Distress among veterans peaked 1 year into COVID-19 pandemic

Distress levels among veterans were greater at 1 year into the COVID-19 pandemic, but decreased at 2 years to pre-pandemic levels, according to data published in JAMA Network Open.

“A considerable minority of U.S. adults (approximately 13%) experienced significant increases in distress during the height of the COVID-19 pandemic,” Ian C. Fischer, PhD, of the Department of Veterans Affairs National Center for Posttraumatic Stress Disorder at the VA Connecticut Healthcare System, and colleagues wrote. “It is not clear whether these increases portend exacerbated or persistent courses of distress, and what risk or protective factors are associated with these courses.”

Fischer and colleagues conducted a longitudinal study among 2,289 veterans as part of the National Health and Resilience in Veterans Study from fall 2019 to summer 2022. The researchers evaluated the prevalence of distress — defined as having major depressive disorder, generalized anxiety disorder or PTSD — among the cohort.

Based on the presence or absence of distress before, during and 2 years after the pandemic began, participants were categorized as:

• resistant if they had no positive screens for distress;
• persistent if they had positive screens at each time point;
• remitted if they had a positive screen before the pandemic only;
• resilient if they had a positive screen in the fall/winter of 2020 only; or
• exacerbated if they had positive screens in the fall/winter of 2020 and in summer 2022, but not before the pandemic.

Most veterans (83.7%) were resistant to distress. The second greatest proportion of veterans were categorized as resilient (5.3%), followed by persistent (5%), remitted (3.5%) and exacerbated (2.5%).

Aside from veterans aged 65 years or older, participants of all sexes and ages experienced significantly greater levels of distress during vs. before the pandemic (weighted estimate, 51% increase), which decreased 2 years into the pandemic to pre-pandemic levels. Specifically, those aged 18 to 44 years (weighted estimate, 64% increase) and women (weighted estimate, 62% increase) had the greatest increase in distress from fall 2019 to fall/winter of 2020.

In relative importance analyses, greater COVID-19 socioeconomic concerns (29.4% relative variance explained [RVE]) and less community integration (28.1% RVE) had the greatest association with persistent distress compared with remitted distress. Veterans who had greater problematic alcohol use before the onset of the pandemic had the greatest association (31.9% RVE) with exacerbated distress relative to resilient distress, researchers reported.

“Further research is needed to replicate these findings in other samples, identify factors associated with continued distress over time and evaluate interventions and policies to mitigate distress in veterans at risk for persistent pandemic-related distress,” Fischer and colleagues wrote.