Epilepsy, and specifically drug-resistant epilepsy (DRE), is associated with an increased risk of psychiatric dysfunction, likely due to a combination of physiological mechanisms, emotional reactions to disease burden, and bi-directional influences. Women with epilepsy warrant special consideration due to many factors, including hormonal influences on seizure susceptibility, reproductive health considerations, and unique psychiatric and clinical profiles. However, there is yet to be large-scale research characterizing women with DRE. The present study characterized psychiatric conditions, treatment, and hospitalization data in a Veterans Health Administration (VHA)-wide sample of women Veterans and then compared results to a male Veteran sample to explore sex differences.

Data from 52,579 Veterans enrolled in VHA care between FY2014 and 2nd Quarter FY2020 were gathered from the VHA Corporate Data Warehouse administrative data. The sample was comprised of 5,983 women (11.4%) and 46,596 men (88.6%). Demographics, psychiatric diagnoses, psychiatric medications, ER visits, and hospitalizations were characterized. Chi-square analyses were used to examine group differences between men and women.

The vast majority of the women Veteran sample had at least one psychiatric diagnosis (86.1%), with over half of the sample diagnosed with depression (68.3%), PTSD (54.1%), and/or anxiety disorders (57.7%). When compared to men, women Veterans were more likely to have a psychiatric diagnosis (86.1% vs. 68.1%), evidenced a higher number of co-morbid psychiatric conditions (2.4 vs. 1.6), and were prescribed more psychiatric medications (3.4 vs. 2.3; all significant at p<0.001). All individual psychiatric diagnoses were more prevalent in women than men and, notably, suicidality was also higher in women (13.5% vs. 10.0%; p < 0.001). Women Veterans also had a higher number of ER visits (6.9 vs. 5.5; p < 0.001) and psychiatric hospitalizations than men (.4 vs. .3, p < 0.001).

The present study represents the largest known investigation to date of women with DRE and is also the largest study of women Veterans with any form of epilepsy. It highlights a vast psychiatric burden in this subset of women Veterans, with high rates of psychiatric comorbidity, lending to downstream effects on psychiatric medication burden and risk for emergency care usage and psychiatric hospitalization. Comparisons to men emphasize that women are differentially impacted by the psychiatric toll of DRE and warrant special consideration. The markedly higher rates of depressive disorders and suicidality in women Veterans with DRE is especially notable when considering risk of harm and mortality. Overall, the present work adds to the paucity of literature of women Veterans with seizures and gaps in the broader DRE research base, with implications for specialized screening and maximizing treatment interventions in this population.