1
|
Pratt BA, Krause-Parello CA, Hardison S, Moreno SJ, Glynn A, Dandu O, Liehr P. My Dog, My Hero: Assessing the Feasibility of a Cross-Generational Digital Storytelling Intervention for Veterans. Issues Ment Health Nurs 2024; 45:686-694. [PMID: 38691465 DOI: 10.1080/01612840.2024.2344787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
During the COVID-19 pandemic, social isolation had a devastating effect on well-being. Veterans were among the most vulnerable given their high rates of military trauma-related conditions. Research supports that dogs can provide veterans with a sense of purpose, social support, and stress management. Digital storytelling provided a unique perspective with focus on a recognized hero, the veteran's dog, and an opportunity for engagement with other veterans during COVID-19. The purpose of the study was to assess the feasibility of this digital storytelling intervention based on Story Theory framework and tailored to encompass components of cross-generational collaboration in combination with individual and group virtual sessions as a mechanism to promote social engagement. The research was conducted using a descriptive exploratory design. Veterans (N = 8) were paired with a trained student and grouped in sets of four. There were eight guided 1-hour weekly virtual sessions to create their digital story. Demographic and pre-post intervention survey data were also collected. Based on eight established criteria, this article systematically evaluates the feasibility of the digital storytelling intervention for veterans. The findings suggest practical considerations to ensure viability of digital storytelling as a therapeutic intervention for veterans and other populations at-risk for suboptimal well-being.
Collapse
Affiliation(s)
- Beth A Pratt
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | | | - Sydney Hardison
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - S Juliana Moreno
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Amanda Glynn
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Olivia Dandu
- Florida Atlantic University High School, Boca Raton, Florida, USA
| | - Patricia Liehr
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| |
Collapse
|
2
|
Hynes KC, Russell BS, Tambling RR, Park CL, Fendrich M. Subjective Stress Appraisals Over Time: the Evolving Structure of the COVID-19 Stressor Scale. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01694-7. [PMID: 38862829 DOI: 10.1007/s11121-024-01694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
The COVID-19 Stressors Scale measures individuals' appraisals of stressors related to the pandemic. Measurement of perceptions of stressors is necessary to understand the socioemotional impacts of not only the COVID-19 pandemic, but other disasters. The study examined the factor structure of the scale among adults in the U.S. over six time points. A shortened version was used, and the fit was examined over time. The results of the study show contextual appraisals change over time and offer important implications for the measurement of stressfulness of disasters, a critical step in designing and assessing impacts of social programs aimed to reduce the deleterious effects of disasters.
Collapse
Affiliation(s)
- Kevin C Hynes
- Counseling, Rehabilitation, and Human Services, University of Wisconsin-Stout, 221 10th Avenue E, Menomonie, WI, 54751, USA.
| | - Beth S Russell
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Rd. U-1058, Storrs, CT, 06269-1058, USA
| | - Rachel R Tambling
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Rd. U-1058, Storrs, CT, 06269-1058, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd, U-1020, Storrs, CT, 06269-1020, USA
| | - Michael Fendrich
- School of Social Work, University of Connecticut, 38 Prospect Street, Hartford, CT, 06103, USA
| |
Collapse
|
3
|
Pratt BA, Krause-Parello CA, Nguyen-Feng VN, Giordano NA, Basin SB, Peterson AL, Walsh P, Siebert AQ, Ruiz R, Kirkland DM, Nolan JP. Mission Alliance Community Engagement Project: Exploring the Impact of COVID-19 on Social Isolation, Loneliness, Mental Health and Wellbeing in Veterans. J Community Health 2024; 49:394-401. [PMID: 38066217 PMCID: PMC10981591 DOI: 10.1007/s10900-023-01314-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 04/02/2024]
Abstract
During the Coronavirus disease pandemic, many U.S. veterans with posttraumatic stress disorder (PTSD) experienced increased symptomology and worsened mental health and well-being due in part to social isolation and loneliness. The Mission Alliance project explored these ramifications and prioritized critical issues expressed by U.S. veterans and stakeholders (N = 182) during virtual regional meetings (N = 32). Field notes created specifically for this project were recorded and thematically analyzed. Emerging themes included: (1) social isolation: missed opportunities, collapsed social circles, work-life balance, fostering relationships, and evolving health care delivery; (2) loneliness: deteriorated mental health, suffered with PTSD together but alone, looked out for each other, ambivalence toward technology, and strained and broken systems; (3) mental health: sense of chaos, increased demand and decreased access, aggravation, implementation of tools, innovative solutions, fear and loss, and availability of resources; (4) wellbeing: sense of purpose, holistic perspective on well-being, recognition of balance, persisting stigma, redefined pressures, freedom to direct treatment, and reconnection and disconnection. A PTSD-related patient centered outcomes research (PCOR)/comparative effectiveness research (CER) agenda was developed from these themes. Establishment of a veteran and stakeholder network is suggested to support, facilitate, and promote the PTSD-related PCOR/CER agenda. Furthermore, enhancement of opportunities for veterans with PTSD and stakeholders to partner in PCOR/CER is required to develop and conduct projects that lead to PTSD-related comprehensive care of veterans affected by traumatic events with the potential to translate findings to other populations.
Collapse
Affiliation(s)
- Beth A Pratt
- College of Nursing, Florida Atlantic University, 3200 College Drive, LA49 228B, Davie, Boca Raton, FL, 33314, USA.
| | - Cheryl A Krause-Parello
- College of Nursing, Florida Atlantic University, 3200 College Drive, LA49 228B, Davie, Boca Raton, FL, 33314, USA
| | | | | | | | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Patrick Walsh
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | | |
Collapse
|
4
|
Serier KN, Zhao Z, Vogt D, Kehle-Forbes S, Smith BN, Mitchell KS. The impact of stress and well-being during the COVID-19 pandemic on mental health in U.S. veterans. Stress Health 2024; 40:e3357. [PMID: 38126682 DOI: 10.1002/smi.3357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/15/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
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.
