Mental health impact of the COVID-19 pandemic in U.S. military veterans: a population-based, prospective cohort study

Hill, Melanie L.; Nichter, Brandon; Na, Peter J.; Norman, Sonya B.; Morland, Leslie A.; Krystal, John H.; Pietrzak, Robert H.

doi:10.1017/s0033291721002361

Cited by 45 publications

(74 citation statements)

References 75 publications

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“…Older veterans indicated that the pandemic increased loneliness and sorrow due to the isolation and disruption of their ordinary routines [ 13 ], and researchers also found that a lack of social support and increasing numbers of pandemic-related stressors were associated with mental health difficulties [ 14 ]. In a national sample of US veterans, the pre- to peripandemic prevalence of generalized anxiety disorder increased from 7.1% to 9.4%, with the most pronounced increase observed in veterans aged 45-64 years (8.2% to 13.5%) [ 15 ]. Results of this study further indicated that prepandemic loneliness and pandemic-related social stressors were associated with an increase in psychological distress [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…In a national sample of US veterans, the pre- to peripandemic prevalence of generalized anxiety disorder increased from 7.1% to 9.4%, with the most pronounced increase observed in veterans aged 45-64 years (8.2% to 13.5%) [ 15 ]. Results of this study further indicated that prepandemic loneliness and pandemic-related social stressors were associated with an increase in psychological distress [ 15 ]. Although suicide among veterans over the course of the pandemic did not increase, low social support and worsening of social relationships were among the risk factors present for veterans who did develop new-onset suicide ideation during the pandemic [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel

Jaworski¹,

Taylor²,

Ramsey³

et al. 2022

JMIR Ment Health

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Background Although the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored. Objective The purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. Methods Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021. Results We found that most US veterans (81.5%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3% of eligible participants, n=34), 50% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently. Conclusions The COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel

Jaworski¹,

Taylor²,

Ramsey³

et al. 2022

JMIR Ment Health

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“…One explanation for this finding could be that loneliness is associated with painful emotions (e.g., sadness, jealousy; Olié & Courtet, 2020), whereas the social connectedness measures reflect more disparate aspects of social support that are less reflective of perceived quality of social relationships and perceptions of social isolation and belongingness. Taken together, these findings suggest that loneliness may potentially have greater prognostic utility in predicting suicide attempts than previously conceptualized and thus warrants additional attention in future research, particularly in light of recent research from the COVID‐19 pandemic, which has demonstrated increasing rates of loneliness (Groarke et al, 2020; Hill et al, 2021).…”

Section: Discussionmentioning

confidence: 80%

Risk factors for suicide attempts among U.S. military veterans: A 7‐year population‐based, longitudinal cohort study

Nichter

Stein

Monteith

et al. 2021

Suicide & Life Threat Behav

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Background: Population-based data on risk factors for suicide attempts among veterans remains limited. Methods:A national probability sample of 2307 veterans was followed over the course of four timepoints spanning seven years to examine how a range of baseline risk factors predict incident suicide attempt. Suicide attempt data were aggregated into a single follow-up timepoint.Results: Sixty-two veterans (3.1%) reported attempting suicide during the 7-year period. The strongest risk factors for suicide attempts were higher baseline levels of loneliness, lower baseline levels of adaptive psychosocial traits (e.g., dispositional gratitude), baseline thoughts of self-harm, and greater post-baseline trauma exposures (12.3%-41.3% of explained variance). Veterans with multiple co-occurring risk factors were at greatest risk for attempts; of veterans with 0, 1, 2, 3, and all 4 of these factors, the predicted probability of suicide attempt was 2.0%, 5.3%, 13.5%, 30.4%, and 55.0%, respectively. Conclusions:Baseline loneliness, dispositional gratitude, thoughts of self-harm, and new-onset traumas emerged as the strongest risk factors for suicide attempts among veterans, underscoring the potential importance of targeting these factors in prevention efforts. Veterans with multiple co-occurring risk factors have

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“…The findings of this study are consistent with emerging results regarding the mental health of veteran populations during the pandemic. In a nationally representative sample of US military veterans, the prevalence of major depressive disorder and PTSD positive screens remained stable while the prevalence of generalized anxiety disorder positive screens increased [ 10 ] and the rate of suicidal ideation decreased nearly 10 months into the pandemic [ 9 ]. Regarding the mental health among treatment-seeking veterans with pre-existing mental health difficulties, the UK study revealed no significant changes in symptoms of PTSD during the pandemic [ 11 ] and a study conducted in Croatia revealed a decrease in PTSD symptoms during the onset of the pandemic as compared to the measurement a year before [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the veteran population, the results from recent studies revealed resilience to mental health problems and lower rates of suicidal ideation among US military veterans nearly 10 months into the pandemic [ 8 , 9 ]. However, these studies also showed that the prevalence of generalized anxiety disorder increased and the prevalence of major depressive disorder and post-traumatic stress disorder (PTSD) remained stable during the pandemic [ 10 ]. A recent longitudinal study, conducted during the period between two lockdowns among treatment-seeking veterans with pre-existing mental health difficulties in the UK, did not find any significant changes in symptoms of PTSD, common mental health disorders, anger, or alcohol use between the lockdowns [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

PTSD Symptoms and Coping with COVID-19 Pandemic among Treatment-Seeking Veterans: Prospective Cohort Study

Letica-Crepulja

Stevanović

Palaić

et al. 2022

JCM

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Background: The aim of this study was to examine post-traumatic stress disorder (PTSD) symptom levels and coping strategies during the COVID-19 pandemic among treatment-seeking veterans with pre-existing PTSD. Method: A cohort of 176 male treatment-seeking veterans with pre-existing PTSD during the first COVID-19 pandemic lockdown (T1) and 132 participants from the same cohort one year after the onset of the pandemic (T2) participated in a longitudinal study. All participants responded to a COVID-19-related questionnaire and the following measures: the Life Events Checklist for DSM-5 (LEC-5), PTSD Checklist for DSM-5 (PCL-5) and the Brief COPE. Results: The intensity of overall PTSD symptoms, avoidance symptoms and negative alterations in cognitions and mood was lower at T2. PTSD symptoms were not significantly correlated with SARS-CoV-2 potentially traumatic events (PTE) at T2. Veterans scored higher on emotion-focused and problem-focused coping than on dysfunctional coping. Conclusions: Veterans with pre-existing PTSD who were receiving long-term treatment coped with COVID-19 stressors without the effects of retraumatization and a consequent worsening of PTSD symptoms.

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Mental health impact of the COVID-19 pandemic in U.S. military veterans: a population-based, prospective cohort study

Cited by 45 publications

References 75 publications

Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel

Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel

Risk factors for suicide attempts among U.S. military veterans: A 7‐year population‐based, longitudinal cohort study

PTSD Symptoms and Coping with COVID-19 Pandemic among Treatment-Seeking Veterans: Prospective Cohort Study

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