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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.
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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
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Marquardt CA, Chu C, Hill JE, Venables NC, Kuzenski L, Davenport ND, Disner SG, Finn JA, Gilmore CS, Erbes CR, Urošević S. Evaluating resilience in response to COVID-19 pandemic stressors among veteran mental health outpatients. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:26-37. [PMID: 36455008 PMCID: PMC9870973 DOI: 10.1037/abn0000789] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
There is a public health need to understand mental health vulnerabilities to COVID-19 pandemic-related stressors and promote resilience among high-risk populations with preexisting psychiatric conditions. Recent cross-sectional studies suggest increases in mental health distress (e.g., depression and anxiety) during the pandemic. The present study expands upon these emerging findings using longitudinal latent modeling and hierarchical linear regressions. Consistent with the developmental psychopathology literature on resilience, we distinguished between promotive or risk (i.e., main effect), and protective or vulnerability (i.e., moderation) effects on mental health during the pandemic. At a large medical center, 398 veterans receiving outpatient mental health care provided prepandemic (Time 1) and during pandemic (Time 2) assessments of mental and physical health-related distress. Additional Time 2 questionnaires assessed pandemic-related stressors and positive behavioral adaptations in the summer of 2020. As expected, total stressor scores predicted longitudinal worsening of self-reported mental (β = -.205) and physical health (β = -.217). Positive behavioral adaptations enacted during the pandemic moderated and protected against stressor effects on mental health (β = .160). In addition, the presence of substance use disorders moderated and conferred vulnerability to stressor effects on physical health (β = -.158). Thus, higher COVID-19 pandemic stressor exposure may have exacerbated mental and physical health distress among veterans with common forms of psychopathology. Nevertheless, behavioral activation, purposeful maintenance of social connections, and focused treatment for substance misuse may be important intervention targets for reducing the longitudinal impact of pandemic stressors and enhancing resilience among people with mental illness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Craig A. Marquardt
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Carol Chu
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Jessica E. Hill
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
| | - Noah C. Venables
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Laci Kuzenski
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
| | - Nicholas D. Davenport
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Seth G. Disner
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Jacob A. Finn
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Casey S. Gilmore
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
| | - Christopher R. Erbes
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
| | - Snežana Urošević
- Minneapolis VA Health Care System; University of Minnesota-Twin Cities
- Department of Psychiatry & Behavioral Sciences, University of Minnesota-Twin Cities
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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.
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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
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Mengin AC, Rolling J, Porche C, Durpoix A, Lalanne L. The Intertwining of Posttraumatic Stress Symptoms, Alcohol, Tobacco or Nicotine Use, and the COVID-19 Pandemic: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14546. [PMID: 36361425 PMCID: PMC9658659 DOI: 10.3390/ijerph192114546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Posttraumatic stress symptoms (PTSSs) and alcohol, tobacco, or nicotine use are frequently associated conditions. The COVID-19 pandemic has been a stressful situation globally and has worsened mental health conditions and addictions in the population. Our systematic review explores the links between PTSSs and (1) alcohol use and (2) tobacco or nicotine use during the COVID-19 pandemic. METHODS We searched the PubMed, PsycINFO, and Web of Science databases for studies published between January 2020 and 16 December 2021. We included studies published in English concerning adults or adolescents. Included articles dealt simultaneously with the COVID-19 pandemic, PTSSs, and alcohol, tobacco, or nicotine use. The reports included were cross-sectional, longitudinal, or cohort studies. We categorized the reports according to the population explored. Our main outcomes are the impacts of PTSSs on (1) alcohol use and (2) tobacco and nicotine use and their relation to COVID-19-related stressors (worries, exposure, lockdown, and infection, either of self or relatives). RESULTS Of the 503 reports identified, 44 were assessed for eligibility, and 16 were included in our review, encompassing 34,408 participants. The populations explored were the general population, healthcare workers, war veterans, patients with substance use disorders, and other vulnerable populations. Most studies were online surveys (14) with cross-sectional designs (11). Every study explored alcohol use, while only two assessed tobacco use. In most populations explored, a high level of PTSSs was associated with alcohol use increase. COVID-19-related stress was frequently correlated with either high PTSSs or alcohol use. In healthcare workers, PTSSs and alcohol use were not associated, while COVID-19 worries were related to both PTSSs and alcohol use. DISCUSSION 1. PTSSs and increased alcohol use are frequently associated, while COVID-19 worries might trigger both conditions and worsen their association. Alcohol use increase may represent either an inadequate way of coping with PTSSs or a vulnerability amid the COVID-19 pandemic, leading to PTSSs. As most studies were cross-sectional online surveys, longitudinal prospective studies are needed to ascertain the direction of the associations between these conditions. These studies need to be sufficiently powered and control for potential bias and confounders. 2. Our review highlighted that research about PTSSs and tobacco or nicotine use is scarce.
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Affiliation(s)
- Amaury C. Mengin
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, 67000 Strasbourg, France
- Regional Center for Psychotrauma Great East, 67000 Strasbourg, France
- Institut National de la Santé et de la Recherche Médiale, Unité de Recherche 1114 (INSERM U1114), Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, 67000 Strasbourg, France
| | - Julie Rolling
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, 67000 Strasbourg, France
- Regional Center for Psychotrauma Great East, 67000 Strasbourg, France
- Centre National de la Recherche Scientifique Unité Propre de Recherche 3212 (CNRS UPR 3212), Institute for Cellular and Integrative Neurosciences (INCI), 67000 Strasbourg, France
| | - Christelle Porche
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, 67000 Strasbourg, France
- Institut National de la Santé et de la Recherche Médiale, Unité de Recherche 1114 (INSERM U1114), Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, 67000 Strasbourg, France
| | - Amaury Durpoix
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, 67000 Strasbourg, France
- Faculty of Medicine, Strasbourg University, 67000 Strasbourg, France
| | - Laurence Lalanne
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, 67000 Strasbourg, France
- Institut National de la Santé et de la Recherche Médiale, Unité de Recherche 1114 (INSERM U1114), Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, 67000 Strasbourg, France
- Faculty of Medicine, Strasbourg University, 67000 Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, 67000 Strasbourg, France
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