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To date, however, no known study has examined changes in mental health during the pandemic in the U.S. military veteran population.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291721002361_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>Data were analyzed from the 2019\u20132020 National Health and Resilience in Veterans Study, a nationally representative, prospective cohort survey of 3078 veterans. Pre-to-peri-pandemic changes in psychiatric symptoms were evaluated, as well as pre-pandemic risk and protective factors and pandemic-related correlates of increased psychiatric distress.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291721002361_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>The prevalence of generalized anxiety disorder (GAD) positive screens increased from pre- to peri-pandemic (7.1% to 9.4%; <jats:italic>p<\/jats:italic> &lt; 0.001) and was driven by an increase among veterans aged 45\u201364 years (8.2% to 13.5%; <jats:italic>p<\/jats:italic> &lt; 0.001), but the prevalence of major depressive disorder and posttraumatic stress disorder positive screens remained stable. Using a continuous measure of psychiatric distress, an estimated 13.2% of veterans reported a clinically meaningful pre-to-peri-pandemic increase in distress (mean = 1.1 standard deviation). Veterans with a larger pre-pandemic social network size and secure attachment style were less likely to experience increased distress, whereas veterans reporting more pre-pandemic loneliness were more likely to experience increased distress. Concerns about pandemic-related social losses, mental health COVID-19 effects, and housing stability during the pandemic were associated with increased distress, over-and-above pre-pandemic factors.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291721002361_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Although most U.S. veterans showed resilience to mental health problems nearly 1 year into the pandemic, the prevalence of GAD positive screens increased, particularly among middle-aged veterans, and one of seven veterans experienced increased distress. Clinical implications of these findings are discussed.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291721002361","type":"journal-article","created":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T07:17:35Z","timestamp":1623655055000},"page":"945-956","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":56,"title":["Mental health impact of the COVID-19 pandemic in U.S. military veterans: a population-based, prospective cohort study"],"prefix":"10.1017","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0943-0854","authenticated-orcid":false,"given":"Melanie L.","family":"Hill","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9606-0355","authenticated-orcid":false,"given":"Brandon","family":"Nichter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3895-7417","authenticated-orcid":false,"given":"Peter J.","family":"Na","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4751-1882","authenticated-orcid":false,"given":"Sonya B.","family":"Norman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2032-6553","authenticated-orcid":false,"given":"Leslie A.","family":"Morland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6952-1726","authenticated-orcid":false,"given":"John H.","family":"Krystal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5561-6414","authenticated-orcid":false,"given":"Robert H.","family":"Pietrzak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2021,6,14]]},"reference":[{"key":"S0033291721002361_ref50","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.07.120"},{"key":"S0033291721002361_ref79","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooz024"},{"key":"S0033291721002361_ref47","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2021.03.021"},{"key":"S0033291721002361_ref57","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291721000015"},{"key":"S0033291721002361_ref67","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.14053"},{"key":"S0033291721002361_ref36","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.60.2.184"},{"key":"S0033291721002361_ref34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jrp.2009.04.011"},{"key":"S0033291721002361_ref6","doi-asserted-by":"publisher","DOI":"10.1111\/j.0963-7214.2005.00347.x"},{"key":"S0033291721002361_ref39","doi-asserted-by":"publisher","DOI":"10.1016\/j.jagp.2013.02.013"},{"key":"S0033291721002361_ref13","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6932a1"},{"key":"S0033291721002361_ref27","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-13-00235"},{"key":"S0033291721002361_ref73","unstructured":"United States Department of Veterans Affairs Office of Mental Health and Suicide Prevention. 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