veterans recognized the important role providers can play in enhancing treatment linkages via support; however, social and logistical factors associated with current living situations exacerbated depression and undermined care. Conclusions: Use of a qualitative approach facilitated rich conversations that revealed facilitators and barriers to treatment and continuity of care related to context and access in living situations. Addressing these issues during screening can maximize treatment linkages following a positive depression screen.