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

COVID-19 impacted the suicidal ideation among health care workers and medical students: An interrupted time-series analysis of data from 30 countries

AIM

To investigate the impact of public health emergencies on the prevalence of suicidal ideation among healthcare workers (HCWs) and medical students.

METHODS

The prevalence of suicidal ideation among HCWs and medical students was searched for analysis. The platforms included PubMed, medRVix, bioRvix, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Interrupted time-series analysis was employed to determine whether the COVID-19 pandemic influenced the prevalence and trends of suicidal ideation. To account for autocorrelation and heteroskedasticity, Newey-West standard errors were utilized with a lag of order one.

RESULTS

Seventy studies with 145,641 HCWs and medical students from 30 countries were included in the final analysis, with 30 studies before COVID-19 and 40 studies during the pandemic. Before the pandemic outbreak (April 2020), the monthly increasing rate was 0.063 % (95 % CI: -0.009 %, 0.135 %, z = 1.73, P = 0.084). The tendency of suicidal ideation prevalence increased by 1.116 % (95%CI: 0.888 %, 1.344 %, z = 9.60, P < 0.001). In other words, the calculated monthly growth rate of suicidal ideation after the pandemic outbreak is 1.179 % (95%CI: 0.968 %, 1.391 %, z = 10.93, P < 0.001) per month. The overall growing trend of prevalence of suicidal ideation during the pandemic is 1.896 % per month in America; 1.590 % in Europe; 0.443 % (95%CI: 0.213 %, 0.673 %, z = 3.77, P < 0.001) in Asia; 1.055 % in HCWs; and 0.645 % in medical students.

CONCLUSION

This study highlights that the COVID-19 pandemic can significantly impact the prevalence of suicidal ideation among HCWs and medical students, and the prevalence showed an upward trend.

The impact of stress and well-being during the COVID-19 pandemic on mental health in U.S. veterans

The COVID-19 pandemic disrupted life around the globe and negatively impacted mental health (MH), including among military veterans. Building on previous research with U.S. veterans, the present study examined the association between a broad array of pandemic stressors and well-being on MH outcomes. A total of 372 veterans (51.3% women) from all service eras completed measures of posttraumatic stress disorder and depression during early (timepoint 1 [T1]) and peri-pandemic (timepoint 2 [T2]) periods. Pandemic-related stressors and well-being (satisfaction in life domains) were assessed at the peri-pandemic timepoint (T2). Logistic regression analyses were used to investigate associations between stressors and well-being with the likelihood of a probable MH diagnosis at T2 controlling for T1 MH status. More negative physical and MH impacts of the pandemic in addition to fewer positive consequences and lower satisfaction with paid work, finances, health, romantic relationships, and social life were associated with a higher likelihood of a probable T2 MH diagnosis. COVID infection was associated with lower odds of a probable T2 MH diagnosis. There were significant indirect effects, such that physical and MH impacts of the pandemic were associated with T2 MH via well-being. Overall, these findings highlight the role of stress and well-being on MH during a global pandemic. Interventions to address well-being may be important to address veteran MH during other periods of stress. Future research should examine the generalizability of study findings and further investigate factors that contribute to veterans' MH resilience during stressful life experiences.

Risk and protective factors for self-harm and suicide behaviours among serving and ex-serving personnel of the UK Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force: A systematic review

BACKGROUND

Self-harm and suicide behaviours are a major public health concern. Several factors are associated with these behaviours among military communities. Identifying these factors may have important implications for policy and clinical services. The aim of this review was to identify the risk and protective factors associated with self-harm and suicide behaviours among serving and ex-serving personnel of the United Kingdom Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force.

METHODS

A systematic search of seven online databases (PubMed, Web of Science, Embase, Global Health, PsycINFO, PTSDpubs and CINAHL) was conducted alongside cross-referencing, in October 2022. Following an a priori PROSPERO approved protocol (CRD42022348867), papers were independently screened and assessed for quality. Data were synthesised using a narrative approach.

RESULTS

Overall, 28 papers were included: 13 from Canada, 10 from the United Kingdom, five from Australia and none from New Zealand. Identified risk factors included being single/ex-relationship, early service leavers, shorter length of service (but not necessarily early service leavers), junior ranks, exposure to deployment-related traumatic events, physical and mental health diagnoses, and experience of childhood adversity. Protective factors included being married/in a relationship, higher educational attainment, employment, senior ranks, and higher levels of perceived social support.

CONCLUSION

Adequate care and support are a necessity for the military community. Prevention and intervention strategies for self-harm and suicide behaviours may be introduced early and may promote social networks as a key source of support. This review found a paucity of peer-reviewed research within some populations. More peer-reviewed research is needed, particularly among these populations where current work is limited, and regarding modifiable risk and protective factors.