Collapse
Affiliation(s)
- Kelsey N Serier
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ziyu Zhao
- National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Dawne Vogt
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Shannon Kehle-Forbes
- Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Brian N Smith
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Karen S Mitchell
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Schmalbach I, Steudte-Schmiedgen S, Osmers A, Witthöft M, Drees P, Petrowski K. Longitudinal Assessment of Hair Cortisol as a Predictor of Psychological Symptoms During COVID-19. Psychoneuroendocrinology 2024; 163:106991. [PMID: 38412741 DOI: 10.1016/j.psyneuen.2024.106991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND There is a lack of evidence regarding enduring psychoneuroendocrine changes following an initial traumatic event, particular in the presence of an ongoing stressor. The coronavirus pandemic presents an opportunity to explore this matter. Consequently, the purpose of the present study was to investigate the impact of the ongoing pandemic (2021) on individuals, who experienced a first-time motor vehicle crash (MVC) at least 6 years earlier. To this end, we hypothesized that hair cortisol concentrations (HCC) following a first-time traumatic event positively predict symptoms of depression. METHOD We investigated N = 69 individuals (18 - 65 yrs.), who were victims of a MVC during 2010 - 2014. Hair strands were collected 10 days (t1) and 3 months after the MVC (t2), as well during the pandemic in 2021 (t3). To assess symptoms of depression, the participants filled out the Beck Depression Inventory at t1 - t3 and were additionally interviewed (Structured Clinical Interview for DSM-IV Axis I) at t1 and t2. Exclusion criteria conveyed a lifetime or acute mental disorder (incl. past trauma exposure). RESULTS Elevated pre-pandemic HCC following adversity (i.e., MVC) significantly predicted symptoms of depression in adults during the coronavirus pandemic (BDI: ß =.44, p =.010, R2 =.20), even after controlling for confounders. HCC significantly decreased over time, while in average psychological symptoms remained consistent. CONCLUSION Cortisol dysregulation in the past presents an enduring vulnerability to ongoing stress. In this regard, vulnerable groups may benefit from preventive measures. This finding validates the predictive power of HCC and extended past evidence in this regard, at the same time reinforcing the concept of the diathesis-stress model.
Collapse
Affiliation(s)
- I Schmalbach
- Department of Medical Psychology and Medical Sociology, Johannes-Gutenberg University Mainz, Mainz, Germany
| | - S Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - A Osmers
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - M Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - P Drees
- University Hospital of the University Johannes-Gutenberg Mainz, Department for Orthopedics and Trauma Surgery, Mainz, Germany
| | - K Petrowski
- Department of Medical Psychology and Medical Sociology, Johannes-Gutenberg University Mainz, Mainz, Germany; Dresden University of Technology, Carl Gustav Carus Medical Faculty, Department of General Medicine/MK3, Dresden, Germany.
| |
Collapse
|
6
|
Bond GR, Al-Abdulmunem M, Ressler DR, Drake RE. Mental Health Impact of COVID Pandemic on Veterans Transitioning from Military. J Behav Health Serv Res 2024; 51:275-288. [PMID: 38133794 PMCID: PMC10940484 DOI: 10.1007/s11414-023-09869-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Gary R Bond
- Social Policy and Economics Research, Westat, Inc., New Hampshire Office, Wheeler Professional Park, 1 Oak Ridge Road, Building 3, Second Floor, Suite 2 West, West Lebanon, NH, 03784, USA.
| | - Monirah Al-Abdulmunem
- Social Policy and Economics Research, Westat, Inc., New Hampshire Office, Wheeler Professional Park, 1 Oak Ridge Road, Building 3, Second Floor, Suite 2 West, West Lebanon, NH, 03784, USA
| | - Daniel R Ressler
- Social Policy and Economics Research, Westat, Inc., New Hampshire Office, Wheeler Professional Park, 1 Oak Ridge Road, Building 3, Second Floor, Suite 2 West, West Lebanon, NH, 03784, USA
| | - Robert E Drake
- Social Policy and Economics Research, Westat, Inc., New Hampshire Office, Wheeler Professional Park, 1 Oak Ridge Road, Building 3, Second Floor, Suite 2 West, West Lebanon, NH, 03784, USA
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
7
|
Bühler AH, Willmund GD. Deployment-related quarantining-a risk or resilience factor for German military service members? A prospective analysis during the third-fifth waves of COVID-19. Front Public Health 2023; 11:1267581. [PMID: 38152661 PMCID: PMC10751356 DOI: 10.3389/fpubh.2023.1267581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/26/2023] [Indexed: 12/29/2023] Open
Abstract
Background Mandatory deployment-related quarantining added further constraints on soldiers during the pandemic. Contrary to overwhelming research documenting an adverse impact of quarantining on mental health, no adverse short-term mental health effects of pre-deployment quarantining for German soldiers were identified. Therefore, we are interested in a potentially delayed onset, the impact of an additional post-deployment quarantine, and quarantine-associated risk and resilience factors predicting mental health post-deployment. Methods In a prospective research design, 928 German soldiers enrolled in the study at the in-processing of pre-deployment quarantine between February 2021 and March 2022. Every German military service member undergoing pre-deployment quarantine could participate. The soldiers were between 18 and 64 years old; 87.5% identified as male and 12.5% as female. Self-reported mental health (Mini-SCL), perceived social support (FSozU-K22), and perceived unit cohesion were assessed three to five times: at the beginning and the end of pre-deployment quarantine (Nt1 = 928, Nt2 = 907), if still mandatory-at the beginning and the end of post-deployment quarantine (Nt3 = 143 and Nt4 = 132), and 3 months post-deployment, on average 7 to 8 months later than pre-deployment quarantine (Nt5 = 308). The analyzed quarantine-associated risk and resilience factors were informedness about COVID-19, infection risk, quarantine benefit, clarity of quarantine protocol, need for intimacy/bonding, norms, stigma, practicality, financial disadvantages, boredom, and health-promoting leadership. Results Despite four different mental health trajectories identified, repeated measures ANOVAs revealed a significant improvement in mental health post-deployment (F[2,265] = 21.54, p < 0.001), a small decrease in social support (F[2,266] = 16.85, p < 0.001), and no significant changes in unit cohesion (F[2,264] = 0.482, p = 0.618) 3 months post-deployment. Using stepwise regression, 24% of variance in mental health symptomatology post-deployment is predicted pre-deployment by a clear quarantine protocol, unit cohesion, intimacy/bonding, and social support (F[4,263] = 22.23, p < 0.001). In total, 30% of mental health at the end of post-deployment quarantine is predicted by stigma and a clear quarantine protocol (F[2,99] = 22.22, p < 0.001). Conclusion Although no overall adverse impact of quarantining on mental health was found, it is recommended to address perceived stigma and clearly communicate the quarantine protocol, and to further follow up on the perceived decrease in social support.
