Veterans and Nonveterans Coping With Stress During 4 Months of COVID-19

Jorie M. Butler; Xuechen Wang; Marian Riddoch; Alistair Thorpe; Vanessa Stevens; Laura D. Scherer; Frank A. Drews; Holly Shoemaker; Angela Fagerlin

doi:10.1370/afm.3046

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Figure 1.
Coping style clusters and their component strategies at 3 time points.
Notes: The adaptive, distressed, and disengaged clusters (coping styles) were based on the extent of use of the 11 coping strategies (see Methods for details).
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Figure 2.
Coping style clusters at 3 points in time.
Note: Time 1 spanned December 2-27, 2020; Time 2 spanned January 21-February 6, 2021; and Time 3 spanned March 8-23, 2021.

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Table 1.

Participant Demographics Over Time and by Veteran Status (N = 2,085)

Demographic	Time 1 (Dec. 2-27, 2020)		Time 2 (Jan. 21-Feb. 6, 2021)		Time 3 (Mar. 8-23, 2021)
Demographic	Nonveteran, No. (%) (n = 1,025)	Veteran, No. (%) (n = 1,060)	Nonveteran, No. (%) (n = 511)	Veteran, No. (%) (n = 746)	Nonveteran, No. (%) (n = 387)	Veteran, No. (%) (n = 688)
Gender
Female	551 (53.8)	84 (7.9)	249 (48.7)	48 (6.4)	180 (46.5)	51 (7.4)
Male	457 (44.6)	975 (92)	260 (50.9)	697 (93.4)	205 (53.0)	636 (92.4)
Transgender/Nonbinary/Other	17 (1.7)	1 (0.1)	2 (0.4)	1 (0.1)	2 (0.5)	1 (0.1)
Age group in years, No. (%)
18-34	265 (25.9)	6 (0.6)	68 (13.3)	0 (0)	51 (13.2)	1 (0.1)
35-54	341 (33.4)	39 (3.7)	120 (23.5)	22 (2.9)	80 (20.7)	21 (3.1)
55-74	353 (34.6)	696 (65.8)	276 (54.1)	497 (66.8)	218 (56.3)	460 (67.1)
≥75	61 (6.0)	317 (30.0)	46 (9.0)	225 (30.2)	38 (9.8)	204 (29.7)
Race
American Indian	8 (0.8)	11 (1.0)	1 (0.2)	8 (1.1)	3 (0.8)	10 (1.5)
Asian	40 (3.9)	22 (2.1)	28 (5.5)	16 (2.1)	20 (5.2)	13 (1.9)
Black	133 (13.0)	129 (12.2)	44 (8.6)	72 (9.7)	25 (6.5)	73 (10.6)
Pacific Islander	1 (0.1)	5 (0.5)	0 (0)	5 (0.7)	0 (0)	4 (0.6)
White	842 (82.1)	879 (82.9)	436 (85.3)	638 (85.5)	338 (87.3)	585 (85.0)
Other	7 (0.7)	30 (2.8)	4 (0.8)	19 (2.5)	4 (1.0)	17 (2.5)
Ethnicity
Non-Latine	954 (93.2)	943 (89.1)	470 (92.0)	671 (90.2)	352 (91.0)	613 (89.2)
Latine	70 (6.8)	115 (10.9)	41 (8.0)	73 (9.8)	35 (9.0)	74 (10.8)
Education^{^a}
<High school	…	5 (0.5)	…	4 (0.5)	…	3 (0.4)
High school graduate/some college	…	434 (40.9)	…	295 (39.5)	…	273 (39.7)
BA/BS degree	…	373 (35.2)	…	259 (34.7)	…	243 (35.3)
Graduate degree	…	248 (23.4)	…	188 (25.2)	…	169 (24.6)
Relationship status
None	256 (25.0)	81 (7.6)	109 (21.4)	54 (7.2)	83 (21.6)	52 (7.6)
Romantic	78 (7.6)	31 (2.9)	23 (4.5)	22 (2.9)	13 (3.4)	19 (2.8)
Married/living with partner	594 (58.1)	791 (74.7)	330 (64.7)	560 (75.1)	253 (65.7)	516 (75.1)
Divorced/separated	62 (6.1)	87 (8.2)	31 (6.1)	64 (8.6)	24 (6.2)	54 (7.9)
Widowed	33 (3.2)	69 (6.5)	17 (3.3)	46 (6.2)	12 (3.1)	46 (6.7)
Income category
<$40,000	304 (31.6)	154 (15.2)	98 (20.4)	100 (14.0)	71 (19.3)	85 (12.8)
$40,000-$74,000	272 (28.2)	325 (32.0)	145 (30.1)	213 (29.8)	114 (31.0)	199 (29.9)
$75,000-$99,000	127 (13.2)	187 (18.4)	72 (15.0)	136 (19.0)	63 (17.1)	126 (18.9)
$100,000-$149,000	149 (15.5)	210 (20.7)	100 (20.8)	159 (22.3)	75 (20.4)	150 (22.5)
≥$150,000	111 (11.5)	140 (13.8)	66 (13.7)	106 (14.8)	45 (12.2)	106 (15.9)
Residence
Rural	207 (20.3)	185 (17.5)	84 (16.5)	121 (16.2)	63 (16.3)	119 (17.3)
Small city	162 (15.9)	197 (18.6)	80 (15.7)	142 (19.0)	62 (16.0)	118 (17.2)
Suburban	412 (40.3)	483 (45.6)	249 (48.8)	349 (46.8)	200 (51.7)	319 (46.4)
Midsized	94 (9.2)	102 (9.6)	46 (9.0)	68 (9.1)	32 (8.3)	70 (10.2)
Large city	145 (14.2)	88 (8.3)	51 (10.0)	62 (8.3)	30 (7.8)	58 (8.4)
Other	2 (0.2)	5 (0.5)	0 (0)	4 (0.5)	0 (0)	4 (0.6)
Number of comorbid conditions^{^b}
0	434 (42.3)	253 (23.9)	196 (38.4)	170 (22.8)	148 (38.2)	162 (23.5)
1	236 (23.0)	303 (28.6)	132 (25.8)	217 (29.1)	99 (25.6)	203 (29.5)
2	140 (13.7)	235 (22.2)	76 (14.9)	152 (20.4)	55 (14.2)	143 (20.8)
3 or 4	149 (14.5)	228 (21.5)	87 (17.0)	171 (22.9)	72 (18.6)	157 (22.8)
≥5	66 (6.4)	41 (3.9)	20 (3.9)	36 (4.8)	13 (3.4)	23 (3.3)

