Symptoms of anxiety and depression increased among post-9/11 veterans over the course of the COVID-19 pandemic, with persistent disparities tied to race, ethnicity and gender, according to researchers at Penn State.
Researchers at the Clearinghouse for Military Family Readiness at Penn State (Clearinghouse) analyzed data from more than 5,200 post-9/11 veterans who separated from active duty in 2016 and followed them over the course of several years. Their research on mental health outcomes linked to COVID-19 was recently published in Depression and Anxiety and was collected as part of The Veterans Metrics Initiative and its follow-up, the Veterans Engaging in Transitions Study.
The study tracked changes in veterans' mental health symptoms at three time points: May 2019 (pre-pandemic), November 2020 (during the pandemic) and March 2023 (post-pandemic). This design enabled the researchers to observe trends over time, rather than relying on a single snapshot.
To screen for symptoms, participants completed a four-item Patient Health Questionnaire that used a scale from 0 to 6. A score of 0 reflected low levels of symptoms, while a score of 6 reflected high levels of symptoms. Using confirmatory factor analysis to analyze the mean differences, the researchers identified significant shifts between the time points. Average depression scores increased from 1.24 before the pandemic to 1.41 after the pandemic, and average anxiety scores rose from 1.49 to 1.70 during the same time period.
The study also revealed that adverse childhood experiences, such as physical, emotional and sexual abuse, along with combat exposure, were among the strongest predictors of higher symptom levels.
Ryan Chesnut, assistant research professor at the Clearinghouse and lead author of the study, said the results align with Cumulative Stress Theory. The theory holds that psychosocial stressors that accumulate over time can have a substantial impact on physical and mental health.
"Many veterans carry stress from early life experiences as well as from their time in service," Chesnut said. "Understanding how those layers of stress and trauma interact helps us see who may be most vulnerable during large-scale crises like COVID-19."
The study also revealed that veterans from racial and ethnic minority groups and female veterans consistently reported more anxiety and depression symptoms than white male veterans. Female veterans from racial and ethnic minority groups had the highest average depression scores, ranging from 1.82 to 1.84, and their average anxiety scores ranged from 2.19 to 2.51. These elevated levels remained stable before, during and after COVID-19.
Chesnut said the disparities may stem from structural and cultural factors.
"Female veterans and veterans of color often face compounded stressors, including discrimination, social isolation and barriers to equitable health care," he said. "These challenges can magnify mental health symptoms, especially during large-scale crises like the pandemic."
While trauma exposure was associated with veterans experiencing higher symptom levels, a greater number of deployments was linked to lower anxiety and depression symptoms. The researchers suggested this outcome may reflect resilience that develops through repeated exposure to stress and adaptation over time.
Daniel F. Perkins, principal scientist at the Clearinghouse and professor of family and youth resiliency and policy in the College of Agricultural Sciences, said the findings reveal both strain and strength within the veteran community. He explained that while many veterans faced substantial challenges during the pandemic, military service can also foster coping skills and psychological resilience that help some individuals adapt under pressure.
"This research highlights how cumulative stress and protective factors interact over time," Perkins said. "Veterans face unique challenges, but they also demonstrate remarkable strength. Understanding which factors promote resiliency will help programs and policies better support veterans and their families."
Keith Aronson, director of the Clearinghouse, associate director of the Social Science Research Institute and research professor in the Department of Biobehavioral Health, said the study also offers valuable insights into how the world should prepare for future global health emergencies.
"Future pandemics are likely to occur and may be as or more disruptive than COVID-19," Aronson said. "One of the lessons learned from this period is that race and ethnicity played important roles in predicting health outcomes. Understanding how those social factors influence mental health among veterans is essential for building more equitable systems of care."
The researchers said their findings point to the need for targeted, evidence-informed mental health services and culturally competent outreach. They also noted that self-reported data may underestimate symptom levels due to the stigma surrounding mental health concerns in military culture.
"Veteran-serving organizations must be proactive in planning for future global shocks," Aronson said. "Our results indicate that responses to crises should account for the specific experiences of diverse veteran groups."
Funding for this study was provided by the Henry M. Jackson Foundation, Pew Charitable Trusts, Arthur M. Blank Family Foundation and ICF International.
