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Impact of SARS-CoV-2 Infection on Long-Term Depression Symptoms among Veterans

  • Original Research
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Abstract

Background

Prior research demonstrates that SARS-COV-2 infection can be associated with a broad range of mental health outcomes including depression symptoms. Veterans, in particular, may be at elevated risk of increased depression following SARS-COV-2 infection given their high rates of pre-existing mental and physical health comorbidities. However, few studies have tried to isolate SARS-COV-2 infection associations with long term, patient-reported depression symptoms from other factors (e.g., physical health comorbidities, pandemic-related stress).

Objective

To evaluate the association between SARS-COV-2 infection and subsequent depression symptoms among United States Military Veterans.

Design

Survey-based non-randomized cohort study with matched comparators.

Participants

A matched-dyadic sample from a larger, stratified random sample of participants with and without known to SARS-COV-2 infection were invited to participate in a survey evaluating mental health and wellness 18-months after their index infection date. Sampled participants were stratified by infection severity of the participant infected with SARS-COV-2 (hospitalized or not) and by month of index date. A total of 186 participants in each group agreed to participate in the survey and had sufficient data for inclusion in analyses. Those in the uninfected group who were later infected were excluded from analyses.

Main Measures

Participants were administered the Patient Health Questionnaire-9 as part of a phone interview survey. Demographics, physical and mental health comorbidities were extracted from VHA administrative data.

Key Results

Veterans infected with SARS-COV-2 had significantly higher depression symptoms scores compared with those uninfected. In particular, psychological symptoms (e.g., low mood, suicidal ideation) scores were elevated relative to the comparator group (MInfected = 3.16, 95%CI: 2.5, 3.8; MUninfected = 1.96, 95%CI: 1.4, 2.5). Findings were similar regardless of history of depression.

Conclusion

SARS-COV-2 infection was associated with more depression symptoms among Veterans at 18-months post-infection. Routine evaluation of depression symptoms over time following SARS-COV-2 infection is important to facilitate adequate assessment and treatment.

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Acknowledgements:

We appreciate the data made available by the VHA Office of Mental Health and Suicide Prevention/Program Evaluation and Resource Center. We also wish to acknowledge the efforts of Sarah M. Seelye, PhD as the primary data manager for this manuscript. We thank the additional non-author members of the VA HSR SARS-COV-2 Observational Research Collaboratory (CORC) for their contributions to our work: Berkowitz, Theodore; Crothers, Kristina; Doll, Jacob; Floyd, Breana; Hastings, Susan; Jones, Makoto; Kamphuis, Lee; McCready, Holly; Moss, Abby; Niederhausen, Meike; Ong, Michael; Rowneki, Mazhgan; Shah, Javeed; Shaukat, Aasma; Slatore, Christopher; Smith, Battista; Suri, Pradeep; Teo, Alan; Turner, Aaron; Vranas, Kelly; Winchell, Kara; Wong, Edwin; Wiederholt, Senta G.; Wyatt, Kristin.

Funding

This work was supported by funding from the US Department of Veterans Affairs (VA) Health Systems Research (HSR) Service awards for the COVID Observational Research Collaboratory (C19-21–278; C19-21–279); and for use of the VA-linked Medicare data (SDR 02–237; SDR 98–004). Drs. Hynes and Maciejewski were each supported in part by a VA Research Career Scientist Award (RCS 21–136 and RCS 10–391, respectively).

Dr. Chen is currently funded on a VA Health Systems Research Career Development Award (CDA 18–185).