BA = bachelor of arts; BS = bachelor of science.
↵a Missing for veterans because of a coding error.
↵b As captured by the Charlson Comorbidity Index. Maximum possible number is 12.

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Table 2.

Coping Styles Over Time Among Veterans and Nonveterans, and for Total Cohort

Group^{^a}	Time 1^{^b} (N = 2,085) (Dec. 2-27, 2020)			Time 2^{^b} (N = 1,257) (Jan. 21-Feb. 6, 2021)			Time 3^{^b} (N = 1,075) (Mar. 8-23, 2021)
Group^{^a}	Adaptive	Distressed	Disengaged	Adaptive	Distressed	Disengaged	Adaptive	Distressed	Disengaged
Veterans, No. (%)	383 (36.1)	61 (5.8)	616 (58.0)	252 (33.7)	36 (4.8)	458 (61.3)	339 (52.3)	162 (15.3)	187 (17.6)
Nonveterans, No. (%)	310 (30.2)	283 (27.6)	432 (42.1)	184 (36.0)	84 (16.4)	243 (47.5)	157 (22.8)	147 (21.3)	83 (8.1)
Total, No. (%)	693 (33.2)	344 (16.5)	1,048 (50.3)	436 (34.7)	120 (9.54)	701 (59.6)	496 (46.0)	309 (28.7)	270 (25.1)

↵a For each group and time point, values total across the row.
↵b Percentages of veterans and nonveterans differed significantly by χ² test (P <.01).

