IntroductionData are emerging showing the adverse consequences on mental health of the general public due to the COVID-19 pandemic. Little is known about the needs of veterans with pre-existing mental health difficulties during the COVID-19 pandemic.MethodsData were collected through a cross-sectional online survey from a randomly selected sample (n=1092) of military veterans who have sought help for mental health difficulties from a veteran-specific UK-based charity. The response rate was 25.2% (n=275). Participants were asked to complete a range of standardised mental health outcomes (post-traumatic stress disorder (PTSD): Post-traumatic Stress Disorder Checklist, common mental health difficulties (CMDs): 12-Item General Health Questionnaire, difficulties with anger: 5-Item Dimensions of Anger Reactions—Revised and alcohol misuse: Alcohol Use Disorders Identification Test) and endorse a list of potential stressors related to changes to daily life resulting from COVID-19. Regression analyses were fitted to explore predictors of mental health severity.ResultsIt was observed that symptoms of common mental disorder and PTSD (69.3% and 65.0%, respectively) were the most commonly reported to have been exacerbated by the pandemic. Lack of social support and reporting increasing numbers of stressors related to COVID-19 were consistently associated with increasing severity of a range of mental health difficulties.ConclusionsOur findings suggest veterans who had pre-existing mental health difficulties prior to the outbreak of COVID-19 may be at increased risk of experiencing CMDs as a result of the pandemic. Intervening to improve levels of social support and offering practical guidance to better manage any additional stressors relating to the pandemic may provide strategies to help reduce the burden of mental health symptoms.

Individuals with preexisting psychological difficulties are at risk of further deterioration of their mental well-being during the COVID-19 pandemic. This longitudinal study, conducted during the period between two national lockdowns, aimed to investigate the impact of the COVID-19 pandemic on veterans in the United Kingdom with preexisting mental health difficulties. Treatment-seeking veterans with preexisting mental health difficulties (N = 95) were surveyed in two waves. Wave 1 was conducted at the end of the first lockdown (June 2020-July 2020), and Wave 2 took place during the second lockdown (November 2020).Participants completed measures to assess symptoms of posttraumatic stress disorder (PTSD); common mental health difficulties (CMDs), including anxiety and depression; anger; and alcohol use. Initial analyses revealed no significant changes in symptoms of PTSD, CMDs, anger, or alcohol use between the lockdowns, ps = .247-.986. However, veterans who experienced more COVID-19related stressors were more likely to experience increases in PTSD, odds ratio (OR) = 6.30, p = .002, and CMD symptoms, OR = 4.32, p = .025. Participants 330

IntroductionAt the start of the COVID-19 pandemic, individuals with pre-existing mental health difficulties were thought to be vulnerable to mental health deterioration due to the emerging threat and the actions taken to control infection rates. Yet, there remained a paucity of research investigating changes in veteran well-being, a population facing higher rates of mental health difficulties compared with the general public. This longitudinal study aimed to investigate the mental health and well-being of UK veterans with pre-existing mental health difficulties at two time points during the COVID-19 pandemic.MethodsUK treatment-seeking veterans (N=121) completed an online survey administered towards the end of the first UK lockdown in June 2020 and 1 year later. Data were gathered on sociodemographic characteristics as well as psychometric measures of post-traumatic stress disorder (PTSD), common mental disorders (CMDs), anger difficulties and alcohol misuse.ResultsThe proportion of veterans meeting criteria of PTSD, anger and alcohol misuse remained similar across the two time points, while significantly fewer veterans met criteria for CMDs 1 year later. A notable proportion of the sample reported challenges in attending mental and physical health appointments, which was positively associated with not working and negatively associated with more COVID-19-related stressors.ConclusionsThese findings suggest that, to date, veterans with pre-existing mental health difficulties appear to demonstrate resilience as the COVID-19 pandemic progressed. However, as the pandemic continued, veterans faced significantly more COVID-19-related stressors, less social support, as well as difficulties attending health appointments.

