The COVID pandemic led to a sharp increase in anxiety, depression, stress, substance use, and other behavioral health conditions in the USA.1,2,3 The increase was greatest during the early months of the COVID pandemic, starting in March of 2020. US Census Bureau data collected in April and May 2020 indicated a threefold increase of positive screens for depressive and/or anxiety disorders in the general US adult population compared to 2019.4 Other studies also detected sharp increases in depressive symptoms during early stages of the pandemic compared to pre-pandemic. For example, one longitudinal study of a nationally representative group of US adults using a widely used depression scale, the Patient Health Questionnaire-9 (PHQ-9),5 found that the percentage of respondents screened with at least moderate depression increased from 5.7% pre-pandemic to 14.8% during the pandemic.6

The COVID pandemic severely impacted the US work force, leading to lay-offs and changes where Americans worked. During the spring and summer of 2020, the US labor market experienced a major shock, and the monthly unemployment rate did not return to pre-pandemic levels until late 2021.7 Surveys found that workers who lost their jobs during the COVID-19 pandemic developed behavioral health conditions.8, 9

Researchers have also examined the mental health impact of the COVID pandemic on US veterans. A 3-year longitudinal study examined self-reported psychiatric symptoms (i.e., positive screens for major depressive disorder, generalized anxiety disorder, or posttraumatic stress disorder) in a national representative sample of 2289 veterans.10 Participants completed interviews before, during, and 2 years after the height of the pandemic (Fall 2019, Fall 2020, and Summer 2022, respectively). Similar to surveys in the general population, the veteran sample reported increased psychiatric symptoms during the pandemic: Positive screens for any psychological distress increased from 8.5% before the pandemic to 12.8% during the pandemic and decreased to 7.5% in the period after the height of the pandemic. However, 84% of veterans were resistant; that is, they screened negative for psychiatric symptoms at all time periods.

Another veteran study examined changes in psychiatric symptoms from pre-pandemic to during the pandemic.11 Using a nationally representative, prospective cohort survey of 3078 veterans, the authors found an increased prevalence in generalized anxiety disorder, but no significant changes in prevalence of major depressive disorder or posttraumatic stress disorder. Overall, the sample reported a 13% increase in psychological distress, which was considered a clinically meaningful increase.

A further study examined the longitudinal impact of the pandemic on 398 veterans receiving outpatient mental health care.12 Comparing changes from pre-pandemic to during the pandemic in the summer of 2020, pandemic-related stressors, consisting of negative life changes in eight life domains (e.g., work, home life, and social activities), were associated with increased mental and physical health distress. Positive behavioral adaptations (such as increased social connections with family and friends, physical exercise, helping other people, and finding greater purpose and productivity during life pursuits) lessened the negative impact of the stressors.

The current report examined the impact of the COVID pandemic on a group of veterans undergoing the transition from military to civilian life. The study sample consisted of young, enlisted men and women with service-connected disabilities who volunteered to participate in a study evaluating a new program to help transitioning veterans gain meaningful employment. While many service men and women successfully make the transition from the military, a large literature has documented that a subgroup experience stress related to the challenges of finding employment, changes in daily schedules, home life, and income, as well as all aspects of the shift from military to civilian culture.13,14,15,16,17 As many as two-thirds of veterans report significant difficulty transitioning from the military.18 Transition stresses can lead to elevated levels of psychiatric symptoms.19,20,21,22 For many veterans, securing a job that matches their skills and interests is the most significant source of stress during the transition period.23,24,25,26 In addition, the first civilian job is not always a good fit. Job turnover is very high among veterans during the first two years after leaving the military.27 Veterans who terminate from civilian jobs during the transition period experience increased risk for negative mental health outcomes.28 The impact of the COVID pandemic on transitioning veterans has not been reported in the literature.

As part of the evaluation study assessing an innovative employment program for transitioning veterans, study participants were interviewed before and during the COVID pandemic.29 The survey included standardized measures of self-reported psychiatric symptoms, including depression. Overall, 41.9% of the sample of 229 veterans completing baseline interviews screened positive for moderate depression, a rate that was four times greater than in a national representative sample of veterans (10.3%).30 Because study participants completed follow-up interviews after enrollment, the serendipitous timing of the interview schedule offered an opportunity to assess the impact of the COVID pandemic by comparing changes over time. Moreover, the sample included a subgroup who indicated that the pandemic had affected their mental health. The current report examined the longitudinal impact of the pandemic on two groups — veterans reporting that the pandemic influenced their mental health and those who reported that they were relatively unaffected.

In a secondary analysis of the longitudinal data from the evaluation study, the authors proposed three exploratory hypotheses based on published studies in both civilian and veteran samples. The authors hypothesized that (1) the total veteran sample would report increased depression during the pandemic compared to pre-pandemic levels and that (2) this increase would be greater for veterans reporting that the pandemic had affected their mental health than those who did not. A final hypothesis examined the protective effects of employment, namely, that (3) veterans gaining employment during the pandemic would experience less adverse impact on their mental health. This hypothesis was derived from a large literature supporting a positive correlation between employment and mental health.31, 32