{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T16:33:41Z","timestamp":1769272421660,"version":"3.49.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"1-2","license":[{"start":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T00:00:00Z","timestamp":1754092800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Veterans Affairs Health Services Research Career Scientist","award":["RCS 21-135"],"award-info":[{"award-number":["RCS 21-135"]}]},{"name":"Guard Women\u2019s Suicide Risks"},{"name":"Department of Veterans Affairs Office of Rural Health"},{"name":"NOMAD","award":["# PROJ-03530"],"award-info":[{"award-number":["# PROJ-03530"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Stress from the COVID-19 pandemic may have had a profound impact on the mental health of Reserve and National Guard (RNG) women Veterans, especially if they have a history of traumatic brain injury (TBI). This cross-sectional study aimed to assess the potential mediating effect of stress stemming from the COVID-19 pandemic on the association between TBI and depression symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Women RNG Veterans between the ages of 18 and 60 were interviewed about their lifetime history of TBI, symptoms of depression, and any stressful experiences resulting from the COVID-19 pandemic. Using interview responses, we utilized exploratory factor analysis (EFA) to approximate COVID-19 stress. We then used the results from EFA in mediation analysis of linear regression models of TBI history on depression. Ethical approval for the study and analyses was obtained from the University of Iowa Institutional Review Board (IRB) (IRB ID #201911171).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 9 items across a 3-factor model (\u201cStress about Daily Necessities,\u201d \u201cStress about Health,\u201d \u201cIncreasing Alcohol Use\u201d) that approximated COVID-19 stress. Of the 351 women Veterans included in this study, 145 (41.3%) had history of TBI. Those with TBI had more severe symptoms of depression (risk difference: 1.81, 95% CI: 0.41-3.20) than those without TBI. Total COVID-19 stress mediated the association between TBI and symptoms of depression (indirect effect: 0.67; 95% CI: 0.24-1.21; 35.5% mediated). Stress about Daily Necessities alone also mediated the TBI-depression association (indirect effect: 0.65; 95% CI: 0.44-0.84; 34.8% mediated).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Women RNG Veterans with prior TBI reported more severe depression symptoms than those without TBI, and these depression symptoms seem to be exacerbated upon the introduction of stress because of the COVID-19 pandemic. Future research of this complex TBI-stress-depression relationship should be longitudinal in nature, especially as the long-term effects of the COVID-19 pandemic continue to emerge, to understand how events that introduce significant economic and health-related consequences affect how symptoms of depression and responses to stress evolve over time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usaf391","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T11:30:14Z","timestamp":1753183814000},"page":"e310-e318","source":"Crossref","is-referenced-by-count":1,"title":["Pandemic Stress and Mediation of Depression Symptoms After Traumatic Brain Injury in Women Veterans: A Cross-Sectional Study"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9616-4621","authenticated-orcid":false,"given":"Daniel T","family":"Corry","sequence":"first","affiliation":[{"name":"Department of Epidemiology, University of 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Rural Health Resource Center\u2014Iowa City, Iowa City Veterans Affairs Health Care System , Iowa City, IA 52242,","place":["United States"]},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA 52242,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian L","family":"Cook","sequence":"additional","affiliation":[{"name":"VA Office of Rural Health, Veterans Rural Health Resource Center\u2014Iowa City, Iowa City Veterans Affairs Health Care System , Iowa City, IA 52242,","place":["United States"]},{"name":"Department of Psychiatry, University of Iowa Carver College of Medicine , Iowa City, IA 52242,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey L","family":"Smith","sequence":"additional","affiliation":[{"name":"VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Affairs Health Care System , Little 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