Background Viral transmission and disease dynamics of COVID-19 in sub-Saharan Africa are still not well understood. This study aims to provide further insight into the epidemiology of COVID-19 in Malawi by estimating the SARS-CoV-2 prevalence and immunity after SARS-CoV-2 infection in a hospital-based setting. Methods We conducted a hospital-based, convenience sampling, cross-sectional survey for SARS-CoV-2 in Lilongwe, Malawi. Participants answered a questionnaire and were tested for SARS-CoV-2 infection using ELISA and RT-PCR. To estimate immunity, a surrogate virus neutralization test was performed in all seropositive samples. Poisson regression was performed to assess the association of SARS-CoV-2 point prevalence and demographic and behavioral variables. Findings A total of 930 participants were included in the study. We found a combined point prevalence of 10.1% (95% CI 8.4-12.3). Separately analyzed, the RT-PCR positivity was 2.0 % (95% CI 1.2-3.4), and the seropositivity was 9.3% (CI 95% 7.6-11.4). Of the tested seropositive samples, 90.1% (95% CI 81.2%-95.1%) were also tested positive in the surrogate virus neutralization assay. We found a high rate of asymptomatic SARS-CoV-2 infection (45.7%). SARS-CoV-2 point prevalence was significantly associated with being health care worker (PR 1.7; 95% CI 1.1-2.5). Interpretation Our study suggests that official data underestimate the true magnitude of COVID-19 transmission. Performance of sVNT to estimate immunity in Malawi is feasible and revealed a considerable rate of post-infection immunity in our cohort. Subclinical infection and transmission are probably a game-changer with regards to surveillance, mitigation and vaccination strategies. Funding GIZ German Development and RKI Germany supported this study.

LAY SUMMARY Adverse childhood experiences (ACEs) are highly stressful events or situations that occur in childhood and adolescence. Childhood adversities can lead to several negative outcomes in adulthood, including poor physical and mental health. Military populations often report a high number of childhood adversities. Research on ACEs that focuses specifically on female Veterans is lacking. The current study explored the relationships among ACEs, military adversities, and adult health outcomes in female army Veterans in the United Kingdom. In total, 750 female army Veterans completed an online survey containing questions about childhood experiences and military adversities, as well as physical and mental health in adulthood. A large percentage of female army Veterans reported at least one ACE, including emotional and physical abuse. Experience of childhood adversities was most strongly linked to experiencing symptoms of posttraumatic stress disorder in adulthood and experiences of emotional bullying, sexual harassment, and assault during military service.

LAY SUMMARY Adverse childhood experiences (ACEs) are highly stressful events or situations that occur in childhood and adolescence. Childhood adversities can lead to several negative outcomes in adulthood, including poor physical and mental health. Military populations often report a high number of childhood adversities. Research on ACEs that focuses specifically on female Veterans is lacking. The current study explored the relationships among ACEs, military adversities, and adult health outcomes in female army Veterans in the United Kingdom. In total, 750 female army Veterans completed an online survey containing questions about childhood experiences and military adversities, as well as physical and mental health in adulthood. A large percentage of female army Veterans reported at least one ACE, including emotional and physical abuse. Experience of childhood adversities was most strongly linked to experiencing symptoms of posttraumatic stress disorder in adulthood and experiences of emotional bullying, sexual harassment, and assault during military service.

LAY SUMMARY Currently, research on the experiences and challenges of being female in the UK Armed Forces is lacking. The current study aimed to explore some of the challenges and obstacles women have experienced both during their military service and as Veterans. In total, 750 female Veterans from the army were surveyed on their experiences during their military service and as Veterans and on their current physical and mental health problems. The results indicate that women experience several gender-based challenges, such as sexism and discrimination, during military service and as Veterans, and these challenges are linked to current physical and mental health difficulties.

Women are often underrepresented or entirely missing from veteran research, and there remains limited understanding of their mental health needs. The present study investigated the mental health needs of a community sample of UK women veterans. A total of 750/1680 (44.6%) participants completed an online survey. Data was collected on sociodemographic and military factors, mental health and wellbeing, and childhood adversity. Findings revealed a high prevalence and comorbidity of mental health difficulties, including common mental health difficulties (28.6%) and posttraumatic stress disorder (PTSD) (10.8%). Women veterans who were older, not working, held a lower rank during service, perceived less social support and experienced greater loneliness were more likely to report such difficulties. Results further revealed high childhood and military adversity, and wellbeing difficulties. Such findings provide insight into the needs of women veterans and have implications for providing appropriate support. Considerations of the generalizability of findings are discussed.