ASU alumni study impact of pandemic on mental health of veterans

Understanding how the COVID-19 pandemic has affected the mental health of military veterans, who have an increased risk for poor mental health compared with civilians, is a priority of two recent graduates of the clinical psychology doctoral program at Arizona State University.

Brandon Nichter is a clinical psychologist with the U.S. Department of Defense. Melanie Hill holds a visiting research scholar appointment in the psychiatry department at the University of California, San Diego, as does Nichter. Both are part of a research team using the National Health and Resilience in Veterans Study, or NHRVS, to examine the impact of the pandemic on veterans’ mental health. 

The NHRVS surveyed approximately 3,000 veterans about their mental health shortly before the start of the COVID-19 pandemic and a year later, approximately 10 months into the ongoing pandemic. The study used a nationally representative sample of veterans, which means that the findings can apply to the entire U.S. veteran population. 

Hill was recently the lead author of a study using the NHRVS that examined how rates of depression, anxiety and post-traumatic stress disorder symptoms changed among veterans during the pandemic. That work was published in Psychological Medicine. 

“We wanted to understand how stressful conditions associated with the pandemic, ranging from worries about contracting COVID-19 and the impacts of mitigation measures like lockdowns, may be affecting veterans,” Hill said.

Nichter was the lead author of another study recently published in JAMA Psychiatry. This work examined how the pandemic has impacted suicidal behavior among veterans.

“Prior to the pandemic, military veterans were 50% more likely to die by suicide relative to civilians. The goal of our study was to examine whether factors connected to the pandemic such as financial hardship, increasing loneliness and COVID-19 infection were associated with higher rates of suicidal behavior,” Nichter said.

General anxiety increased among middle-aged veterans during the pandemic 

The NHRVS surveyed veterans in November 2019, four months before the onset of the COVID-19 pandemic, and again a year later in November 2020, about 10 months into the pandemic. Participants were asked to report about symptoms of anxiety, depression and PTSD.

There were no changes in depression or PTSD symptoms, but there was an increase in veterans experiencing symptoms of generalized anxiety disorder. This change was driven by increasing anxiety among middle-aged veterans who were 45 to 64 years old.

“It is possible that middle-aged veterans experienced an increase in anxiety because the pandemic has been a stressful time to balance competing demands,” Hill said. “This group might be taking care of kids and older relatives while still working and having to deal with job uncertainty, remote learning for kids and worrying about older relatives getting infected.” 

Suicidal ideation among veterans decreased during the pandemic

The NHRVS also asked participating veterans about incidences of suicidal ideation — or how many times they had thoughts about suicide over the past year. 

The prevalence of suicidal ideation in the overall veteran population decreased by nearly 30% during the pandemic relative to pre-pandemic levels. But 2.6% of the study participants reported developing new suicidal ideation during the pandemic.  

“Using population benchmarks, our findings suggest that roughly half a million new veterans may have contemplated suicide during the pandemic,” Nichter said. 

The strongest risk factors for new-onset suicidal ideation included low social support and previous mental health problems prior to the pandemic. 

“Given the increases in stressors associated with the pandemic, we anticipated this stress might have contributed to higher rates of suicidal thinking in veterans. However, our findings showed a decrease in the prevalence of suicidal ideation in the overall veteran population, which is consistent with data from the CDC that found that the rate of deaths by suicide among Americans decreased during the first year of the pandemic by 5.6%,” Nichter said.

Veterans who had been ill with COVID-19 were 2.5 times more likely to report new onset of suicidal ideation. When the research team took previous mental health problems and other factors for suicide behaviors into account, COVID-19 illness still remained a risk factor for new instances of suicidal ideation. 

“It is important to understand how different populations respond to the pandemic, and our studies are the first, to my knowledge, to have examined trends in mental health symptoms in a nationally representative sample of U.S. veterans during the pandemic. This work highlights the need for additional research into the long-term mental health impact of the COVID-19 pandemic,” Hill said.

Trained by ASU

At ASU, Nichter earned his PhD in clinical psychology under the mentorship of Nancy Gonzales, who was then a Foundation Professor of psychology and is now executive vice president and university provost. Nichter said he chose Gonzales as his doctoral adviser because of her nationally recognized expertise in understanding the developmental processes that put Latino and other minority youth at risk for mental health and substance use problems.

“The clinical science program at ASU strongly influenced where I am currently. Attending ASU helped me better understand the pathways and processes that lead at-risk populations like veterans to develop mental health problems,” he said.

Hill worked under the mentorship of Madeline Meier, associate professor of psychology, and conducted research on how stress and emotion regulation affect substance use and mental health.

“I received a strong foundation in clinical science research at ASU, and I use that groundwork in my current postdoctoral fellowship. Right now I am studying how mental health problems and substance use impact one another, with a specific focus on cannabis use and PTSD in veterans,” Hill said.

For veterans who are struggling, the veterans crisis line offers free, confidential support 24 hours a day, seven days a week, at 1-800-273-8255 (press 1) or text 838255. For anyone else who is struggling, the National Suicide Prevention Lifeline offers free, confidential support 24 hours a day, seven days a week, also at 1-800-273-8255.