The coronavirus disease-2019 (COVID-19) pandemic has caused myriad health, social, and economic stressors. To date, however, no known study has examined changes in mental health during the pandemic in the U.S. military veteran population.

Data were analyzed from the 2019–2020 National Health and Resilience in Veterans Study, a nationally representative, prospective cohort survey of 3078 veterans. Pre-to-peri-pandemic changes in psychiatric symptoms were evaluated, as well as pre-pandemic risk and protective factors and pandemic-related correlates of increased psychiatric distress.

The prevalence of generalized anxiety disorder (GAD) positive screens increased from pre- to peri-pandemic (7.1% to 9.4%; p < 0.001) and was driven by an increase among veterans aged 45–64 years (8.2% to 13.5%; p < 0.001), but the prevalence of major depressive disorder and posttraumatic stress disorder positive screens remained stable. Using a continuous measure of psychiatric distress, an estimated 13.2% of veterans reported a clinically meaningful pre-to-peri-pandemic increase in distress (mean = 1.1 standard deviation). Veterans with a larger pre-pandemic social network size and secure attachment style were less likely to experience increased distress, whereas veterans reporting more pre-pandemic loneliness were more likely to experience increased distress. Concerns about pandemic-related social losses, mental health COVID-19 effects, and housing stability during the pandemic were associated with increased distress, over-and-above pre-pandemic factors.

Although most U.S. veterans showed resilience to mental health problems nearly 1 year into the pandemic, the prevalence of GAD positive screens increased, particularly among middle-aged veterans, and one of seven veterans experienced increased distress. Clinical implications of these findings are discussed.

2019 年冠状病毒病 (COVID-19) 大流行造成了无数的健康、社会和经济压力。然而，迄今为止，还没有已知的研究调查过大流行期间美国退伍军人群体心理健康的变化。

数据分析来自 2019-2020 年国家退伍军人健康与复原力研究，这是一项对 3078 名退伍军人进行的具有全国代表性的前瞻性队列调查。评估了精神症状在大流行前至围期间的变化，以及大流行前的风险和保护因素以及与大流行相关的精神痛苦增加的相关因素。

广泛性焦虑症 (GAD) 阳性筛查的患病率从大流行前到大流行期间有所增加（7.1% 至 9.4%；p < 0.001），这是由 45-64 岁退伍军人的增加（8.2% 至 13.5%；p < 0.001）推动的p< 0.001)，但重度抑郁症和创伤后应激障碍阳性筛查的患病率保持稳定。使用持续的精神痛苦测量，估计有 13.2% 的退伍军人报告说，在大流行前至围期间痛苦增加具有临床意义（平均值 = 1.1 个标准差）。大流行前社交网络规模较大和安全依恋风格的退伍军人不太可能经历更多的痛苦，而报告大流行前更多孤独感的退伍军人更有可能经历更多的痛苦。对大流行期间与大流行相关的社会损失、心理健康 COVID-19 影响和住房稳定性的担忧与更大的痛苦、超过大流行前的因素有关。

虽然大多数美国退伍军人在大流行近 1 年时表现出对心理健康问题的适应力，但 GAD 阳性筛查的流行率有所增加，尤其是在中年退伍军人中，七名退伍军人中有一名经历了更大的痛​​苦。讨论了这些发现的临床意义。