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Table 3.

Changes in Coping Style and Study Attrition Over Time Among All Participants (N = 2,085)

Status at Time 2	Time 1, No. (%)^{^a} (Dec. 2-27, 2020)			Status at Time 3	Time 2, No. (%)^{^a} (Jan. 21-Feb. 6, 2021)
Status at Time 2	Adaptive	Disengaged	Distressed	Status at Time 3	Adaptive	Disengaged	Distressed
Drop-out (n = 828)	267 (38.5)	341 (32.5)	220 (64.0)	Drop-out (n = 327)	103 (23.6)	169 (24.1)	55 (45.8)
Adaptive (n = 436)	260 (37.5)	147 (14.0)	29 (8.4)	Adaptive (n = 433)	144 (33.0)	271 (38.7)	18 (15.0)
Disengaged (n = 701)	138 (19.9)	534 (51.0)	29 (8.4)	Disengaged (n = 235)	33 (7.6)	197 (28.1)	5 (4.2)
Distressed (n = 120)	28 (4.0)	26 (2.5)	66 (19.2)	Distressed (n = 262)	156 (35.8)	64 (9.1)	42 (35.0)
Total (N = 2,085)	693 (100)	1,048 (100)	344 (100)	Total (N = 1,257)	436 (100)	701 (100)	120 (100)

Note: Table includes data from all participants at each time point. Time 3 spanned Mar 8-23, 2021
↵a For each status and time point, numbers total across rows. For each time point, percentages total down columns.

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Table 4.

Changes in Coping Style Among Participants With Data at All 3 Time Points (N = 930)

Time Point and Coping Style	Time 2			Time 3
Time Point and Coping Style	Adaptive, No. (%)	Disengaged, No. (%)	Distressed, No. (%)	Adaptive, No. (%)	Disengaged, No. (%)	Distressed, No. (%)
Time 1
Adaptive	195 (60.6)	111 (34.5)	16 (5.0)	136 (42.2)	34 (10.6)	152 (47.2)
Disengaged	113 (21.3)	401 (75.7)	16 (3.0)	273 (51.5)	193 (36.4)	64 (12.1)
Distressed	25 (32.1)	20 (25.6)	33 (42.3)	24 (30.8)	8 (10.3)	46 (59.0)
Time 2
Adaptive	…	…	…	144 (43.2)	33 (9.9)	156 (46.8)
Disengaged	……	…	…	271 (50.9)	197 (37.0)	64 (12.0)
Distressed	…	…	…	18 (27.7)	5 (7.7)	42 (64.6)

Note: Time 1 spanned December 2-27, 2020; Time 2 spanned January 21-February 6, 2021; and Time 3 spanned March 8-23, 2021.

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Table 5.

