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      Exploring the trajectory and correlates of social isolation for veterans across a 6-month period during COVID-19

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          Abstract

          Social isolation is a relevant problem for veterans who are at risk for disengaging from others as a function of transition stress from military life to civilian life, and given high rates of exposure to trauma and psychological distress. Few researchers have examined social isolation in veterans over time, particularly during COVID-19 that led to significant barriers and restrictions on social interactions. The purpose of this longitudinal study was to assess veterans’ experience of social isolation and its mental health and social functioning correlates during a 6-month period of the COVID-19 pandemic. Participants were 188 United States veterans of the Iraq and Afghanistan wars. A total of four assessments were administered: one every two months for a total duration of six months. The average number of completed assessments across all participants was 3.70 ( SD = 0.75) with 159 participants (84.13%) completing all four timepoints. Surveys included measures of global mental health and social functioning as indicated by perceived emotional support, quality of marriage, and couple satisfaction. Multilevel modeling was used to assess 1) growth models to determine whether social isolation changed over time and the trajectory of that change (i.e., linear or quadratic); and 2) whether social isolation was related to both concurrent and prospective indicators of mental health and social functioning. All analyses included person mean centered and grand mean centered isolation to assess for within-and between-person effects. Veterans reported a quadratic trajectory in social isolation that decreased slightly and stabilized over time. Findings indicate that higher social isolation, at both the within- and between-person level, was negatively associated with concurrent emotional support, mental health, quality of marriage, and couple satisfaction. However, all prospective effects were nonsignificant at the within-person level. Results suggest although isolation may decrease over time, veterans report worse mental health and social functioning during times when they report higher levels of social isolation compared to themselves and others. Future work is needed to determine if interventions can be applied during those times to prevent or target those negative associations.

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          Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

          The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. Copyright 2004 Massachusetts Medical Society
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            R: a language and environment for statisticalcomputing

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              Risk and Protective Factors for Prospective Changes in Adolescent Mental Health during the COVID-19 Pandemic

              The restrictions put in place to contain the COVID-19 virus have led to widespread social isolation, impacting mental health worldwide. These restrictions may be particularly difficult for adolescents, who rely heavily on their peer connections for emotional support. However, there has been no longitudinal research examining the psychological impact of the COVID-19 pandemic among adolescents. This study addresses this gap by investigating the impact of the COVID-19 pandemic on adolescents’ mental health, and moderators of change, as well as assessing the factors perceived as causing the most distress. Two hundred and forty eight adolescents (M age  = 14.4; 51% girls; 81.8% Caucasian) were surveyed over two time points; in the 12 months leading up to the COVID-19 outbreak (T1), and again two months following the implementation of government restrictions and online learning (T2). Online surveys assessed depressive symptoms, anxiety, and life satisfaction at T1 and T2, and participants’ schooling, peer and family relationships, social connection, media exposure, COVID-19 related stress, and adherence to government stay-at-home directives at T2 only. In line with predictions, adolescents experienced significant increases in depressive symptoms and anxiety, and a significant decrease in life satisfaction from T1 to T2, which was particularly pronounced among girls. Moderation analyses revealed that COVID-19 related worries, online learning difficulties, and increased conflict with parents predicted increases in mental health problems from T1 to T2, whereas adherence to stay-at-home orders and feeling socially connected during the COVID-19 lockdown protected against poor mental health. This study provides initial longitudinal evidence for the decline of adolescent’s mental health during the COVID-19 pandemic. The results suggest that adolescents are more concerned about the government restrictions designed to contain the spread of the virus, than the virus itself, and that those concerns are associated with increased anxiety and depressive symptoms, and decreased life satisfaction.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: VisualizationRole: Writing – review & editing
                Role: Data curationRole: Project administrationRole: Writing – original draft
                Role: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                1 March 2023
                2023
                1 March 2023
                : 18
                : 3
                : e0281575
                Affiliations
                [1 ] VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, United States of America
                [2 ] Central Texas Veterans Health Care System, Temple, TX, United States of America
                [3 ] Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States of America
                [4 ] Department of Health, Human Performance and Recreation, Baylor University, Waco, TX, United States of America
                [5 ] Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI, United States of America
                [6 ] Department of Psychiatry and Behavioral Sciences, Dell Medical School of the University of Texas, Austin, TX, United States of America
                La Trobe University - Melbourne Campus: La Trobe University, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-4512-1207
                Article
                PONE-D-22-08375
                10.1371/journal.pone.0281575
                9977007
                36857305
                c729f2a1-9eb8-449f-b4d0-3d5a8631fcae

                This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                : 21 March 2022
                : 26 January 2023
                Page count
                Figures: 1, Tables: 3, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000738, U.S. Department of Veterans Affairs;
                Award ID: 1I01RX003618-01
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000738, U.S. Department of Veterans Affairs;
                Award ID: I21-RX003035
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000738, U.S. Department of Veterans Affairs;
                Award ID: IK1-RX003122
                Award Recipient :
                This work was supported by Department of Veterans Affairs Office of Research and Development (VA ORD) Rehabilitation Research and Development (RR&D) award 1I01RX003618-01 to SC. AM is supported by an RR&D Small Projects in Rehabilitation award I21-RX003035 and YS is supported by an RR&D Career Development Award IK1-RX003122. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. https://www.research.va.gov/services/rrd.cfm.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Biology and Life Sciences
                Psychology
                Emotions
                Social Sciences
                Psychology
                Emotions
                Biology and Life Sciences
                Psychology
                Collective Human Behavior
                Interpersonal Relationships
                Social Sciences
                Psychology
                Collective Human Behavior
                Interpersonal Relationships
                Medicine and Health Sciences
                Health Care
                Veteran Care
                Social Sciences
                Political Science
                Governments
                Armed Forces
                Military Personnel
                Veterans
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Custom metadata
                There are legal restrictions to sharing the study data publicly based on institutional policies (Central Texas Veterans Health Care System) given that data contains potentially identifying and sensitive patient information. The minimal data set underlying the results described in this manuscript may be made available on request from the last author ( suzannah.creech@ 123456va.gov ) or the office of Research Service ( jeffrey.wilkes@ 123456va.gov ), pending appropriate institutional approval.
                COVID-19

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