Effects of pandemic-related stressors on anxiety and mood difficulty during versus before the COVID-19 pandemic in US Army soldiers and veterans

Ronald C. Kessler*, Amy M. Millikan-Bell, Emily R. Edwards, Sarah M. Gildea, Andrew J. King, Howard Liu, Maria V. Petukhova, Nancy A. Sampson, Hannah N. Ziobrowski, James R. Wagner, Murray B. Stein, Robert J. Ursano

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Military personnel are routinely involved in pandemic relief efforts, placing them at risk of increased exposure to pandemic-related stressors. Although ample research suggests that exposure to pandemic-related stressors contributed to decrements in mental health among civilians during the COVID-19 pandemic, limited work has examined whether these patterns were also salient in military populations. Here we report data on The Army Study to Assess Risk and Resilience in Servicemembers (STARRS) Longitudinal Study, which screened for 30-day prevalence of major depressive episode, generalized anxiety disorder, post-traumatic stress disorder and panic attack among 10,206 US Army soldiers and veterans before (2018–2019) and then again during (2020–2022) the COVID-19 pandemic. Statistically significant increases were found in prevalence, with relative risk (RR) comparable to that observed in civilian samples (RR 1.28–1.40). The greatest increases were observed among women, Black and Hispanic individuals, those of lower socioeconomic status and Regular Army soldiers compared with reservists and those separated from service. Exposures to pandemic-related stressors, although associated with significantly increased mental health difficulty (RR 1.06–1.17), did not explain associations of sociodemographics and Army career characteristics with difficulty RR. No significant interactions were found between pandemic-related stressors and either baseline difficulty prevalence, sociodemographics or Army career characteristics predicting difficulty RR. Results suggest that military personnel may experience pandemic-related declines in mental health similar to those observed in civilian populations, with the largest changes occurring among individuals with greater socioeconomic vulnerability and/or higher exposure to pandemic-related stress. Findings emphasize the importance of ensuring accessibility to appropriate support for military personnel during pandemic conditions.

Original languageEnglish
Pages (from-to)1191-1201
Number of pages11
JournalNature Mental Health
Volume3
Issue number10
DOIs
StatePublished - Oct 2025

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