Collapse
Affiliation(s)
- Antje H. Bühler
- Bundeswehr Center for Military Mental Health, Military Hospital Berlin, Berlin, Germany
| | | |
Collapse
|
8
|
Morse JL, Fischer IC, Na PJ, Afari N, Pietrzak RH. Functional decline during the COVID-19 pandemic among U.S. military veterans: Results from the National Health and Resilience in Veterans Study. Int J Geriatr Psychiatry 2023; 38:e6040. [PMID: 38072628 DOI: 10.1002/gps.6040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVES The coronavirus disease-2019 pandemic has contributed to widespread social and economic stressors, along with substantial health problems, including loss of life. To date, however, relatively few studies have examined the prevalence and correlates of declines in mental and physical functioning in U.S. military veterans, an older and potentially vulnerable segment of the U.S. adult population. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative, longitudinal study of 3078 veterans. Veterans were surveyed prior to the pandemic (pre-pandemic) and 1 year later during the height of the pandemic (peri-pandemic). Multivariable analyses were conducted to identify risk and protective variables associated with pre-to-peri pandemic declines in self-reported physical and mental functioning. RESULTS The prevalence of veterans who experienced functional decline (≥0.5 standard deviation reductions) pre-to-peri-pandemic was 18.1% (N = 541) for physical functioning and 18.3% (N = 547) for mental functioning. Older age, greater adverse childhood experiences (ACEs), and pandemic-related posttraumatic stress symptoms were the strongest correlates of physical functional decline, while greater ACEs, loneliness, pandemic-related posttraumatic and social restriction stress symptoms, and lower protective psychosocial characteristics were the strongest correlates of mental functional decline. CONCLUSIONS Although the majority of U.S. Veterans showed functional maintenance or improvement 1 year into the pandemic, nearly one-in-five experienced a decline in physical or mental functioning. Results could help inform identification of veterans who may be at risk for functional decline during large-magnitude stressors, such as national or global pandemics.
Collapse
Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Ian C Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
9
|
Hausmann LRM, Cohen AJ, Eliacin J, Gurewich DA, Lee RE, McCoy JL, Meterko M, Michaels Z, Moy EM, Procario GT, Russell LE, Schaefer JH. Developing a brief assessment of social risks for the Veterans Health Administration Survey of Healthcare Experiences of Patients. Health Serv Res 2023; 58:1209-1223. [PMID: 37674359 PMCID: PMC10622278 DOI: 10.1111/1475-6773.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To determine whether a 6- or 12-month look-back period affected rates of reported social risks in a social risk survey for use in the Veterans Health Administration and to assess associations of social risks with overall health and mental health. STUDY DESIGN Cross-sectional survey of respondents randomized to 6- or 12-month look-back period. DATA SOURCES AND STUDY SETTING Online survey with a convenience sample of Veterans in June and July 2021. DATA COLLECTION/EXTRACTION METHODS Veteran volunteers were recruited by email to complete a survey assessing social risks, including financial strain, adult caregiving, childcare, food insecurity, housing, transportation, internet access, loneliness/isolation, stress, discrimination, and legal issues. Outcomes included self-reported overall health and mental health. Chi-squared tests compared the prevalence of reported social risks between 6- and 12-month look-back periods. Spearman correlations assessed associations among social risks. Bivariate and multivariable logistic regression models estimated associations between social risks and fair/poor overall and mental health. PRINCIPAL FINDINGS Of 3418 Veterans contacted, 1063 (31.10%) responded (87.11% male; 85.61% non-Hispanic White; median age = 70, interquartile range [IQR] = 61-74). Prevalence of most reported social risks did not significantly differ by look-back period. Most social risks were weakly intercorrelated (median |r| = 0.24, IQR = 0.16-0.31). Except for legal issues, all social risks were associated with higher odds of fair/poor overall health and mental health in bivariate models. In models containing all significant social risks from bivariate models, adult caregiving and stress remained significant predictors of overall health; food insecurity, housing, loneliness/isolation, and stress remained significant for mental health. CONCLUSIONS Six- and 12-month look-back periods yielded similar rates of reported social risks. Although most individual social risks are associated with fair/poor overall and mental health, when examined together, only adult caregiving, stress, loneliness/isolation, food, and housing remain significant.
