Study Shows Rates of Mental Health Diagnoses are Higher among Veterans with Obesity than Veterans without Obesity
Among the six million Veterans using VA healthcare, more than 40% have obesity. About 95% of VA patients are weighed annually, and VA administrative data provide national, population-level information on a wide range of mental health conditions; thus, VA data are useful for comparisons of mental health diagnosis rates among people with and without obesity. The objective of this study was to examine rates of mental health diagnoses among a national cohort of women and men VA primary care patients with and without obesity. Mental health diagnoses included depressive disorders, anxiety disorders, PTSD, alcohol and drug use disorders, psychotic disorders (e.g., schizophrenia), and other mental health diagnoses (e.g., eating disorders, personality disorders) based on fiscal year 2014 ICD-9 diagnosis codes in VA inpatient, ambulatory care, and VA-purchased community care. The final study cohort included 4,524,787 men (42% with obesity) and 342,262 women (44% with obesity).
- Rates of any mental health diagnosis were higher among women than men (52% vs. 36%) and people with versus without obesity (women 54% vs. 50%; men 38% vs. 35%).
- Depression and PTSD diagnosis rates were higher for women and men with versus without obesity. For example, there was a 25% higher PTSD diagnosis rate among men with obesity versus without.
- Women with obesity had higher rates of psychotic disorder diagnoses than women without obesity; this was not found for men.
- Substance use disorder diagnosis rates were lower for women and men with versus without obesity. Anxiety diagnosis rates were slightly lower among women with versus without obesity; this was not found for men.
- A sizable proportion of women (46%) and men (62%) with obesity had no mental health diagnoses.
- Results provide further support for the finding that many Veterans have concurrent obesity and mental health diagnoses. Integrated treatments addressing obesity and mental health could benefit patients, providers, and the healthcare system by meeting patients' physical and mental health needs in less time than separate treatments.
- The study did not assess for differences by race/ethnicity.
- The study relied on administrative data, so it is possible that some patients had undiagnosed mental health conditions.
This work was supported by an HSR&D Career Development Award (CDA 15-257) to Dr. Breland; Drs. Breland, Frayne, and Timko are part of HSR&D’s Center for Innovation to Implementation; Dr. Washington is part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy, and Dr. Maguen is with the San Francisco VA Health Care System.
Breland JY, Frayne SM, Timko C, Washington DL, and Maguen S. Mental Health and Obesity among Veterans: A Possible Need for Integrated Care. Psychiatric Services. January 30, 2020; Epub ahead of print.