Suicidality and its associated factors among mood disorder patients in emergency department in China: a comparative study using propensity score matching approach

Suicidality in mood disorder patients is common, especially in emergency department (ED), but the patterns and associated factors of suicidality are not clear. This study compared biomarkers and mental health symptoms (i.e., depression, anxiety, and psychiatric symptoms) between mood disorder patients with and without the whole range of suicidality comprising suicidal ideation (SI), suicide plan (SP), and suicide attempt (SA). This cross-sectional, comparative, convenient-sampling study was conducted between January 2021 and March 2022, in emergency department of Beijing Anding Hospital, China. Patients with mood disorders at a psychiatric emergency department were assessed, with measurements of suicidality, biomarkers, depressive, anxiety, and psychiatric symptoms were assessed using the 24 items-Hamilton Depression Rating Scale (HAMD-24), Hamilton Anxiety Rating Scale (HAMA), Young Manic Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS), respectively. The propensity score matching (PSM) method was used to identify patients in mood disorder with and without SI, SP, and SA. A generalized linear model (GLM) was used to assess the differences in biomarkers, depressive, anxiety, and psychiatric symptoms between patients in mood disorder with and without SI, SP, and SA. In total, 898 participated in this survey and completed the assessment. Illness duration was significantly negatively associated with SA (OR = 0.969, 95%CI = 0.939-0.999, P = 0.046). HAMD-24 total score was significantly positively associated with the SI (OR = 1.167, 95%CI = 1.134-1.201, p < 0.001), SP (OR = 1.159, 95%CI = 1.126-1.192, p < 0.001) and SA (OR = 1.189, 95%CI = 1.144-1.235, p < 0.001) of the matched samptched sample. However, YMRS total score was significantly negatively associated with the SI (OR = 0.928, 95%CI = 0.905-0.951, p < 0.001), SP (OR = 0.920, 95%CI = 0.897-0.944, p < 0.001) and SA (OR = 0.914, 95%CI = 0.890-0.938, p < 0.001) of the matched sample after adjusting for age, gender, marital status, and occupation. The duration of illness, severity of depressive symptoms and severity of manic symptoms appeared to be more likely to influence suicidality. Considering the significant risk of suicide in mood disorders on psychiatric emergency care, timely treatment and effective management of suicidality in this population group need to be developed.

The prevalence and correlates of suicidal ideation in Chinese psychiatric patients during the fifth wave of COVID-19 in Hong Kong

People with mental disorders have increased risk of psychological distress during COVID-19. However, there is limited research comprehensively examining factors associated with suicidal ideation, the strongest predictor of suicidal behavior, among psychiatric patients amidst pandemic. We investigated prevalence and correlates of suicidal ideation in 407 Chinese psychiatric outpatients (diagnosed with mood, anxiety or schizophrenia-spectrum disorders) aged 18-64 years during the peak of fifth COVID-19 wave in Hong Kong between 28 March and 8 April, 2022, based on a comprehensive array of variables encompassing socio-demographics, illness profile, psychopathological symptoms, psychological measures and pandemic-related factors. Univariate and multivariate logistic regression analyses were conducted to determine correlates of suicidal ideation. Results showed that 128 (31.4%) participants exhibited suicidal ideation. Univariate analyses revealed that being unemployed or full-time student, more severe depressive, anxiety, PTSD-like, insomnia and psychotic symptoms, higher levels of loneliness, avoidant-coping, greater pandemic-related stress burden and distress by social-distancing measures were related to suicidal ideation. Conversely, participants with higher monthly household-income, better quality-of-life, and greater resilience were less likely to have suicidal ideation. Notably, only depressive symptom severity was retained in final multivariate model as a factor significantly associated with suicidal ideation. Hence, we observed that approximately one-third of Chinese psychiatric patients experienced suicidal ideation during fifth pandemic wave. Our findings underscore the influence of depressive symptoms being above and beyond that of other psychopathological symptoms, psychological and pandemic-related variables on suicidal ideation. Longitudinal research is required to clarify suicidal ideation trajectories and predictors of persistent suicidal ideation across pandemic and post-pandemic periods.

Long COVID coping and recovery (LCCR): Developing a novel recovery-oriented treatment for veterans with long COVID

Background

Long COVID has affected 13.5% of Veterans Affairs (VA) Healthcare System users during the first pandemic year. With 700,000+ United States Veterans diagnosed with COVID-19, addressing the impact of Long COVID on this population is crucial. Since empirically-based mental health interventions for Long COVID are lacking, a vital need exists for a tailored recovery-oriented intervention for this population. This study intends to assess the feasibility and acceptability of a novel recovery-oriented intervention, Long COVID Coping and Recovery (LCCR), for Veterans with Long COVID, aiming to support symptom management and quality of life. LCCR is an adaptation of Continuous Identity Cognitive Therapy (CI-CT), a suicide recovery-oriented treatment for Veterans.