Collapse
Affiliation(s)
- Leslie R. M. Hausmann
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System (VAPHS); Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Alicia J. Cohen
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System; Department of Health Services, Policy, and Practice, Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Johanne Eliacin
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts; Department of General Internal Medicine and Geriatrics, Indiana University School of MedicineIndianapolisIndianaUSA
- Department of Health Services ResearchRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Deborah A. Gurewich
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Section of General Internal Medicine, Boston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Richard E. Lee
- Veterans Rural Health Resource CenterWhite River JunctionVermontUSA
| | - Jennifer L. McCoy
- Center for Health Equity Research and Promotion and Office of Research and Development StatCore, VAPHSPittsburghPennsylvaniaUSA
| | - Mark Meterko
- Analytics and Performance Integration, Office of Quality and Patient SafetyDepartment of Veterans Affairs; Department of Health Law, Policy and Management, Boston University School of Public HealthBostonMassachusettsUSA
| | - Zachary Michaels
- Center for Health Equity Research and Promotion, VAPHSPittsburghPennsylvaniaUSA
| | - Ernest M. Moy
- Office of Health EquityVeterans Health AdministrationWashingtonDCUSA
| | - Gregory T. Procario
- Center for Health Equity Research and Promotion, VAPHSPittsburghPennsylvaniaUSA
| | - Lauren E. Russell
- Office of Health EquityVeterans Health AdministrationWashingtonDCUSA
| | - James H. Schaefer
- Analytics and Performance Integration, Office of Quality and Patient SafetyDepartment of Veterans AffairsDurhamNorth CarolinaUSA
| |
Collapse
|
10
|
Baker JC, Bhola S, Tabares JV, Beckman D, Martin C, Khazem LR, Bryan AO, Bryan CJ. Impact of the COVID-19 Pandemic on Indicators of Psychological Health and Suicidal Ideation Within an Active Duty U.S. Military Population. Mil Med 2023; 188:450-456. [PMID: 37948266 DOI: 10.1093/milmed/usad200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/31/2023] [Accepted: 08/08/2023] [Indexed: 11/12/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43214, USA
| | - Simran Bhola
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43214, USA
| | - Jeffrey V Tabares
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43214, USA
| | - Derek Beckman
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43214, USA
| | - Christiana Martin
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43214, USA
| | - Lauren R Khazem
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43214, USA
| | - AnnaBelle O Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43214, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43214, USA
| |
Collapse
|
11
|
Castellini G, Cassioli E, Rossi E, Marchesoni G, Cerini G, Pastore E, De Bonfioli Cavalcabo' N, Rotella F, Mezzani B, Alterini B, Lucarelli S, Magazzini S, Corazzesi P, Caini S, Ricca V. Use and misuse of the emergency room by patients with eating disorders in a matched-cohort analysis: What can we learn from it? Psychiatry Res 2023; 328:115427. [PMID: 37647700 DOI: 10.1016/j.psychres.2023.115427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
We examined the pattern of access to hospital emergency room (hER) in 2018-2021 among patients with eating disorders (ED) from Florence, Italy, diagnosed during 1994-2018, using a matched cohort design. We included 902 ED patients and an equal number of sex-, age-, and residence-matched individuals. We fitted conditional Poisson regression models with robust variance estimator to estimate incidence rate ratios (IRR) and 95% confidence intervals. ED patients accessed hER more than twice as often as matched individuals: the IRR was 2.11 (1.21-3.70), 2.02 (1.36-3.00), and 2.49 (1.71-3.61) among AN, BN, and BED patients. Factors associated with increased hER use were older age (≥40 years; for AN patients, also younger age, <20 years), BMI ≤ 16 kg/m2 (for AN), and psychopathological severity. The rise in access to hER was particularly marked during the early phases of the COVID-19 pandemic and declined only partially thereafter. Acute psychiatric symptoms and non-specific medical conditions represented the main causes of increased access to hER. Use of hER was more often inappropriate among ED patients than matched individuals. Integration of primary and mental health care may be necessary to counteract the high and often inappropriate use of hER by patients with ED.
Collapse
Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Cerini
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Elisa Pastore
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Nora De Bonfioli Cavalcabo'
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Francesco Rotella
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | | | - Brunetto Alterini
- Division of Cardiovascular and Perioperative Medicine, Careggi University Hospital, Florence, Italy
| | - Stefano Lucarelli
- Eating Disorders Unit, Central Tuscany Local Health Authority, Florence, Italy
| | - Simone Magazzini
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Patrizia Corazzesi
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
12
|
Fox AB, Baier AL, Alpert E, Nillni YI, Galovski TE. Psychosocial and Economic Impacts of the COVID-19 Pandemic on the Mental Health of Veteran Men and Women. J Womens Health (Larchmt) 2023; 32:1041-1051. [PMID: 37610854 DOI: 10.1089/jwh.2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Purpose: The psychosocial impacts of the coronavirus disease-2019 (COVID-19) pandemic on women Veterans' mental health compared to men are understudied, with few studies examining the differential impact of COVID-19 stressors on depression and post-traumatic stress disorder (PTSD). Furthermore, little is known about whether social support may buffer against adverse pandemic-related outcomes for this population. In the present study, we examined (1) gender differences in the impact of the COVID-19 pandemic on numerous life domains, including economic, work, home, social, and health; (2) how pandemic impacts in these domains were associated with depression and PTSD symptoms; and (3) whether social support buffered against worse mental health outcomes. Materials and Methods: Data from 1530 Veterans enrolled in the Longitudinal Investigation of Gender, Health, and Trauma (LIGHT) study were analyzed using descriptive statistics and multiple groups' path analyses. Results: Women reported higher pandemic impact scores across life domains. For both men and women, higher health impacts were associated with increased PTSD symptoms; differential findings emerged for depressive symptoms. Home and economic impacts were associated with increased depression for both men and women, social and health impacts were associated with depression for women, and work impacts were associated with depression for men. Higher social support was associated with decreased depressive symptoms for both men and women; however, social support moderated the relationship between pandemic impacts and both PTSD and depressive symptoms for women only. Conclusions: Findings highlight the value of social support in mitigating effects of pandemic-related stress, particularly for women Veterans.