Comparisons of Participants With Stable vs Changing Coping Style Over Time

Demographic	Total (N = 930)	Coping Style Trajectory^{^a}
Demographic	Total (N = 930)	Stable (n = 267)	Changing (n = 663)	P Value
Gender, No. (%)				.23^{^b}
Female	193 (20.8)	47 (17.6)	146 (22.0)
Male	735 (79.0)	220 (82.4)	515 (77.7)
Transgender/Nonbinary/Other	2 (0.2)	0 (0.0)	2 (0.3)
Age group in years, No. (%)				.50^{^c}
18-34	37 (4.0)	13 (4.9)	24 (3.6)
35-54	87 (9.4)	21 (7.9)	66 (10.0)
55-74	591 (63.7)	176 (65.9)	415 (62.8)
≥75	213 (23.0)	57 (21.3)	156 (23.6)
Race, No. (%)				.19^{^b}
American Indian	8 (0.9)	1 (0.4)	7 (1.1)
Asian	31 (3.3)	6 (2.2)	25 (3.8)
Black	73 (7.8)	14 (5.2)	59 (8.9)
Pacific Islander	4 (0.4)	0 (0)	4 (0.6)
White	810 (87.1)	243 (91.0)	567 (85.5)
Other	17 (1.8)	4 (1.5)	13 (2.0)
Ethnicity, No. (%)				.52^{^c}
Non-Latine	837 (90.1)	237 (89.1)	600 (90.5)
Latine	92 (9.9)	29 (10.9)	63 (9.5)
Veteran status, No. (%)				.16^{^c}
Veteran	584 (62.8)	177 (66.3)	407 (61.4)
Nonveteran	346 (37.2)	90 (33.7)	256 (38.6)
Education, No. (%)				.050^{^b}
<High school	2 (0.3)	2 (1.1)	0 (0)
High school graduate/some college	235 (40.2)	80 (45.2)	155 (38.1)
BA/BS degree	204 (34.9)	53 (29.9)	151 (37.1)
Graduate degree	143 (24.5)	42 (23.7)	101 (24.8)
Income category				.16^{^c}
<$40,000	136 (15.2)	47 (18.4)	89 (14.0)
$40,000-$74,000	264 (29.6)	73 (28.5)	191 (30.0)
$75,000-$99,000	168 (18.8)	40 (15.6)	128 (20.1)
$100,000-$149,000	194 (21.7)	63 (24.6)	131 (20.6)
≥$150,000	131 (14.7)	33 (12.9)	98 (15.4)
Residence				.31^{^b}
Rural	151 (16.2)	46 (17.2)	105 (15.8)
Small city	159 (17.1)	36 (13.5)	123 (18.6)
Suburban	457 (49.1)	138 (51.7)	319 (48.1)
Midsized	90 (9.7)	26 (9.7)	64 (9.7)
Large city	70 (7.5)	19 (7.1)	51 (7.7)
Other	3 (0.3)	2 (0.7)	1 (0.2)
Number of comorbid conditions				.58^{^c}
0	275 (29.6)	83 (31.1)	192 (29.0)
1	269 (28.9)	79 (29.6)	190 (28.7)
2	173 (18.6)	43 (16.1)	130 (19.6)
3 or 4	190 (20.4)	53 (19.9)	137 (20.7)
≥5	23 (2.5)	9 (3.4)	14 (2.1)
PHQ-4 Depression and Anxiety scale^{^d}
Ordinal score, No. (%)				.050^{^c}
0	572 (61.5)	183 (68.5)	389 (58.7)
1	102 (11.0)	27 (10.1)	75 (11.3)
2	60 (6.5)	11 (4.1)	49 (7.4)
3	60 (6.5)	12 (4.5)	48 (7.2)
4	61 (6.6)	12 (4.5)	49 (7.4)
≥5	75 (8.1)	22 (8.2)	53 (8.0)
Score, mean (SD)	1.3 (2.3)	1.1 (2.2)	1.4 (2.3)
Score, median (IQR)	0 (0-2)	0 (0-1)	0 (0-2)	.008^{^e}

BA = bachelor of arts; BS = bachelor of science; IQR = interquartile range; PHQ-4 = Patient Health Questionnaire-4.
↵a Stable participants (28.7%) remained in the same cluster at all 3 time points; changing participants (71.3%) switched clusters at least once.
↵b The Fisher exact test was used for the comparison.
↵c The χ² test was used for the comparison.
↵d Score of 0 to 2 is normal, 3 to 5 indicates mild symptoms, 6 to 8 indicates moderate symptoms, and 9 to 12 indicates severe symptoms.
↵e The Wilcoxon rank sum test was used for the comparison.