Clinical and functional effects of the COVID-19 pandemic and social distancing on vulnerable veterans with psychosis or recent homelessness

Abstract

The COVID-19 pandemic has upended the lives of everyone in the United States, negatively impacting social interactions, work, and living situations, and potentially exacerbating mental health issues in vulnerable individuals. Within the Department of Veterans Affairs (VA) healthcare system, two vulnerable groups include those with a psychotic disorder (PSY) and those who have recently experienced homelessness (recently housed Veterans, RHV). We conducted phone interviews with PSY (n = 81), RHV (n = 76) and control Veterans (CTL, n = 74) between mid-May – mid-August 2020 (“initial”) and between mid-August – mid-October 2020 (“follow-up”). At the initial period, we also collected retrospective ratings relative to January 2020 (“pre-COVID-19”). We assessed clinical factors (e.g., depression, anxiety, loneliness) and community integration (e.g., social and role functioning). All groups reported worse clinical outcomes after the onset of the COVID-19 pandemic. However, PSY and RHV exhibited improvements in depression and anxiety from initial to follow up, whereas CTL continued to exhibit elevated levels. There was little change in community integration measures. Our results indicate that all groups reported increased mental health problems after the onset of the pandemic, but vulnerable Veterans were not disproportionately affected and had better mental health resilience (i.e., for depression and anxiety) as the pandemic progressed compared to CTL. This effect could be due to the availability and utilization of VA services for PSY and RHV (e.g., housing and financial support, medical and mental health services), which may have helped to mitigate the impact of the pandemic.