Collapse
Affiliation(s)
- Annie B Fox
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- School of Healthcare Leadership, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Allison L Baier
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Elizabeth Alpert
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Yael I Nillni
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Tara E Galovski
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Cao F, Li J, Xin W, Yang Z, Wu D. The impact of resilience on the mental health of military personnel during the COVID-19 pandemic: coping styles and regulatory focus. Front Public Health 2023; 11:1240047. [PMID: 37621610 PMCID: PMC10445488 DOI: 10.3389/fpubh.2023.1240047] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Military personnel encountered multiple stressful events during the COVID-19 lockdown. Reducing non-combat attrition due to mental disorders is crucial for military morale and combat effectiveness. Grounded in stress theory and regulatory focus theory, this study investigates the influence of resilience on military personnel's mental health; coping style and regulatory focus are considered potential mediators and moderators, respectively. We conducted a routine psychological assessment on 1,110 military personnel in China. The results indicate that: (1) resilience has a negative impact on the psychological symptoms of military groups; (2) mature and mixed coping styles in military personnel mediate the association between resilience and psychological symptoms; and (3) regulatory focus predominance has a negative moderating effect on mature coping styles' effects on psychological symptoms. Furthermore, this study supports previous findings that resilience and mental health are interrelated; it demonstrates that military personnel can effectively reduce negative psychological symptoms by improving their resilience level and adopting mature coping styles under stressful situations. The current study presents interventional insights regarding coping styles and mental health from a self-regulatory perspective during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Fei Cao
- Department of Sociology, School of Law, Jiangnan University, Wuxi, China
| | - Juan Li
- Department of Sociology, School of Law, Jiangnan University, Wuxi, China
| | - Wei Xin
- Department of Medical Psychology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Zhibing Yang
- Department of Military and Political Training, Army Academy of Armed Forces, Beng Bu, China
| | - Di Wu
- Department of Medical Psychology, Air Force Medical University, Xi’an, China
| |
Collapse
|
14
|
Patil T, Raguindin JJ, Radtke M, Smigiel J, Savona N, Kavuru B, Sekhri A. Evaluating the Association of Montelukast Use on Neuropsychiatry-Related Healthcare Utilization and Depression in COVID-19-Hospitalized Veterans: A Nationwide VA Observational Cohort Study. Clin Drug Investig 2023; 43:605-619. [PMID: 37498493 DOI: 10.1007/s40261-023-01292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Montelukast's new boxed warning for neuropsychiatric events questions its use in the setting of coronavirus disease 2019 (COVID-19) due to increased risk for new-onset psychiatric diagnoses. OBJECTIVE We aim to evaluate the impact of using montelukast in patients hospitalized with COVID-19 on neuropsychiatry-related healthcare utilization and depression. METHODS This retrospective nationwide observational cohort study using the Veterans Health Administration database included patients from January 1, 2020, through July 1, 2021. The treatment cohorts consisted of patients with and without montelukast use prior to COVID-19 hospitalization and matched using propensity score (PS) to two control cohorts: patients with COVID-19-related hospitalization without prior montelukast use and patients with prior montelukast use who were hospitalized for reasons other than COVID-19. The primary outcome of psychiatric hospitalizations at 90 days and 180 days and mental health visits at 180 days were compared using Poisson or negative binomial regression. Secondary outcomes of new-onset depression and new use of antidepressants were analyzed using multivariable logistic regression. RESULTS After PS matching, a total of 415 patients were included in COVID-19 with and without montelukast matched cohort and 409 patients in montelukast with and without COVID-19-related hospitalization matched cohorts. For the primary outcomes, inpatient psychiatric hospitalization at 90 days [incidence rate ratio (IRR) 95% CI 1.79 (1.36-2.36)] and 180 days [IRR 95% CI 1.79 (1.32-2.25)] and mental health visits at 180 days [IRR 95% CI 1.72 (1.45-2.03)] were significantly higher in the montelukast with COVID-19 hospitalization group compared with those hospitalized without COVID-19. No difference in primary outcomes were noted in patients hospitalized with COVID-19 with and without use of montelukast. No significant difference was found in the secondary outcomes between either comparator group. CONCLUSIONS Patients with prior montelukast use who were hospitalized with COVID-19 appeared to have increased rate of neuropsychiatry-related healthcare utilization.
Collapse
Affiliation(s)
- Tanvi Patil
- Salem Veterans Affairs HealthCare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA.
| | - Jasper Jade Raguindin
- Central Western Massachusetts Veterans Affair Health Care System, 421 N Main St, Leeds, MA, 01053, USA
| | - Michelle Radtke
- Salem Veterans Affairs HealthCare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - Joseph Smigiel
- Salem Veterans Affairs HealthCare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - Natalie Savona
- Salem Veterans Affairs HealthCare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - Bush Kavuru
- Salem Veterans Affairs HealthCare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| | - Anuradha Sekhri
- Salem Veterans Affairs HealthCare System, 1970 Roanoke Blvd, Salem, VA, 24153, USA
| |
Collapse
|
15
|
Valladares-Garrido MJ, Picón-Reátegui CK, Zila-Velasque JP, Grados-Espinoza P, Vera-Ponce VJ, Pereira-Victorio CJ, Valladares-Garrido D, Failoc-Rojas VE. Depression and anxiety in peruvian military personnel during the pandemic context: a cross-sectional study. BMC Public Health 2023; 23:691. [PMID: 37055833 PMCID: PMC10100618 DOI: 10.1186/s12889-023-15612-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, increased workload and stress could have increased mental health problems (anxiety and depression) in military personnel. However, the number of studies in military members is scarce, especially in regard to mental health. The objective of this study was determine the prevalence and factors associated with depression and anxiety in Peruvian military personnel. METHODS We undertook an analytical cross-sectional study. The survey was distributed face to face between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic among the military personnel. We used some instruments to measure depression (Patient Health Questionnaire, PHQ-9), anxiety (Generalized Anxiety Disorder, GAD-7), insomnia (Insomnia Severity Index, ISI), food insecurity (Household Food Insecurity Access Scale, HFIAS), physical activity (International Physical Activity Questionnaires, IPAQ-S), resilience (abbreviated CD-RISC), and fear of COVID-19 scale. The exclusion criteria included those who did not completely fill out the evaluation instruments. RESULTS We analyzed the data of 615 military personnel that participated in the survey. Of them, 93.7% were male and the median age was 22 years old. There was a prevalence of 29.9% and 22.0% in regard to depression and anxiety symptoms, respectively. In addition, it was found that being married (PR: 0.63; 95% IC: 0.42-0.94), having a relative with mental health problems (PR: 2.16), having experienced food insecurity (PR: 1.48), insomnia (PR: 2.71), fear of COVID-19 (PR: 1.48), and a high level of resilience (PR: 0.65) were factors associated with depression. In regard to anxiety, the factors associated were working for more than 18 months since the beginning of the COVID-19 pandemic (PR: 0.52), a high level of resilience (PR: 0.50; 95% IC: 0.33-0.77), insomnia (PR: 3.32), fear of COVID-19 (PR: 2.43). CONCLUSION We found a prevalence of symptoms of depression and anxiety of 29.9% and 22.0%, respectively. In regard to the factors that attenuate depression, we can mention being married and having resilience; and among the aggravating factors, having a relative with mental health problems, food insecurity, insomnia, and fear of COVID-19. Finally, anxiety increased through working time, insomnia, and fear of COVID-19.
