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Introduction: Published research indicates that posttraumatic stress disorder (PTSD) is associated with increased mortality. However, causes of death among treatment-seeking PTSD patients remain poorly characterized. The study objective was to describe causes of death among PTSD patients to inform preventive interventions for this treatment population. Methods: A retrospective cohort study was conducted of all veterans who initiated PTSD treatment at any Department of Veterans Affairs Medical Center from fiscal year 2008-2013. The primary outcome was mortality within the first year after treatment initiation. In 2018, the collected data was analyzed to determine leading causes of death. For the top 10 causes, standardized mortality ratios (SMRs) were calculated from age-and sex-matched mortality tables of the U.S. general population. Results: 491,040 veterans were identified who initiated PTSD treatment. Mean age was 48.5 years (+/− 16.0 years), 90.7% were male, and 63.5% were of white race. In the year following treatment initiation, 1.1% (5,215/491,040) died. All-cause mortality was significantly higher for veterans with PTSD compared to the U.S. population (SMR 1.05, 95% CI: 1.02-1.08, p<0.001). Veterans with PTSD had a significant increase in mortality from suicide (SMR 2.52, CI: 2.24-2.82, p<0.001), accidental injury (SMR 1.99, CI: 1.83-2.16, p<0.001) and viral hepatitis (SMR 2.26, CI: 1.68-2.93, p<0.001) compared to the U.S. population. Of those dying from accidental injury, more than half died of poisoning (52.3%, 325/622).

Introduction There is emerging evidence to support that the COVID-19 pandemic and related public health measures may be associated with negative mental health sequelae. Rural populations in particular may fair worse because they share many unique characteristics that may put them at higher risk for adverse outcomes with the pandemic. Yet, rural populations may also be more resilient due to increased sense of community. Little is known about the impact of the pandemic on the mental health and well-being of a rural population pre- and post-pandemic, especially those with serious mental illness. Material and Methods We conducted a longitudinal, mixed-methods study with assessments preceding the pandemic (between October 2019 and March 2020) and during the stay-at-home orders (between April 23, 2020, and May 4, 2020). Changes in hopelessness, suicidal ideation, connectedness, and treatment engagement were assessed using a repeated-measures ANOVA or Friedman test. Results Among 17 eligible participants, 11 people were interviewed. Overall, there were no notable changes in any symptom scale in the first 3-5 months before the pandemic or during the stay-at-home orders. The few patients who reported worse symptoms were significantly older (mean age: 71.7 years, SD: 4.0). Most patients denied disruptions to treatment, and some perceived telepsychiatry as beneficial. Conclusions Rural patients with serious mental illness may be fairly resilient in the face of the COVID-19 pandemic when they have access to treatment and supports. Longer-term outcomes are needed in rural patients with serious mental illness to better understand the impact of the pandemic on this population.

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