Prevalence, risk and protective factors associated with suicidal ideation during the COVID-19 pandemic in U.S. military veterans with pre-existing psychiatric conditions

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the mental health of the general population. However, less is known about its impact on vulnerable populations, such as veterans with pre-existing psychiatric conditions. Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative cohort of U.S. veterans. Pre-pandemic and 1-year peri-pandemic risk and protective factors associated with suicidal ideation (SI) were examined in veterans with pre-existing psychiatric conditions. 19.2% of veterans screened positive for SI peri-pandemic. Relative to veterans without SI, they had lower income, were more likely to have been infected with COVID-19, reported greater COVID-19-related financial and social restriction stress, and increases in psychiatric symptoms and loneliness during the pandemic. A multivariable analysis revealed that older age, greater pre-pandemic psychiatric symptom severity, past-year SI, lifetime suicide attempt, psychosocial difficulties, COVID-19 infection, and past-year increase in psychiatric symptom severity were linked to peri-pandemic SI, while pre-pandemic higher income and purpose in life were protective. Among veterans who were infected with COVID-19, those aged 45 or older and who reported lower purpose in life were more likely to endorse SI. Monitoring for suicide risk and worsening psychiatric symptoms in older veterans who have been infected with COVID-19 may be important. Interventions that enhance purpose in life may help protect against SI in this population.

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

“…In addition, veterans are more likely to have a history of psychiatric conditions, such as PTSD, suicidal behavior, and substance use disorders relative to the non-veteran population (Hoggatt, Lehavot, Krenek, Schweizer, & Simpson, 2017 ; Lehavot, Katon, Chen, Fortney, & Simpson, 2018 ; United States Department of Veterans Affairs Office of Mental Health & Suicide Prevention, 2019 ), which may be exacerbated by pandemic stressors (Murphy, Williamson, Baumann, Busuttil, & Fear, 2020 ). Indeed, one previous study of veterans with pre-existing psychiatric disorders found that pre-pandemic psychiatric symptom severity predicted suicide ideation during the pandemic (Na et al, 2021 ). Finally, relative to civilians, veterans have higher rates of medical morbidities such as cardiovascular disease, obesity, and diabetes (Hoerster et al, 2012 ; Lehavot, Hoerster, Nelson, Jakupcak, & Simpson, 2012 ), which may increase vulnerability to health-related stressors including risk of severe disease from COVID-19 infection and pandemic-related delays in obtaining routine health care (Földi et al, 2020 ; Ssentongo, Ssentongo, Heilbrunn, Ba, & Chinchilli, 2020 ).…”

Prevalence of suicidality in clinically stable patients with major depressive disorder during the COVID-19 pandemic

“…Previous studies have found that the overall prevalence of SI is 16.4% in the general population of China during the COVID-19 pandemic ( Shi et al, 2021 ). Moreover, 19.2% of veterans with pre-existing psychiatric conditions in the US screened positive for SI during the peri-pandemic period ( Na et al, 2021 ). A multivariable analysis has also linked greater pre-pandemic psychiatric symptom severity, past-year SI, lifetime SA, psychosocial difficulties, COVID-19 infection, and past-year increases in psychiatric symptom severity to peri-pandemic SI ( Na et al, 2021 ).…”

“…Moreover, 19.2% of veterans with pre-existing psychiatric conditions in the US screened positive for SI during the peri-pandemic period ( Na et al, 2021 ). A multivariable analysis has also linked greater pre-pandemic psychiatric symptom severity, past-year SI, lifetime SA, psychosocial difficulties, COVID-19 infection, and past-year increases in psychiatric symptom severity to peri-pandemic SI ( Na et al, 2021 ). In addition, individuals with psychiatric disorders have a 1.64-fold higher risk of SI compared to those without disorders ( Papadopoulou et al, 2021 ).…”

“…One limitation of the literature on suicidality during the COVID-19 pandemic is that studies have tended to focus exclusively upon SI ( Na et al, 2021 ; Shi et al, 2021 ), even though suicidality also comprises SP and SA ( Tuisku et al, 2006 ). In addition, studies have tended to assess risk in heterogeneous populations so less in known about prevalence and predictors within certain diagnostic groups such as people with MDD.…”

Spontaneous transient states of fronto-temporal and default-mode networks altered by suicide attempt in major depressive disorder

“…A meta-analysis provides that suicide attempt (SA) has 31% lifetime prevalence in individuals with major depressive disorder (MDD) across the world [2]. The topic of depression and suicide is unprecedentedly urgent and essential as the increased suicidality in the COVID-19 pandemic reported from different countries [3][4][5]. At present, clinical assessments of suicide risk usually rely on retrospective information, which are often unsatisfactory [6].…”