Depressive disorder — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 11 of 2024

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting depressive disorder or death from depressive disorder with the circumstances of a person's relevant service:

1. (1)
   being a prisoner of war before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;
2. (2)
   experiencing a category 1A stressor within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

   Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

3. (3)
   experiencing a category 1B stressor within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

   Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

4. (4)
   experiencing severe childhood abuse before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

   Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.

5. (5)
   experiencing a potentially morally injurious event within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

   Note: potentially morally injurious event is defined in the Schedule 1 - Dictionary.

6. (6)
   having a family member or close friend who experiences a category 1A stressor within the 2 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

   Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

7. (7)
   experiencing the death of a family member or close friend within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;
8. (8)
   experiencing miscarriage, fetal death in utero or stillbirth as a parent, within the 6 months before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;
9. (9)
   experiencing a category 2 stressor within the one year before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

   Note: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.

   Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

10. (10)
    having a clinically significant disorder of mental health within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

    Note: clinically significant disorder of mental health is defined in the Schedule 1 - Dictionary.

11. (11)
    having a sleep-wake disorder for at least the 6 months before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

    Note: Examples of sleep-wake disorders include chronic insomnia disorder, hypersomnolence disorder, narcolepsy, restless legs syndrome and untreated obstructive sleep apnoea.

12. (12)
    having an injury which is life-threatening or which results in serious physical or cognitive disability, within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;
13. (13)
    having a severe, chronic medical condition for at least the 2 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

    Note: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.

14. (14)
    having epilepsy at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;
15. (15)
    having severe and permanent tinnitus at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

    Note: severe and permanent tinnitus is defined in the Schedule 1 - Dictionary.

16. (16)
    having persistent pain of at least 3 months duration at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

    Note: persistent pain is defined in the Schedule 1 - Dictionary.

17. (17)
    having untreated or unsuccessfully treated vitamin D deficiency, with a serum 25-hydroxyvitamin D level of less than 25 nanomoles per litre, at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;
18. (18)
    being obese at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

    Note: being obese is defined in the Schedule 1 - Dictionary.

19. (19)
    experiencing pregnancy or the first 12 months after childbirth as a parent, at the time of the clinical onset of major depressive disorder, major depressive episode or persistent depressive disorder;
20. (20)
    being in the menopausal transition or within the 2 years after the final menstrual period at the time of the clinical onset of major depressive disorder, major depressive episode or persistent depressive disorder;

    Note: menopausal transition is defined in the Schedule 1 - Dictionary.

21. (21)
    having another medical condition, including an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder, where the signs or symptoms of depression are directly related to the pathological process of the medical condition and not solely due to its psychosocial stress effects, at the time of the clinical onset of “depressive disorder due to another medical condition”;
22. (22)
    taking mefloquine or corticosteroids, excluding topical or inhaled corticosteroids, within the 30 days before the clinical onset of substance/medication-induced depressive disorder, where substance/medication-induced depressive disorder persists after the discontinuation or tapering of mefloquine or corticosteroid therapy;
23. (23)
    using a psychoactive substance from the specified list of psychoactive substances at an intoxicant dose within the 30 days before the clinical onset of substance/medication-induced depressive disorder;

    Note: intoxicant dose and specified list of psychoactive substances are defined in the Schedule 1 - Dictionary.

24. (24)
    taking a drug that cannot be ceased or substituted in the long term and which is associated in the individual with the development of depressive symptoms during drug therapy and either: (a) the improvement of depressive symptoms within days or weeks of discontinuing or tapering drug therapy; or (b) the redevelopment of depressive symptoms on rechallenge with the same drug; where the drug was being taken within the 30 days before the clinical onset of substance/medication-induced depressive disorder;
25. (25)
    using a psychoactive chemical or substance at an intoxicant dose, which is associated in the individual with the development of depressive symptoms, and where the psychoactive chemical or substance was being taken within the 30 days before the clinical onset of substance/medication-induced depressive disorder;

    Note: intoxicant dose is defined in the Schedule 1 - Dictionary.

26. (26)
    having ceased or reduced therapeutic or illicit drug use or other substance use within the 30 days before the clinical onset of substance/medication-induced depressive disorder;
27. (27)
    having an alcohol use disorder or a substance use disorder at the time of the clinical onset of substance/medication-induced depressive disorder;
28. (28)
    having smoked tobacco products: (a) on an average of at least 20 cigarettes per day or the equivalent thereof in other tobacco products; and (b) for at least the 2 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder, premenstrual dysphoric disorder or substance/medication-induced depressive disorder; and if smoking has ceased before the clinical onset then that onset occurred within 6 months of cessation;

    Note: cigarettes per day or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.

29. (29)
    inhaling, ingesting or having cutaneous contact with organic solvents, in an unventilated and confined space, on more days than not for a continuous period of at least 5 years before the clinical onset of substance/medication-induced depressive disorder, and where the clinical onset occurs within 2 years of that period;
30. (30)
    having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester or paraquat poisoning within the 30 days before the clinical onset of substance/medication-induced depressive disorder;

    Note: acute cholinergic poisoning, organophosphorus ester and paraquat are defined in the Schedule 1 - Dictionary.