Methods

In a two-year open-label pilot, three single-arm treatment trials will be conducted with 18 Veterans suffering from Long COVID. Each trial includes 16 weekly 60-min sessions delivered via VA Video Connect (VVC) and/or VA WebEx. Primary objectives include optimizing LCCR for Veterans with Long COVID and assessing the acceptability and feasibility of the intervention, using attendance and retention rates, drop-out statistics, and client satisfaction levels. Additionally, potential benefits of LCCR will be explored by evaluating alterations in quality of life, resilience, mental health status (anxiety, depression, suicide risk/behavior), and personal identity. The protocol has been tailored based on Veterans' needs assessment interviews and stakeholder feedback.

Conclusion

If the LCCR intervention proves feasible and acceptable, a manualized version will be created and a randomized controlled trial planned to examine its efficacy in the broader Veteran population.

Primary care provider perspectives on virtual and in-person depression management during the COVID-19 pandemic

INTRODUCTION

During the COVID-19 pandemic, primary care providers (PCPs), nurses, and integrated mental health specialists continued to collaboratively manage depression among patients using both in-person and virtual (i.e., hybrid) modalities. Few studies have characterized how hybrid services are currently delivered within interdisciplinary primary care teams. This study aimed to understand frontline PCPs' perspectives on providing hybrid virtual and in-person depression care during the pandemic.

METHOD

From September to November 2020, 12 semistructured individual interviews focused on depression management were conducted with PCPs in two Veterans Health Administration (VA) clinics in Los Angeles, which resumed in-person services while balancing rising COVID-19 cases. Interviews were audio-recorded, transcribed, and coded for depression management patterns. Themes were derived using a team-based constant comparative analytic approach.

RESULTS

The pandemic and subsequent expanded use of virtual care necessitated clinic adaptations to depression assessments and procedures. PCPs perceived increased depression and anxiety among patients with existing psychiatric conditions, attributed to social distancing and isolation restrictions. They expressed acceptance of virtual care modalities for patients' depression management. PCPs did not perceive a delay in mental health care delivery in the shift to virtual care but noted the possibility of patients being lost to follow-up.

CONCLUSIONS

During the pandemic, there has been heightened PCP concern for patients' emotional well-being and adaptations of clinic processes to meet needs for depression care. While PCPs were optimistic about new virtual care options for depression management, virtual care transfers remained poorly defined and the extent to which patient care experiences and health outcomes have been disrupted remains unknown. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of the COVID-19 Pandemic on Indicators of Psychological Health and Suicidal Ideation Within an Active Duty U.S. Military Population

INTRODUCTION

The COVID-19 pandemic has had a significant impact on the psychological health of individuals. The pandemic has contributed to increased anxiety, elevated rates of depression, and worsening suicidal ideation among civilians. Reported rates of burnout are also elevated as employees and employers adapted to ever-changing work environments, finding it increasingly difficult to maintain a work-life balance. The objective of this study is to determine how the COVID-19 pandemic impacted the psychological health and rates of suicidal ideation of active duty military personnel in the USA.

MATERIALS AND METHODS

A total of 2055 military personnel and military-adjacent employees stationed at a U.S. Air Force base completed a self-report survey that was administered six times from January 2020 to December 2021. Validated scales assessed measures of psychological health and suicidal ideation. General Estimating Equations were used to examine how indicators of time and psychological health predicted suicidal ideation in a military population.

RESULTS

Life satisfaction, happiness, feeling life is worthwhile, depression severity, and suicidal ideation did not statistically change across the six time points. Worry (P < .01) and depression (P < .001) did decrease significantly, while burnout (P = .01) significantly increased across these time points. Feeling life is worthwhile significantly predicted reduced suicidal ideation (B = -.19; SE = 0.05), while depression (B = 0.11; SE = 0.03), depression severity (B = 0.24; SE = 0.05), worry (B = 0.06; SE = 0.02), and burnout (B = 0.15; SE = 0.07) predicted increased suicidal ideation.

CONCLUSIONS

The rates of depression and worry decreased throughout the pandemic for those in the study while rates of suicidal ideation remained constant, demonstrating the potential resilience of military personnel and military-adjacent employees in response to the COVID-19 pandemic. However, burnout increased and significantly predicted elevated rates of suicidal ideation, highlighting the importance of focusing on reducing workplace stressors for military personnel.

