Risks and Protective Factors for Veterans’ PTSD, Mental Well-Being, and Substance Use during the COVID-19 Pandemic

Background: The COVID-19 pandemic has caused profound impacts on vulnerable individuals including veterans. Veterans’ PTSD, mental well-being, and substance use need professionals’ attention. Due to the COVID-19 pandemic, research on risk and protective factors on veterans’ behavioral health outcomes is highly needed.The ecological systems theory posits that human development is the product of interactions with multiple systems, including individual, family, and broader community environment. Informed by the ecological systems theory, we specifically examined how the veterans’ pre-military trauma, family functioning and unit support were associated with their PSTD, mental well-being, and substance use.

Methods: We recruited 509 veteran participants from Qualtrics online research panel during the time of the COVID-19 pandemic. Participants’ PTSD, mental health well-being, and substance use problems were measured by 17 items PTSD Checklist-Military Versions, 5 items WHO Well-being index, and 4 items CAGE Adapted to Include Drugs Questionnaire. Participants pre-military trauma and unit support were measured by 2 sub-scales adapted from the Manual for the Deployment Risk & Resilience Inventory-2. Pre-military trauma were measured by 17 questions from the scale of Difficult Living and Working Environment and unit support was measured by 12 questions from the scale of Unit Social Support. Participants family functioning were measured by 12 items Family Assessment Device-General Functioning Scale. We included demographic and socioeconomic covariates that were shown by existing research to be associated with mental health and substance use conditions, including age, gender, education, race, household income, marital status, years in the military, rank, and deployment. The Ordinary Least Squares regression model was used to examine the predictors for veterans’ PTSD, mental well-being, and substance use.

Results: The sample was predominantly male (76.2%) with a mean age of 39 years. Participants were predominantly White/European American (78.6%) with at least a bachelor’s degree (67.8%) and 64.4% of them experienced deployment when serving in the military. The household annual income was relatively high, with over 50% of the participants reporting above $70,000. Most participants (81.1%) were married. After controlling variates, we found veterans’ PTSD was positively associated with problematic family functioning (B= 0.66, p <.001) and numbers of pre-military traumatic events (B= 0.11, p <.001). Veterans’ mental well-being was negatively associated with problematic family functioning (B= -0.45, p <.001), numbers of pre-military traumatic events (B = -0.03, p =0.013) and positively associated with unit support (B = 0.28, p < .001). Veterans’ substance use was positively associated with problematic family functioning (B=0.42, p<.001) and numbers of pre-military traumatic events (B=0.15, p<.001).

Conclusions and implications: Our findings highlighted the interconnectedness of risk and protective factors for veterans’ behavioral health outcomes. We revealed certain under-studied predictors such as pre-military trauma, family functioning, and unit support, to inform professionals working with the veteran population. We strongly advocate implementing a trauma-informed care approach for the veteran population. This trauma- informed care framework should not only consider veterans’ current PTSD symptoms, but also consider how their past traumatic events and how their support systems may cause lasting and profound impact on their lives.