Collapse
Affiliation(s)
- Mario J. Valladares-Garrido
- Escuela de Medicina, Universidad Cesar Vallejo, Piura, Peru
- Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo, Peru
| | | | - J. Pierre Zila-Velasque
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrión, Pasco, Peru
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Pamela Grados-Espinoza
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrión, Pasco, Peru
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Víctor J. Vera-Ponce
- Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, 15039 Peru
- Universidad Tecnológica del Perú, Lima, 15046 Peru
| | | | - Danai Valladares-Garrido
- Escuela de Medicina, Universidad Cesar Vallejo, Piura, Peru
- Unidad de Epidemiología y Salud Ambiental, Hospital de Apoyo II Santa Rosa, Piura, Peru
| | - Virgilio E. Failoc-Rojas
- Research Unit for Generation and Synthesis Evidence in Health, Universidad San Ignacio de Loyola, Lima, Peru
| |
Collapse
|
16
|
Patel EU, Astemborski J, Feder KA, Rudolph JE, Winiker A, Sosnowski DW, Kirk GD, Mehta SH, Genberg BL. Temporal association of pre-pandemic perceived social support with psychological resilience and mental well-being during the COVID-19 pandemic among people with a history of injection drug use. Drug Alcohol Depend 2023; 244:109802. [PMID: 36774804 PMCID: PMC9908589 DOI: 10.1016/j.drugalcdep.2023.109802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND There are limited data on whether modifiable social factors foster psychological resilience and mental well-being among people who use drugs following Big Events. We examined the temporal association of pre-pandemic perceived social support with psychological resilience and negative mental health symptoms during the COVID-19 pandemic among people with a history of injection drug use. METHODS Between June and September 2020, we conducted a telephone survey among 545 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study: a community-based cohort of adults with a history of injection drug use. Leveraging data from study visits in 2018-early 2020, associations of pre-pandemic perceived social support with psychological resilience scores (range=1-5) and the probability of negative mental health symptoms during the pandemic were assessed using multivariable linear and modified Poisson regression models, respectively. RESULTS Participants' median age was 58 years, 38.2% were female, 83.3% identified as Black, and 30.3% were living with HIV. During the pandemic, 14.5% had low (<3) resilience scores, 36.1% experienced anxiety, and 35.8% reported increased loneliness. Compared to participants in the lowest tertile of pre-pandemic social support, participants in the highest tertile had higher mean resilience scores (β = 0.27 [95% CI = 0.12, 0.43]), a lower probability of anxiety (prevalence ratio [PR] = 0.71 [95% CI = 0.52, 0.96]), and a lower probability of increased loneliness (PR = 0.62 [95% CI = 0.45, 0.84]). CONCLUSIONS Pre-pandemic perceived social support was associated with greater psychological resilience and generally better mental well-being during the pandemic. Interventions that improve social support may foster psychological resilience and protect the mental well-being of people who use drugs, especially during periods of social disruption.
Collapse
Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacquie Astemborski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kenneth A Feder
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacqueline E Rudolph
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Abigail Winiker
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - David W Sosnowski
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
17
|
Fischer IC, Na PJ, Harpaz-Rotem I, Krystal JH, Pietrzak RH. Characterization of Mental Health in US Veterans Before, During, and 2 Years After the Onset of the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e230463. [PMID: 36821116 PMCID: PMC9951035 DOI: 10.1001/jamanetworkopen.2023.0463] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
This cohort study of US veterans reports changes in rates of anxiety and depressive disorders following the COVID-19 pandemic.
Collapse
Affiliation(s)
- Ian C. Fischer
- National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Peter J. Na
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Ilan Harpaz-Rotem
- National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - John H. Krystal
- National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Robert H. Pietrzak
- National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
18
|
Arizmendi BJ, Gress-Smith JL, Krieg C, Waddell J. Adapting Group CBT-I for Telehealth-to-Home With Military Veterans in Primary Care. J Prim Care Community Health 2023; 14:21501319221143722. [PMID: 36625248 PMCID: PMC9834777 DOI: 10.1177/21501319221143722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Utilization of telehealth modalities to provide cognitive and behavioral therapies is rapidly increasing. Limitations to access to care can prohibit individuals from getting the care they need, especially evidence-based treatments. In the U.S., Veterans are a population in great need of accessible and high-quality evidence-based psychotherapy for insomnia, as it often co-occurs with other common syndromes such as depression and PTSD. Cognitive Behavioral Therapy for Insomnia (CBT-I) offers effective treatment for insomnia and can be delivered via telehealth and in a group format to greatly increase availability and accessibility. To date, however, few programs exist offering telehealth-to-home CBT-I, fewer still are offered in a primary care setting, and none to our knowledge are offered in group format. We examine the feasibility and efficacy of a fully telehealth-to-home (TTH) group CBT-I pilot program in primary care and compare primary outcomes to those seen in a face-to-face (F2F) format as well as meta-analytic studies of group CBT-I. Primary endpoints, as typically defined such as sleep efficiency (SE) and scores on the insomnia severity index (ISI) appear comparable to those seen in F2F groups in our clinic, and to outcomes seen in the literature. We discuss challenges and strategies for successful implementation of such a program in integrated primary care to increase access and availability of this evidence-based treatment.
Collapse
Affiliation(s)
- Brian J. Arizmendi
- Mayo Clinic Arizona, Scottsdale, AZ,
USA,Brian J. Arizmendi, Mayo Clinic Arizona,
13400 E Shea Boulevard, Scottsdale, AZ 85259, USA.
| | | | | | | |
Collapse
|
19
|
McLean CP, Wachsman T, Morland L, Norman SB, Hooper V, Cloitre M. The mental health impact of COVID-19-related stressors among treatment-seeking trauma-exposed veterans. J Trauma Stress 2022; 35:1792-1800. [PMID: 36065487 PMCID: PMC9538243 DOI: 10.1002/jts.22874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022]
Abstract
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.