"I Can't See an End in Sight." How the COVID-19 Pandemic May Influence Suicide Risk

Background: The COVID-19 pandemic and its consequences may affect population mental health and suicide risk. Aims: To explore the experiences among suicidal individuals who made calls to a suicide prevention hotline and to identify factors and psychological responses that may influence suicide risk. Method: We identified 60 eligible recorded calls to Taiwan's suicide prevention hotline (January 23, 2020-May 31, 2020) and analyzed the transcripts using a framework analysis. Results: We identified three themes: (a) effects of the COVID-19 pandemic on society (impacts on local economies, the fear of contagion, and disruptions caused by outbreak control measures); (b) stress experienced by callers, including increased challenges (financial burden, restricted freedom of movement, interpersonal conflicts, feelings of uncertainty, and education/career interruption) and reduced support (reduced access to health services and social support); and (c) the callers' psychological responses to stress, including anxiety, sleep disturbance, depression, loneliness, hopelessness, and entrapment, which may increase suicide risk. Limitations: Only the experiences among those who sought help by calling the hotline during the early months of the pandemic in 2020 were explored. Conclusion: Our findings revealed the potential process underlying the impact of the COVID-19 pandemic on suicide risk and have implications for prevention and intervention strategies.

Changes in mental health among U.S. military veterans during the COVID-19 pandemic: A network analysis

Increases of symptoms of posttraumatic stress disorder (PTSD), anxiety and depression have been observed among individuals exposed to potentially traumatic events in the first months of the COVID-19 pandemic. Similarly, associations among different aspects of mental health, such as symptoms of PTSD and suicidal ideation, have also been documented. However, studies including an assessment prior to the onset and during the height of the pandemic are lacking. We investigated changes in symptoms of PTSD, depression, anxiety, suicidal ideation, and posttraumatic growth in a population-based sample of 1232 U.S. military veterans who experienced a potentially traumatic event during the first year of the pandemic. Symptoms were assessed prior to (fall/winter 2019) and one year into the pandemic (fall/winter 2020). We compared changes in symptom interrelations using network analysis, and assessed their associations with pandemic-related PTSD and posttraumatic growth symptoms. A subtle increase in psychopathological symptoms and a decrease in posttraumatic growth was observed one year into the pandemic. The peripandemic network was more densely connected, and pandemic-related PTSD symptoms were positively associated with age, anxiety, worst-event PTSD symptoms, and pandemic-related posttraumatic growth. Our findings highlight the resilience of veterans exposed to a potentially traumatic event during the first year of a pandemic. Similarly, the networks did not fundamentally change from prepandemic to one year into the pandemic. Despite this relative stability on a group level, individual reactions to potentially traumatic events could have varied substantially. Clinicians should individualize their assessments but be aware of the general resilience of most veterans.

Hope, proactive personality, coping styles, and satisfaction with life among veterans during COVID-19

Veterans of the U.S. Armed Forces are an at-risk population given their increased mental health concerns resulting from their military service. However, there has been limited research conducted with this population during the novel coronavirus (COVID-19) pandemic. The purpose of this exploratory study was to examine aspects of positive psychological functioning with 132 U.S. veterans during COVID-19 using Lazarus and Folkman's (1984) transactional model of stress and coping. Specifically, we examined the personal resources of hope and proactive personality, two coping styles, and satisfaction with life. We performed correlation analyses to determine how these constructs related to each other. We also conducted a regression analysis to examine if the two dimensions of hope, proactive personality, adaptive coping, and maladaptive coping predicted veterans' satisfaction with life. Lastly, we utilized a mediation analysis to investigate whether two coping styles mediated the relationships among personal resources and satisfaction with life. Findings from the regression analysis suggested hope pathways and proactive personality were significant predictors of satisfaction with life. Results from the mediation analysis suggested that adaptive and maladaptive coping did not mediate the relationships among personal resources and satisfaction with life.

The perceived impact of pandemic scale (PIPS): Initial development and examination among U.S. military veterans

The COVID-19 pandemic has had significant impacts, including increases in mental health problems, distress, interpersonal conflict, unemployment, loss of income, housing instability, and food insecurity. Veterans may be particularly vulnerable to such impacts given their burden of mental and physical health problems. Few existing measures assess pandemic impact, and none have been validated for use with Veterans. We developed such a measure (the Perceived Impact of the Pandemic Scale; PIPS) and examined its psychometric performance in a national sample of US Veterans. Survey data from 567 Veterans were collected between 12/2020 and 2/2021. To examine PIPS factor structure, split sample exploratory/confirmatory factor analyses (EFA/CFA) were conducted to identify and test the most plausible model among an initial set of 18 items. Based on tests of factor extraction and factor loadings, 15 items clearly loaded onto three distinct factors. Internal reliability of all factors was ω > 0.8 and CFA model fit was good (χ2(87) = 167.39, p < .001; SRMR = 0.068; RMSEA = 0.060 [95% CI: 0.05, 0.07], CFI = 0.92). Mean factor scores were significantly positively correlated with measures of depression and loneliness, and negatively correlated with perceived social support. Results suggest the PIPS assesses three internally reliable factors comprised of perceived impact of the pandemic on interpersonal relationships, financial impact, and personal health and well-being. Construct validity with US Veterans was supported. The PIPS may be useful for examining the potentially disparate impact of pandemics on different populations. Research is needed to validate the PIPS in non-Veteran populations.