31. (31)
    being a prisoner of war before the clinical worsening of depressive disorder;
32. (32)
    experiencing a category 1A stressor within the 5 years before the clinical worsening of depressive disorder;

    Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

33. (33)
    experiencing a category 1B stressor within the 5 years before the clinical worsening of depressive disorder;

    Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

34. (34)
    experiencing severe childhood abuse before the clinical worsening of depressive disorder;

    Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.

35. (35)
    experiencing a potentially morally injurious event within the 5 years before the clinical worsening of depressive disorder;

    Note: potentially morally injurious event is defined in the Schedule 1 - Dictionary.

36. (36)
    having a family member or close friend who experiences a category 1A stressor within the 2 years before the clinical worsening of depressive disorder;

    Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

37. (37)
    experiencing the death of a family member or close friend within the 5 years before the clinical worsening of depressive disorder;
38. (38)
    experiencing miscarriage, fetal death in utero or stillbirth as a parent, within the 6 months before the clinical worsening of depressive disorder;
39. (39)
    experiencing a category 2 stressor within the 1 year before the clinical worsening of depressive disorder;

    Note: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.

    Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

40. (40)
    having a clinically significant disorder of mental health within the 5 years before the clinical worsening of depressive disorder;

    Note: clinically significant disorder of mental health is defined in the Schedule 1 - Dictionary.

41. (41)
    having a sleep-wake disorder for the 6 months before the clinical worsening of depressive disorder;

    Note: Examples of sleep-wake disorders include chronic insomnia disorder, hypersomnolence disorder, narcolepsy, restless legs syndrome and untreated obstructive sleep apnoea.

42. (42)
    having an injury which is life-threatening or which results in serious physical or cognitive disability, within the 5 years before the clinical worsening of depressive disorder;
43. (43)
    having a severe, chronic medical condition for at least the 2 years before the clinical worsening of depressive disorder;

    Note: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.

44. (44)
    having epilepsy at the time of the clinical worsening of depressive disorder;
45. (45)
    having severe and permanent tinnitus at the time of the clinical worsening of depressive disorder;

    Note: severe and permanent tinnitus is defined in the Schedule 1 - Dictionary.

46. (46)
    having persistent pain of at least 3 months duration at the time of the clinical worsening of depressive disorder;

    Note: persistent pain is defined in the Schedule 1 - Dictionary.

47. (47)
    having untreated or unsuccessfully treated vitamin D deficiency, with a serum 25-hydroxyvitamin D level of less than 25 nanomoles per litre, at the time of the clinical worsening of depressive disorder;
48. (48)
    being obese at the time of the clinical worsening of depressive disorder;

    Note: being obese is defined in the Schedule 1 - Dictionary.

49. (49)
    experiencing pregnancy or the first 12 months after childbirth as a parent, at the time of the clinical worsening of depressive disorder;
50. (50)
    being in the menopausal transition or within the 2 years after the final menstrual period at the time of the clinical worsening of depressive disorder;

    Note: menopausal transition is defined in the Schedule 1 - Dictionary.

51. (51)
    having another medical condition, including an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder, where the signs or symptoms of depression are directly related to the pathological process of the medical condition and not solely due to its psychosocial stress effects, at the time of the clinical worsening of depressive disorder;
52. (52)
    taking mefloquine or corticosteroids, excluding topical or inhaled corticosteroids, within the 30 days before the clinical worsening of depressive disorder, where depressive disorder persists after the discontinuation or tapering of mefloquine or corticosteroid therapy;
53. (53)
    using a psychoactive substance from the specified list of psychoactive substances at an intoxicant dose within the 30 days before the clinical worsening of depressive disorder;

    Note: intoxicant dose and specified list of psychoactive substances are defined in the Schedule 1 - Dictionary.

54. (54)
    taking a drug that cannot be ceased or substituted in the long term and which is associated in the individual with the worsening of depressive symptoms during drug therapy and either: (a) the improvement of depressive symptoms within days or weeks of discontinuing or tapering drug therapy; or (b) the worsening of depressive symptoms on rechallenge with the same drug; where the drug was being taken within the 30 days before the clinical worsening of depressive disorder;
55. (55)
    using a psychoactive chemical or substance at an intoxicant dose, which is associated in the individual with the worsening of depressive symptoms, and where the psychoactive chemical or substance was being taken within the 30 days before the clinical worsening of depressive disorder;

    Note: intoxicant dose is defined in the Schedule 1 - Dictionary.

56. (56)
    having ceased or reduced therapeutic or illicit drug use or other substance use within the 30 days before the clinical worsening of depressive disorder;
57. (57)
    having an alcohol use disorder or a substance use disorder at the time of the clinical worsening of depressive disorder;
58. (58)
    inhaling, ingesting or having cutaneous contact with organic solvents, in an unventilated and confined space, on more days than not for a continuous period of at least 5 years before the clinical worsening of depressive disorder, and where the clinical worsening occurs within 2 years of that period;
59. (59)
    having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester or paraquat poisoning within the 30 days before the clinical worsening of depressive disorder;

    Note: acute cholinergic poisoning, organophosphorus ester and paraquat are defined in the Schedule 1 - Dictionary.

60. (60)
    inability to obtain appropriate clinical management for depressive disorder before the clinical worsening of depressive disorder;

Aggravation-only factors: the factors in subsections 9(31) to 9(60) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.