Collapse
Affiliation(s)
- Carmen P. McLean
- Dissemination and Training Division, National Center for PTSDVA Palo Alto Health Care SystemMenlo ParkCalifornia
- Department of Psychiatry and Behavioral Sciences, School of MedicineStanford UniversityStanfordCalifornia
| | | | - Leslie Morland
- VA San Diego Healthcare SystemSan DiegoCalifornia
- National Center for PTSDPacific Islands DivisionHonoluluHawaii
- Department of PsychiatryUniversity of California San Diego School of MedicineSan DiegoCalifornia
| | - Sonya B. Norman
- VA San Diego Healthcare SystemSan DiegoCalifornia
- Department of PsychiatryUniversity of California San Diego School of MedicineSan DiegoCalifornia
- Executive DivisionNational Center for PTSDWhite River JunctionVermont
| | - Vaughan Hooper
- Dissemination and Training Division, National Center for PTSDVA Palo Alto Health Care SystemMenlo ParkCalifornia
| | - Marylene Cloitre
- Dissemination and Training Division, National Center for PTSDVA Palo Alto Health Care SystemMenlo ParkCalifornia
- Department of Psychiatry and Behavioral Sciences, School of MedicineStanford UniversityStanfordCalifornia
| |
Collapse
|
20
|
Wynn JK, McCleery A, Novacek DM, Reavis EA, Senturk D, Sugar CA, Tsai J, Green MF. The impact of the COVID-19 pandemic on mental health and functional outcomes in Veterans with psychosis or recent homelessness: A 15-month longitudinal study. PLoS One 2022; 17:e0273579. [PMID: 36001641 PMCID: PMC9401176 DOI: 10.1371/journal.pone.0273579] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The COVID-19 pandemic has had unprecedented effects on mental health and community functioning. Negative effects related to disruption of individuals’ social connections may have been more severe for those who had tenuous social connections prior to the pandemic. Veterans who have recently experienced homelessness (RHV) or have a psychotic disorder (PSY) are considered particularly vulnerable because many had poor social connections prior to the pandemic.
Methods
We conducted a 15-month longitudinal study between May 2020 –July 2021 assessing clinical (e.g., depression, anxiety) and community (e.g., social functioning, work functioning) outcomes. Eighty-one PSY, 76 RHV, and 74 Veteran controls (CTL) were interviewed over 5 assessment periods. We assessed changes in mental health and community functioning trajectories relative to pre-pandemic retrospective ratings and examined group differences in these trajectories.
Results
All groups had significantly increased symptoms of depression, anxiety, and concerns with contamination at the onset of the pandemic. However, RHV and PSY showed faster returns to their baseline levels compared to CTL, who took nearly 15 months to return to baseline. With regards to functioning, both RHV and PSY, but not CTL, had significant improvements in family and social networks over time. Work functioning worsened over time only in PSY, and independent living increased over time in both RHV and PSY but not CTL.
Conclusions
These results reveal that vulnerable Veterans with access to VA mental health and case management services exhibited lower negative impacts of the COVID-19 pandemic on mental health and community functioning than expected.
Collapse
Affiliation(s)
- Jonathan K. Wynn
- Veterans Affairs Rehabilitation Research & Development Center for Enhancing Community Integration for Homeless Veterans, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Amanda McCleery
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, United States of America
| | - Derek M. Novacek
- Veterans Affairs Rehabilitation Research & Development Center for Enhancing Community Integration for Homeless Veterans, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Eric A. Reavis
- Veterans Affairs Rehabilitation Research & Development Center for Enhancing Community Integration for Homeless Veterans, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Damla Senturk
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, United States of America
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Catherine A. Sugar
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, United States of America
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Jack Tsai
- Veterans Affairs National Center on Homelessness Among Veterans, Washington, DC, United States of America
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Michael F. Green
- Veterans Affairs Rehabilitation Research & Development Center for Enhancing Community Integration for Homeless Veterans, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, United States of America
| |
Collapse
|
21
|
Na PJ, Straus E, Jack Tsai, Norman SB, Southwick SM, Pietrzak RH. Loneliness in U.S. military veterans during the COVID-19 pandemic: A nationally representative, prospective cohort study. J Psychiatr Res 2022; 151:546-553. [PMID: 35636030 PMCID: PMC9126310 DOI: 10.1016/j.jpsychires.2022.05.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/04/2022] [Accepted: 05/20/2022] [Indexed: 12/14/2022]
Abstract
Loneliness was deemed a behavioral epidemic even prior to the COVID-19 pandemic. The COVID-19 pandemic and the subsequent social distancing policy measures have raised concerns about increased social isolation and loneliness, especially in vulnerable populations such as military veterans. However, little is known about the impact of the pandemic on longitudinal changes in loneliness in veterans, and potential protective psychosocial factors that may mitigate loneliness in this population. We analyzed data from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative, prospective cohort of 3,078 US veterans before and 1-year into the pandemic. Prevalence, and risk and protective factors associated with changes in loneliness were examined. Results revealed that the prevalence of loneliness decreased over the study period-17.3% pre-pandemic to 15.9% peri-pandemic (p = 0.032). A total of 5.4% (n = 164) of veterans reported increased loneliness, 6.4% (n = 196) decreased loneliness, and 10.6% (n = 325) persistent loneliness during the pandemic. Multivariable logistic regression models indicated that not being married/partnered, and scoring lower on pre-pandemic measures of purpose in life and cognitive functioning were most strongly associated with increased loneliness. Pre-pandemic psychiatric disorder, unpartnered marital status, and pandemic-related social restriction and financial stressors were most strongly associated with persistent loneliness. Collectively, these results suggest that, contrary to concerns, the prevalence of loneliness subtly decreased one year into the pandemic. Veterans who are not partnered, have pre-existing psychiatric conditions, and endorse more COVID-related stressors may be at higher risk for experiencing loneliness during the pandemic. Interventions that promote social connectedness, as well as that target the aforementioned risk and protective factors, may help mitigate loneliness in veterans.