Telehealth experiences in Canadian veterans: associations, strengths and barriers to care during the COVID-19 pandemic

INTRODUCTION

Identifying barriers to care in veteran populations is critical, as veterans face increased social isolation, relationship strains and financial insecurities. For Canadian veterans experiencing barriers to accessing healthcare, telehealth may be a promising alternative with comparable effectiveness to in-person services; however, the potential benefits and limitations of telehealth require further examination to determine its long-term utility, and to inform health policy and planning. The goal of the present research was to identify predictors and barriers to telehealth usage in Canadian veterans in the context of the COVID-19 pandemic.

METHODS

Data were drawn from baseline data of a longitudinal survey examining the psychological functioning of Canadian veterans during the COVID-19 pandemic. Participants were 1144 Canadian veterans aged 18-93 years (M_age=56.24, SD=12.92; 77.4% men). We assessed reported telehealth use (ie, for mental healthcare, physical healthcare), healthcare access (ie, difficulty accessing care, avoidance of care) and mental health and stress since the beginning of the COVID-19 pandemic, sociodemographic variables and open-ended responses about telehealth experiences.

RESULTS

Findings suggest that sociodemographic factors and previous telehealth use were significantly associated with telehealth use during the COVID-19 pandemic. Qualitative evidence highlighted both the benefits (eg, reducing barriers of access) and drawbacks (eg, not all services can be delivered) of telehealth services.

CONCLUSIONS

This paper provided a deeper understanding of Canadian veterans' experiences with accessing telehealth care during the COVID-19 pandemic. While for some, the use of telehealth mitigated perceived barriers (eg, safety concerns of leaving home), others felt that not all health services could be appropriately carried out through telehealth. Altogether, findings support the use of telehealth services in increasing care accessibility for Canadian veterans. Continued use of quality telehealth services may be a valuable form of care that extends the reach of healthcare professionals.

Psychological consequences among veterans during the COVID-19 pandemic: A scoping review

Although there is an increasing number of studies reporting the psychological impact of COVID-19 on the general population and healthcare workers, relatively less attention has been paid to the veterans. This study aimed to review the existing literature regarding the psychological consequences of COVID-19 on veterans. A systematic search was conducted on PubMed, Embase, and the Cochrane Library from inception to December 3, 2022. A total of twenty-three studies were included with moderate-quality of evidence. Veterans experienced more mental health problems than civilians. The prevalence rates of alcohol use, anxiety, depression, post-traumatic stress disorder, stress, loneliness, and suicide ideation significantly increased during the pandemic, ranging from 9.6% to 47.4%, 9.4% to 53.5%, 8.6% to 55.1%, 4.1% to 58.0%, 4.3% to 39.4%, 15.9% to 28.4%, and 7.8% to 22.0%, respectively. The main risk factors of negative consequences included pandemic-related stress, poor family relationships, lack of social support, financial problems, and preexisting mental disorders. In contrast, higher household income and greater community interaction and support appeared to be resilience factors. In conclusion, the COVID-19 pandemic has increased adverse mental health consequences among veterans. Tackling mental health issues due to the COVID-19 pandemic among veterans should be a priority.

Suicide and COVID-19: a rapid scoping review

There is considerable interest in exploring effects of coronavirus disease 2019 (COVID-19) pandemic on mental health. Suicide is one of the leading causes of mortality worldwide and changes in daily life brought by the pandemic may be additional risk factors in people with pre-existing mental disorders. This rapid PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between COVID-19 pandemic outbreak, along with COVID-19 disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, and suicide in individuals with previously diagnosed mental disorders. First, we conducted a comprehensive review of the literature, then proceeded to discuss findings in a narrative way. Tables were constructed and articles sorted according to the studies' methodologies. 53 papers were eventually identified as eligible, among which 33 are cross-sectional studies, 9 are longitudinal studies, and 11 studies using other methodologies. Despite suffering from a mental disorder is a risk factor for suicidal behavior per se, the advent of COVID-19 pandemic may exacerbate this relation. Nevertheless, data addressing a clear correlation between suicidal behavior and the pandemic outbreak are still controversial. Longitudinal analysis using validated suicide scales and multicenter studies could provide deeper insight and knowledge about this topic.

Outreach to the Veterans Crisis Line During the COVID-19 Pandemic: A Mixed-Methods Analysis

OBJECTIVE

The mental health impacts of the COVID-19 pandemic have been widely felt among already vulnerable populations, such as U.S. military veterans, including a heightened risk for depression and suicidal ideation. Support hotlines such as the Veterans Crisis Line (VCL) took a central role in addressing various concerns from callers in distress; research has yet to examine the concerns of veterans who used the VCL during the early months of the pandemic.

