Clinical and functional effects of the COVID-19 pandemic and social distancing on Veterans with psychotic disorders and recently-housed Veterans

Abstract

Background: The COVID pandemic has upended the daily lives of everyone in the United States, negatively impacting social interactions, work, and living situations. The pandemic could lead to or exacerbate mental health issues, especially in people who are already vulnerable to such effects. Within the Department of Veterans Affairs (VA) healthcare system two populations vulnerable to social and functional disruptions include those who have recently experienced homelessness (recently housed Veterans, RHV) and those who have a psychotic disorder (PSY). Methods and Findings: We conducted phone interviews with PSY (n = 81), RHV (n = 76) and control Veterans (CTL, n = 74) between mid-May – mid-August, 2020 (“current”) and a retrospective assessment relative to January, 2020 (“pre-COVID”). We assessed clinical factors (e.g., depression, anxiety, loneliness) and community integration (e.g., family and social functioning, work) at both time periods, and risk and protective factors (e.g., resilience, uncertainty) for the current period. The two vulnerable groups had higher levels of clinical symptoms and poorer community integration relative to CTL, as expected. Regarding the effect of the pandemic, results showed that all three groups experienced worse clinical outcomes (i.e., increased depression, anxiety, loneliness) currently vs. pre-COVID; there were no significant interactions between group and time period indicating all three groups were equally impacted by the pandemic. For community integration, there was a small but significant decrease in social networks in all three groups currently vs. pre-COVID. RHV showed a small but significant increase in independent living relative to pre-COVID ratings. Finally, RHV had greater levels of intolerance of uncertainty compared to PSY and CTL.Conclusions: Our results indicate that vulnerable and non-vulnerable Veterans were equally negatively impacted by the COVID-19 pandemic. The lack of a disproportionate effect of the pandemic on the vulnerable groups may be due to the availability and utilization of comprehensive VA services available to vulnerable Veterans (e.g., housing and financial support, medical and mental health services), which may have helped to mitigate the impact of the pandemic.