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Original research
Mental health and suicidal ideation in US military veterans with histories of COVID-19 infection
  1. Peter Na1,
  2. J Tsai2,3,
  3. I Harpaz-Rotem1,4 and
  4. R Pietrzak1,4,5
  1. 1Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
  2. 2U.S. Department of Veterans Affairs National Center on Homelessness Among Veterans, Tampa, Florida, USA
  3. 3School of Public Health, University of Texas Health Science Center at Houston, San Antonio, Texas, USA
  4. 4U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut, USA
  5. 5Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
  1. Correspondence to Peter Na, Psychiatry, Yale University School of Medicine, New Haven, CT 06516, USA; peter.na{at}yale.edu

Abstract

Introduction There have been reports of increased prevalence in psychiatric conditions in non-veteran survivors of COVID-19. To date, however, no known study has examined the prevalence, risk and protective factors of psychiatric conditions among US military veterans who survived COVID-19.

Methods Data were analysed from the 2019 to 2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative, prospective cohort of 3078 US veterans. Prepandemic and 1-year peripandemic risk and protective factors associated with positive screens for peripandemic internalising (major depressive, generalised anxiety and/or posttraumatic stress disorders) and externalising psychiatric disorders (alcohol and/or drug use disorders) and suicidal ideation were examined using bivariate and multivariate logistic regression analyses.

Results A total of 233 veterans (8.6%) reported having been infected with COVID-19. Relative to veterans who were not infected, veterans who were infected were more likely to screen positive for internalising disorders (20.5% vs 13.9%, p=0.005), externalising disorders (23.2% vs 14.8%, p=0.001) and current suicidal ideation (12.0% vs 7.6%, p=0.015) at peripandemic. Multivariable analyses revealed that greater prepandemic psychiatric symptom severity and COVID-related stressors were the strongest independent predictors of peripandemic internalising disorders, while prepandemic trauma burden was protective. Prepandemic suicidal ideation, greater loneliness and lower household income were the strongest independent predictors of peripandemic suicidal ideation, whereas prepandemic community integration was protective.

Conclusion Psychiatric symptoms and suicidal ideation are prevalent in veterans who have survived COVID-19. Veterans with greater prepandemic psychiatric and substance use problems, COVID-related stressors and fewer psychosocial resources may be at increased risk of these outcomes.

  • epidemiology
  • mental health
  • depression & mood disorders
  • substance misuse
  • suicide & self-harm
  • adult psychiatry

Data availability statement

The data that support the findings of this study are available upon reasonable request.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bmjmilitary-2021-001846

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    Data availability statement

    The data that support the findings of this study are available upon reasonable request.

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    Footnotes

    • Contributors PN assisted with the study design and conceptualisation, and writing of the paper. JT and IH-R collaborated in the writing and editing of the paper. RP designed the study, analysed the data, and collaborated in the writing and editing of the paper.

    • Funding This study was funded internally through the National Center for PTSD and thus does not have a grant number.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.