METHODS

A mixed-methods analysis of characteristics of veteran outreach to the VCL during the first year of the COVID-19 pandemic in the United States was conducted on 342,248 calls during April-December 2020; 3.8% (N=12,869) of calls were coded as related to COVID-19. Quantitative examination was conducted regarding COVID-19-related reasons for contact, suicide risk screens, and caller concerns; 360 unique calls with synopsis notes that included a COVID-19 flag were qualitatively analyzed.

RESULTS

Quantitative analysis of the calls with a COVID-19 flag revealed mental health concerns, loneliness, and suicidal thoughts as top reasons veterans contacted the VCL during the pandemic. Qualitative analysis identified specific economic and mental health concerns, including negative impacts on income and housing, increased feelings of depression or anxiety, and pandemic-specific concerns such as testing and vaccine availability. Disrupted access to resources for coping, including support groups or gyms, had negative perceived impacts and sometimes exacerbated preexisting problems such as substance abuse or depression.

CONCLUSIONS

These findings emphasize the role of VCL as providing general support to veterans experiencing loneliness and supplying assistance in coping with pandemic-related distress.

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

BACKGROUND

The coronavirus disease-2019 (COVID-19) pandemic has caused myriad health, social, and economic stressors. To date, however, no known study has examined changes in mental health during the pandemic in the U.S. military veteran population.

METHODS

Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative, prospective cohort survey of 3078 veterans. Pre-to-peri-pandemic changes in psychiatric symptoms were evaluated, as well as pre-pandemic risk and protective factors and pandemic-related correlates of increased psychiatric distress.

RESULTS

The prevalence of generalized anxiety disorder (GAD) positive screens increased from pre- to peri-pandemic (7.1% to 9.4%; p < 0.001) and was driven by an increase among veterans aged 45-64 years (8.2% to 13.5%; p < 0.001), but the prevalence of major depressive disorder and posttraumatic stress disorder positive screens remained stable. Using a continuous measure of psychiatric distress, an estimated 13.2% of veterans reported a clinically meaningful pre-to-peri-pandemic increase in distress (mean = 1.1 standard deviation). Veterans with a larger pre-pandemic social network size and secure attachment style were less likely to experience increased distress, whereas veterans reporting more pre-pandemic loneliness were more likely to experience increased distress. Concerns about pandemic-related social losses, mental health COVID-19 effects, and housing stability during the pandemic were associated with increased distress, over-and-above pre-pandemic factors.

CONCLUSIONS

Although most U.S. veterans showed resilience to mental health problems nearly 1 year into the pandemic, the prevalence of GAD positive screens increased, particularly among middle-aged veterans, and one of seven veterans experienced increased distress. Clinical implications of these findings are discussed.

The mental health impact of COVID-19-related stressors among treatment-seeking trauma-exposed veterans

Trauma-exposed veterans receiving mental health care may have an elevated risk of experiencing COVID-19-related difficulties. Using data from several ongoing clinical trials (N = 458), this study examined exposure to COVID-19-related stressors and their associations with key sociodemographic factors and mental health outcomes. The results showed that exposure to COVID-19-related stressors was common, higher among veterans who were racial/ethnic minorities d = 0.32, and associated with elevated posttraumatic stress disorder (PTSD), r = .288, and depressive symptom severity, r = .246. Women veterans experienced more difficulty accessing social support, d = 0.31, and higher levels of COVID-19-related distress, d = 0.31, than men. Qualitative data were consistent with survey findings and highlighted the broader societal context in veterans' experience of COVID-19-related distress. These findings may inform future research on the impact of the pandemic on veterans, particularly those who are women and members of minoritized racial/ethnic groups, as well as mental health treatment planning for this population.

SARS-CoV-2 Infection and the Risk of Suicidal and Self-Harm Thoughts and Behaviour: A Systematic Review

OBJECTIVE

The COVID-19 pandemic has had a complex impact on risks of suicide and non-fatal self-harm worldwide with some evidence of increased risk in specific populations including women, young people, and people from ethnic minority backgrounds. This review aims to systematically address whether SARS-CoV-2 infection and/or COVID-19 disease confer elevated risk directly.

METHOD

As part of a larger Living Systematic Review examining self-harm and suicide during the pandemic, automated daily searches using a broad list of keywords were performed on a comprehensive set of databases with data from relevant articles published between January 1, 2020 and July 18, 2021. Eligibility criteria for our present review included studies investigating suicide and/or self-harm in people infected with SARS-CoV-2 with or without manifestations of COVID-19 disease with a comparator group who did not have infection or disease. Suicidal and self-harm thoughts and behaviour (STBs) were outcomes of interest. Studies were excluded if they reported data for people who only had potential infection/disease without a confirmed exposure, clinical/molecular diagnosis or self-report of a positive SARS-CoV-2 test result. Studies of news reports, treatment studies, and ecological studies examining rates of both SARS-CoV-2 infections and suicide/self-harm rates across a region were also excluded.

