Background and ObjectivesBehavioral health issues, such as substance use, depression, and social isolation, are of grave concern during COVID‐19, especially for vulnerable populations. One such population is US veterans, who have high rates of pre‐existing behavioral health conditions and may thus be at‐risk for poorer outcomes. The current study aimed to investigate substance use among US veterans during COVID‐19 as a function of pre‐existing depression, loneliness, and social support.MethodsWe investigated the relationship between pre‐pandemic depression and substance use during COVID‐19 using linear (alcohol) and logistic (cannabis) regression among a large sample of US veterans (N = 1230). We then tested if loneliness and social support moderated these effects.ResultsThough there was a decrease in alcohol and cannabis use among the overall sample, veterans who screened for depression prior to the pandemic exhibited higher levels of substance use after the pandemic's onset. Loneliness compounded the effects of depression on rates of alcohol use. Social support was not protective for the effects of depression on either alcohol or cannabis use.Discussion and ConclusionsVeterans with pre‐existing depression may be in need of attention for substance use behaviors. Interventions aimed at alleviating loneliness among veterans may be useful in mitigating alcohol use, but not cannabis use, amid COVID‐19.Scientific SignificanceOur findings are among the first to report tangible behavioral health outcomes experienced by US veterans as a result of COVID‐19. Results can help inform treatment efforts for veterans who are struggling with substance use during and post‐pandemic.

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The COVID-19 pandemic may have a compounding effect on the substance use of American veterans with posttraumatic stress disorder (PTSD). This study investigated the relationship between PTSD and current reactions to COVID-19 on alcohol and cannabis use among veterans who completed a survey 1 month prior to the pandemic in the USA and a 6-month follow-up survey. We hypothesized that veterans with PTSD would experience more negative reactions to COVID-19 and increased alcohol and cannabis use behaviors over those without PTSD. Veterans with PTSD prior to the pandemic, relative to those without, endorsed poorer reactions, greater frequency of alcohol use, and greater cannabis initiation and use during the pandemic. Veterans with PTSD may use substances to manage COVID-related stress. Clinicians may see an increase in substance use among this group during and after the pandemic and may need to implement specific behavioral interventions to mitigate the negative effects of COVID-19.

Objective: Prior work has linked exposure to multiple types of trauma (i.e., polyictimization) to increased risk of negative behavioral health outcomes compared with exposure to any single event. However, few studies have attempted to understand how polyvictimization theory relates specifically to veterans' experiences and behavioral health outcomes. The present study assessed heterogeneity in reports of childhood trauma, combat trauma, and military sexual trauma. Method: We recruited 1,230 veterans outside of traditional Veterans Health Administration settings to participate in a study assessing behavioral health. On average, participants were 34.5 years old with the majority identifying as White (79.3%) and male (88.7%). We used latent class analysis to extract classes of traumatic experience exposure including childhood trauma, combat trauma, and military sexual trauma. Results: Five classes emerged: (a) high all; (b) moderate combat trauma, high military sexual trauma; (c) high combat trauma, moderate military sexual harassment; (d) moderate childhood trauma and combat trauma; and (e) combat trauma only. Overall, veterans in profiles that endorsed multiple trauma types (i.e., polyvictimization) evidenced greater symptoms of depression, posttraumatic stress disorder, and hazardous alcohol or cannabis use. Further, women were overly represented in profiles that included multiple victimization typologies, especially when profiles included elevated endorsement of military sexual trauma. Conclusion: A polyvictimization framework was partially supported, with differential effects on behavioral health outcomes noted across trauma experiences. Public Health Significance StatementThis study provides continued support for a polyvictimization framework among a veteran population spanning multiple areas of trauma-related factors. Veterans entering care with multiple traumas may require additional services, particularly women reporting military sexual trauma.

COVID-19 has impacted higher education greatly, with many colleges and universities being forced to quickly implement procedures for operation as closures and restrictions shifted many programs online. These abrupt changes amounted to uncertainty and challenges for students worldwide. Students who were studying abroad during the onset of the COVID-19 pandemic faced unique challenges as programs shut down and many returned home from overseas. The current study investigated the impact of COVID-19 on U.S. study abroad students through a qualitative lens. Students reported unique stressors related to being abroad during the onset of the pandemic, such as missed experiences, financial loss, travel difficulties, and stressors related to academic programs. Additionally, many reported considerable and lasting impacts on emotional and behavioral health. This study provides preliminary evidence for the effects of COVID-19 on study abroad students, and highlights the importance of addressing the needs of this population during and after the pandemic.