Changes in perceived stress during the COVID‐19 pandemic among American veterans

Abstract

American veterans are a population that suffer from both context specific stressors as well as many population‐specific major‐life events. The present exploratory study utilises a longitudinal cohort of 1230 U.S. veterans surveyed from February 2020 through February 2021. We sought to understand heterogeneity in perceived stress, using growth mixture modelling, over this time period, how COVID‐specific factors such as negative reactions to the pandemic, loneliness, and employment disruptions influence perceived stress trajectories, and how veterans vary across distal outcomes including posttraumatic stress disorder (PTSD), pain, depression, sleep problems, physical health, and alcohol use disorder. Results revealed a 4‐class solution: Stable High, Stable Low, Steady Increasing, and Steady Decreasing classes. In terms of COVID specific factors, negative reactions to COVID were consistently associated with perceived stress for those in the Stable High and Steady Increasing classes whereas loneliness was associated with stress trajectories for all emergent classes. Finally, in terms of our distal outcomes, results showed a relatively robust pattern with veterans in the Stable High or Steady Increasing classes reporting worse scores across all outcomes including PTSD, pain, sleep problems, physical health, depression, and alcohol use disorder. Understanding the interplay between existing vulnerabilities, ongoing stressors, and behavioural health outcomes among veterans is crucial for prevention and intervention efforts.

Bidirectional Associations Between Pain and Perceived Stress Among Veterans: Depressive Disorder as a Predisposing Factor

“…In our sample of combat-injured veterans, preexisting depression seemed to be a catalyst of the dynamic associations between pain and perceived stress, such that pain and perceived stress were bidirectionally associated at the within-person level only in those who screened positive for depression. This is in line with the system model of pain's conception of depression as an amplifier of pain and stress symptom dynamics (14), and builds on prior empirical work demonstrating links between depression, pain, and perceived stress among veterans (9,10,24). Although prior prospective studies demonstrated that both perceived stress and depression are associated with subsequent pain among veterans (9,10), our results further clarify how all three variables may be linked.…”

“…Strikingly large numbers of veterans report pain (1,2,40) along with co-occurring perceived stress and depression (10,20,28,29). As many US veterans are currently returning from deployment, it is necessary to improve understanding of the associations between pain and its psychological correlates, as this could inform…”

“…Two psychological factors associated with pain among combat-injured veterans are perceived stress (i.e., the perception that one's situation is unpredictable or beyond one's ability to manage) (5) and mental health problems such as depressive disorder (hereafter referred to as depression). Combat-injured veterans are highly susceptible to perceived stress and depression (6,7), and both have been linked to worse pain and difficulty coping with pain (8)(9)(10). Psychological problems complicate the assessment and treatment of pain (11,12), especially when individuals face multiple problems simultaneously (13).…”

“…Injured veterans have relatively high perceived stress (20), as do individuals with pain (21,22). Perceived stress has been shown, in turn, to heighten pain intensity and precede the development of persistent pain (10,(23)(24)(25). For example, in a recent prospective study, veterans high in perceived stress had the highest pain 1 year later, even when controlling for prior pain (10).…”

“…Perceived stress has been shown, in turn, to heighten pain intensity and precede the development of persistent pain (10,(23)(24)(25). For example, in a recent prospective study, veterans high in perceived stress had the highest pain 1 year later, even when controlling for prior pain (10). In another study of veterans, perceived stress was prospectively associated with the incidence of persistent pain 5 years later (24).…”