RESULTS

We identified 12 studies examining STBs in nine distinct samples of people with SARS-CoV-2. These studies, which investigated STBs in the general population and in subpopulations, including healthcare workers, generally found positive associations between SARS-CoV-2 infection and/or COVID-19 disease and subsequent suicidal/self-harm thoughts and suicidal/self-harm behaviour.

CONCLUSIONS

This review identified some evidence that infection with SARS-CoV-2 and/or COVID-19 disease may be associated with increased risks for suicidal and self-harm thoughts and behaviours but a causal link cannot be inferred. Further research with longer follow-up periods is required to confirm these findings and to establish whether these associations are causal.

Symptom severity and well-being of patients with mental illness during the COVID-19 pandemic: a two-wave survey

PURPOSE OF THE ARTICLE

To examine changes in symptom severity and well-being during the coronavirus disease 2019 (COVID-19) pandemic among individuals with pre-existing mental illness.

MATERIALS AND METHODS

In February 2021, we conducted a follow-up questionnaire-based survey among adults with mental illness, who responded to a similar survey on mental health in June 2020. The participants completed the 18-item Brief Symptom Inventory (BSI-18), the five-item World Health Organization Well-Being Index (WHO-5), and 14 questions evaluating worsening or improvement in mental health using the pre-pandemic period as reference. The survey data were merged with sociodemographic and clinical data from the medical records of all invitees to the first survey, enabling analysis of attrition and weighting of the results.

RESULTS

A total of 613 of 992 (62%) invitees participated in the follow-up wave of the survey. The weighted mean WHO-5 and BSI-18 scores were 38 and 27, respectively, and did not differ statistically significantly from the first wave. Multivariate logistic regression showed that having a vocational education (skilled worker/craftsman) was positively associated with reporting deterioration in psychological well-being (OR: 2.95, 95%CI: 1.14-7.81), while being unemployed was negatively associated with reporting deterioration in psychological well-being (OR: 0.20, 95%CI: 0.07-0.56) from the first to the second survey wave. The most common reason for self-reported deterioration in mental health was loneliness (70%).

CONCLUSIONS

Approximately one year into the COVID-19 pandemic, the level of symptoms remained high, whereas the level of psychological well-being remained low among patients with mental illness.

Variation in call volume to the Veterans Crisis Line by women and men veterans prior to and following onset of the COVID-19 pandemic

OBJECTIVES

To identify trends in volume of calls to the Veterans Crisis Line (VCL) around the onset of the COVID-19 pandemic.

METHODS

Analysis of call frequency from VCL administrative records for all veteran contacts calling on their own behalf with gender identified from January 1, 2018 through December 31, 2020. Interrupted time series analysis used to identify potential impact of COVID-19 pandemic on call volume by women and men veteran contacts.

RESULTS

Call volume to VCL from veterans increased over time, for both women and men veterans, with no significant change in call volume by women contacts following the onset of the COVID-19 pandemic and a decrease in calls by men contacts associated with COVID-19 onset. Call volume varied by month with patterns similar in years prior to and following COVID-19 onset.

CONCLUSIONS

The onset of the COVID-19 pandemic in 2020 was not associated with a spike in calls by veterans to VCL. The pandemic may have led to an increase in calls by some as well as a decrease in calls by others, leveling out the overall volume trends.

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

BACKGROUND

The COVID-19 pandemic is associated with an increased risk of mental health problems including suicide in many subpopulations, but its influence on stable patients with major depressive disorder (MDD) has been studied fleetingly. This study examined the one-year prevalence of suicidality including suicidal ideation (SI), suicide plans (SP), and suicide attempts (SA) as well as their correlates in clinically stable MDD patients during the COVID-19 pandemic.

METHODS

A cross-sectional, observational study was conducted between October 1, 2020, and October 15, 2021, in six tertiary psychiatric hospitals. Socio-demographic information, clinical data and one-year prevalence of suicidality were recorded.

RESULTS

Altogether, 1718 participants who met the eligibility criteria were included. The overall one-year prevalence of suicidality during the COVID-19 pandemic was 68.04% (95% confidence intervals (CI) =65.84-70.25%), with one-year SI prevalence of 66.4% (95%CI = 64.18-68.65%), SP prevalence of 36.26% (95%CI = 33.99-38.54%), and SA prevalence of 39.35% (95%CI = 37.04-41.66%). Binary logistic regression analyses revealed male gender, married marital status, college education level and above and age were negatively associated with risk of suicidality. Urban residence, unemployed work status, experiences of cyberbullying, a history of suicide among family members or friends, and more severe fatigue, physical pain, and residual depressive symptoms were positively associated with risk of suicidality.

