Temporal trends in the prevalence of psychiatric diagnoses among aging veterans in the U.S. Department of Veterans Affairs healthcare system: An analysis by sex, age, period, and cohort.

Women and older adults represent rapidly growing segments of the US veteran population. Understanding sex-specific patterns in psychiatric diagnoses among aging veterans is essential for anticipating future healthcare service needs within the Department of Veterans Affairs (VA). The purpose of this retrospective study was to estimate prevalence and evaluate age-period-cohort trends in overall and broadly defined psychiatric disorders among women and men veterans aged ≥50 years. Using VA Corporate Data Warehouse data, 254,138 women veterans ≥50 years were 1:1 matched to 254,138 men veterans ≥50 years who used VA healthcare between 2000 and 2023. Twelve-month prevalence of overall psychiatric diagnoses and major diagnostic categories, including substance use disorders (SUDs) (alcohol, drug) and mental health disorders (mood, anxiety, and psychotic), were examined by sex across age, period, and cohort axes using descriptive and age-period-cohort interaction analyses. In the overall population, psychiatric diagnoses were identified in 9.0% of women and 10.6% of men veterans. Women had lower SUDs prevalence than men, with SUD rates declining with age in both sexes. Mental health disorders, particularly mood and anxiety disorders, increased during 2015-2023. Psychotic disorders increased with age but declined across calendar periods. Cohort effects were observed for several diagnostic categories, though less pronounced for alcohol use and mood disorders in both sexes and for psychotic disorders among women. In conclusion, psychiatric disorders are increasingly prevalent among more recent cohorts of aging US veterans, with distinct sex-specific age-period-cohort patterns, underscoring the need for tailored strategies for older women and men veterans.