Collapse
Affiliation(s)
- Peter J. Na
- VA Connecticut Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Corresponding author. 300 George St, Suite 901, New Haven, CT, 06511, USA
| | | | - Jack Tsai
- U.S. Department of Veterans Affairs National Center on Homelessness Among Veterans, Tampa, FL, USA,School of Public Health, University of Texas Health Science Center at Houston, San Antonio Campus, San Antonio, TX, USA
| | - Sonya B. Norman
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California, San Diego, CA, USA,National Center for PTSD, White River Junction, VT, USA,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | | | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
22
|
Valladares-Garrido MJ, Picón-Reátegui CK, Zila-Velasque JP, Grados-Espinoza P. Prevalence and Factors Associated with Insomnia in Military Personnel: A Retrospective Study during the Second COVID-19 Epidemic Wave in Peru. Healthcare (Basel) 2022; 10:healthcare10071199. [PMID: 35885726 PMCID: PMC9315965 DOI: 10.3390/healthcare10071199] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Studies in military personnel are scarce and have reported increased rates of medical consultations and insomnia. The COVID-19 pandemic has been associated with a number of factors that increase the prevalence of insomnia, which has established consequences in the military. However, reported data are from different settings. We aimed to identify the prevalence and factors associated with insomnia during the second COVID-19 epidemic wave in Lambayeque, Peru. A retrospective study in 566 participants was conducted face-to-face in November 2021. The dependent variable was insomnia, measured with the Insomnia Severity Index. The independent variables were socio-labor variables, physical activity, food insecurity, eating behavior disorder, fear of COVID-19, and resilience. The prevalence of insomnia was 23% (95% CI: 19.6–26.7%). In multivariate analysis, insomnia was associated with a personal history of mental health (PR: 1.71, 95% CI: 1.01–2.93), food insecurity (PR: 1.43, 95% CI: 1.05–1.95), fear of COVID-19 (PR: 2.57, 95% CI: 1.87–3.54), and high resilience (PR: 0.60, 95% CI: 0.42–0.86). Overall, the Peruvian military population presents a high prevalence of insomnia during the pandemic period. Special attention should be paid to factors that influence insomnia. Prevention and promotion programs should be established to reverse this negative trend in the military.
Collapse
Affiliation(s)
- Mario J. Valladares-Garrido
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima 15046, Peru
- Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, EsSalud, Lima 15072, Peru
- Correspondence:
| | | | - J. Pierre Zila-Velasque
- School of Medicine, Universidad Nacional Daniel Alcides Carrion, Pasco 19001, Peru; (J.P.Z.-V.); (P.G.-E.)
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco 19001, Peru
| | - Pamela Grados-Espinoza
- School of Medicine, Universidad Nacional Daniel Alcides Carrion, Pasco 19001, Peru; (J.P.Z.-V.); (P.G.-E.)
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco 19001, Peru
| |
Collapse
|
23
|
PTSD Symptoms and Coping with COVID-19 Pandemic among Treatment-Seeking Veterans: Prospective Cohort Study. J Clin Med 2022; 11:jcm11102715. [PMID: 35628844 PMCID: PMC9147870 DOI: 10.3390/jcm11102715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
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.
Collapse
|
24
|
Jaworski BK, Taylor K, Ramsey KM, Heinz AJ, Steinmetz S, Owen JE, Tsai J, Pietrzak RH. Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel. JMIR Ment Health 2022; 9:e36217. [PMID: 35245204 PMCID: PMC8985691 DOI: 10.2196/36217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Beth K Jaworski
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Katherine Taylor
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Kelly M Ramsey
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Adrienne J Heinz
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Sarah Steinmetz
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Jason E Owen
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Jack Tsai
- National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Tampa, FL, United States.,School of Public Health, San Antonio Campus, University of Texas Health Science Center at Houston, San Antonio, TX, United States
| | - Robert H Pietrzak
- National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, US Department of Veterans Affairs, New Haven, CT, United States.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
25
|
Nichter B, Stein MB, Monteith LL, Herzog S, Holliday R, Hill ML, Norman SB, Krystal JH, Pietrzak RH. Risk factors for suicide attempts among U.S. military veterans: A 7-year population-based, longitudinal cohort study. Suicide Life Threat Behav 2022; 52:303-316. [PMID: 34873738 DOI: 10.1111/sltb.12822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 12/29/2022]
Abstract
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 substantially greater risk for suicide attempts, suggesting that examination of multiple coinciding vulnerability factors may help improve suicide risk prediction models.
Collapse
Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,VA San Diego Healthcare System, San Diego, California, USA
| | - Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarah Herzog
- Columbia University Irving Medical Center, Columbia University, New York, New York, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York, USA
| | - Ryan Holliday
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Melanie L Hill
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,VA San Diego Healthcare System, San Diego, California, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,National Center for PTSD, White River Junction, Vermont, USA
| | - John H Krystal
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
26
|
Sudom KA, Lee JEC. Well-being of Canadian Armed Forces members during the COVID-19 pandemic: the influence of positive health behaviours. Health Promot Chronic Dis Prev Can 2022; 42:113-121. [PMID: 35262313 PMCID: PMC9022951 DOI: 10.24095/hpcdp.42.3.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has been linked to increased depression, anxiety and other adverse mental health outcomes. Understanding the behaviours that positively influence health is important for the development of strategies to maintain andimprove well-being during the pandemic. METHODS This study focussed on Canadian Armed Forces Regular Force members (N = 13 668) who participated in the COVID-19 Defence Team Survey, administered between April and May 2020. The use of positive health behaviours and the extent to which such behaviours were associated with anxiety, depression and self-reported change in health and stress levels compared to before the pandemic were examined. RESULTS Depression and anxiety were experienced by 14% and 15% of the sample, respectively, while 36% reported that their mental health had gotten worse since the pandemic started, and close to half reported worse physical health and stress levels. The most common behaviours respondents reported engaging in to maintain or improve their health were exercising outdoors, healthy eating and connecting with loved ones. Although most behaviours were associated with better health outcomes, meditation and connecting with loved ones showed associations with worse health. CONCLUSION Engaging in behaviours such as exercise and healthy eating was generally associated with better health outcomes. Unexpected relationships of meditation and connecting with loved ones are discussed in terms of their use in stressful times among those with mental health issues, past research on coping strategies and impacts of the pandemic and physical distancing on social connections. The findings may have implications for strategies to promote healthy behaviours during the remainder of the pandemic and similar crises in the future.
Collapse
Affiliation(s)
- Kerry A Sudom
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Ontario, Canada
| | - Jennifer E C Lee
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Ontario, Canada
| |
Collapse
|