Author information

Authors and Affiliations

  1. Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA

    Jason I. Chen PhD, David Bui PhD, Alex Hickok MS, Diana J. Govier MPH, PhD & Denise M. Hynes MPH, PhD, RN

  2. Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA

    Jason I. Chen PhD

  3. Departments of Medicine and Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA

    Theodore J. Iwashyna MD, PhD

  4. Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA

    Theodore J. Iwashyna MD, PhD, Elizabeth M. Viglianti MD, MPH & Amy S.-B. Bohnert PhD

  5. VHA, Patient Care Services: Health Solutions, Washington, DC, USA

    Troy A. Shahoumian MPH, PhD

  6. Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA

    Megan Shepherd-Banigan PhD, Valerie A. Smith DrPh, C. Barrett Bowling MD, MSPH & Matthew L. Maciejewski PhD

  7. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA

    Megan Shepherd-Banigan PhD, Valerie A. Smith DrPh & Matthew L. Maciejewski PhD

  8. Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA

    Eric J. Hawkins PhD, George N. Ioannou BMBCh, MS & Ann M. O’Hare MA, MD

  9. Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound HCS, Seattle, WA, USA

    Eric J. Hawkins PhD

  10. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA

    Eric J. Hawkins PhD

  11. School of Medicine, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA

    Jennifer Naylor PhD

  12. VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA

    Jennifer Naylor PhD

  13. Durham VA HCS, Durham, NC, USA

    Jennifer Naylor PhD

  14. OHSU-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA

    Diana J. Govier MPH, PhD

  15. VA Palo Alto HCS, Palo Alto, CA, USA

    Thomas F. Osborne MD

  16. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA

    Thomas F. Osborne MD

  17. Department of Medicine, Duke University, Durham, NC, USA

    Valerie A. Smith DrPh & C. Barrett Bowling MD, MSPH

  18. Durham VA Geriatric Research Education and Clinical Center, Durham VA HCS, Durham, NC, USA

    C. Barrett Bowling MD, MSPH

  19. Seattle Epidemiologic Research Information Center, VA Puget Sound HCS, Seattle, WA, USA

    Edward J. Boyko MD, MPH

  20. Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA

    George N. Ioannou BMBCh, MS

  21. Hospital and Specialty Medicine Service, VA Puget Sound HCS, Seattle, WA, USA

    Ann M. O’Hare MA, MD

  22. University of Washington, Seattle, WA, USA

    Ann M. O’Hare MA, MD

  23. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Elizabeth M. Viglianti MD, MPH

  24. Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA

    Amy S.-B. Bohnert PhD

  25. College of Public Health and Human Sciences, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA

    Denise M. Hynes MPH, PhD, RN

  26. School of Nursing, Oregon Health & Science University (OHSU), Portland, OR, USA

    Denise M. Hynes MPH, PhD, RN

Authors
  1. Jason I. Chen PhD
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  2. David Bui PhD
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  3. Theodore J. Iwashyna MD, PhD
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  4. Troy A. Shahoumian MPH, PhD
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  9. Diana J. Govier MPH, PhD
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  10. Thomas F. Osborne MD
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  11. Valerie A. Smith DrPh
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  12. C. Barrett Bowling MD, MSPH
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  13. Edward J. Boyko MD, MPH
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  14. George N. Ioannou BMBCh, MS
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  15. Matthew L. Maciejewski PhD
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  16. Ann M. O’Hare MA, MD
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  17. Elizabeth M. Viglianti MD, MPH
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  18. Amy S.-B. Bohnert PhD
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  19. Denise M. Hynes MPH, PhD, RN
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Consortia

for the V. A. HSRDSARS-C.O.V.-2 Observational Research Collaboratory (CORC)

Corresponding author

Correspondence to Jason I. Chen PhD.

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Conflict of Interest:

The authorship team reports having no conflicts of interest in relation to this manuscript.

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Author Note

This material is the result of work supported with resources and the use of facilities at the VA Portland Health Care System, Portland, OR. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Dr. Bohnert and Dr. Hynes served as co-senior authors for this manuscript.

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Chen, J.I., Bui, D., Iwashyna, T.J. et al. Impact of SARS-CoV-2 Infection on Long-Term Depression Symptoms among Veterans. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08630-z

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