CONCLUSIONS

Suicidality is common among clinically stable MDD patients during the COVID-19 pandemic. Regular suicide screening and preventive measures should be provided to clinically stable MDD patients during the pandemic.

Suicidal Behaviours During Covid-19 Pandemic: A Review

Objective

Novel COVID-19 disease has become a major concern worldwide, and a recent line of research warned that the context of the COVID-19 pandemic may be a major risk factor for developing severe suicidal behaviors. A broad systematic review is needed to cover the studies that have already assessed the potential underlying factors for suicidal behaviors in the context of the COVID-19 outbreak.

Method

A total of 52 studies met the inclusion criteria, and data were then described according to the subsequent categories: (1) countries where the studies were carried out; (2) factors impacting suicidal behaviors during the COVID-19 outbreak; and (3) examination of the observed populations.

Results

Findings of the current systematic review suggest that there is a certain amount of heterogeneity in factors impacting suicidal behaviors during the COVID-19 outbreak, with economic downturn, psychiatric vulnerability, isolation and quarantine, health concerns, and relational difficulties being the most prominent reasons for developing suicidal behaviors during the COVID-19 outbreak.

Conclusions

Timely interventions are needed to prevent suicidal behaviors in both the clinical and general populations, and in this regard, the creation of standard procedures may speed up the process.

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

Major depressive disorder (MDD) is associated with increased suicidality, and it's still challenging to identify suicide in clinical practice. Although suicide attempt (SA) is the most relevant precursor with multiple functional abnormalities reported from neuroimaging studies, little is known about how the spontaneous transient activated patterns organize and coordinate brain networks underlying SA. Thus, we obtained resting-state magnetoencephalography data for two MDD subgroups of 44 non-suicide patients and 34 suicide-attempted patients, together with 49 matched health-controls. For the source-space signals, Hidden Markov Model (HMM) helped to capture the sub-second dynamic activity via a hidden sequence of finite number of states. Temporal parameters and spectral activation were acquired for each state and then compared between groups. Here, HMM states characterized the spatiotemporal signatures of eight networks. The activity of suicide attempters switches more frequently into the fronto-temporal network, as the time spent occupancy of fronto-temporal state is increased and interval time is decreased compared with the non-suicide patients. Moreover, these changes are significantly correlated with Nurses' Global Assessment of Suicide Risk scores. Suicide attempters also exhibit increased state-wise activations in the theta band (4-8 Hz) in the posterior default mode network centered on posterior cingulate cortex, which can't be detected in the static spectral analysis. These alternations may disturb the time allocations of cognitive control regulations and cause inflexible decision making to SA. As the better sensitivity of dynamic study in reflecting SA diathesis than the static is validated, dynamic stability could serve as a potential neuronal marker for SA.

Factors associated with post-traumatic growth in response to the COVID-19 pandemic: Results from a national sample of U.S. military veterans

RATIONALE

The COVID-19 pandemic has had numerous negative effects globally, contributing to mortality, social restriction, and psychological distress. To date, however, the majority of research on the psychological impact of the COVID-19 pandemic has focused on negative psychological outcomes, such as depression, anxiety, and posttraumatic stress disorder (PTSD).

OBJECTIVE

Although there is debate about the constructive vs. illusory nature of post-traumatic growth (PTG), it has been found to be prevalent in a broad range of trauma survivors, including individuals affected by the COVID-19 pandemic. The objective of this study was to identify pre- and peri-pandemic factors associated with pandemic-related PTG in a national sample of U.S. veterans.

METHODS

Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative cohort of 3078 U.S. veterans. A broad range of pre-pandemic and 1-year peri-pandemic factors associated with pandemic-related PTG were evaluated. Curve estimation and receiver operating characteristic curve analyses were conducted to characterize the association between pandemic-related PTSD symptoms and PTG.

RESULTS

Worries about the effect of the pandemic on one's physical and mental health, PTG in response to previous traumas (i.e., new possibilities and improved interpersonal relationships), and pandemic-related avoidance symptoms were the strongest correlates of pandemic-related PTG. An inverted-U shaped relationship provided the best fit to the association between pandemic-related PTSD symptoms and endorsement of PTG, with moderate severity of PTSD symptoms optimally efficient in identifying veterans who endorsed PTG.

CONCLUSIONS

Results of this study suggest that psychosocial interventions that promote more deliberate and organized rumination about the pandemic and enhance PTG in response to prior traumatic events may help facilitate positive psychological changes related to the COVID-19 pandemic in U.S. military veterans. Longitudinal studies on functional correlates of PTG may help inform whether these changes are constructive vs. illusory in nature.