Characterization of Mental Health in US Veterans Before, During, and 2 Years After the Onset of the COVID-19 Pandemic (Psychiatry | JAMA Network Open)

February 23, 2023


A considerable minority of US adults (approximately 13%)1,2 experienced significant increases in distress2 during the height of the COVID-19 pandemic. It is not clear whether these increases portend exacerbated or persistent courses of distress, and what risk or protective factors are associated with these courses.

In this study, we build upon our previous study of US military veterans,2 which characterized the prevalence of distress (ie, positive screens for major depressive disorder [MDD], generalized anxiety disorder [GAD], or posttraumatic stress disorder [PTSD]) before and 1 year into the COVID-19 pandemic by analyzing 2 additional years of longitudinal data, and identifying factors associated with exacerbated and persistent courses of distress.




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(2):e230463. doi:10.1001/jamanetworkopen.2023.0463

Article Information

Accepted for Publication: January 9, 2023.

Published: February 23, 2023. doi:10.1001/jamanetworkopen.2023.0463

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2023 Fischer IC et al. JAMA Network Open.

Corresponding Author: Ian C. Fischer, PhD, US Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516 (

Author Contributions: Drs Fischer and Pietrzak had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Fischer, Pietrzak.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Fischer, Pietrzak.

Critical revision of the manuscript for important intellectual content: Na, Harpaz-Rotem, Krystal, Pietrzak.

Statistical analysis: Fischer, Pietrzak.

Obtained funding: Krystal, Pietrzak.

Administrative, technical, or material support: Pietrzak.

Supervision: Pietrzak.

Conflict of Interest Disclosures: Dr Harpaz-Rotem reported receiving grants from Boehringer Ingelheim International GmbH outside the submitted work. Dr Krystal reported receiving personal fees from Freedom Biosciences, Neumora Pharmaceuticals, BioXcel, Cerevel Therapeutics, Eisai, Jazz Pharmaceuticals, Neurocrine Biosciences, Novartis, PsychoGenics, Aptynix, Biogen, Bionomics, Boehringer Ingelheim, Janssen Research and Development, Otsuka, and Sunovion outside the submitted work; he also reported holding stock or options from Freedom Biosciences, Biohaven Pharmaceuticals, Neumora Pharmaceuticals, Terran Biosciences, Spring Health, EpiVario, Tempero Bio; he reported service on the science advisory board for Delix Therapeutics; in addition, Dr Krystal had a patent for ketamine with royalties paid from Janssen Pharmaceuticals, a patent for an NMDA antagonist plus mTORC1 inhibitor licensed to Freedom Biosciences, a patent for an NMDA antagonist plus opiate receptor blocker licensed to Freedom Biosciences, a patent for riluzole licensed to Biohaven Pharmaceuticals, and a patent for methods for personalized medicine licensed to Spring Health; he reported receiving compensation as journal editor from the Society of Biological Psychiatry. No other disclosures were reported.

Data Sharing Statement: See Supplement 2.

Additional Contributions: The authors thank the veterans who participated in the National Health and Resilience in Veterans Study.



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