Depressive Symptoms Before and During the COVID-19 Pandemic in Veteran Nursing Home Residents.

Benz MB, Rudolph JL, DeVone F, Bayer TA, Garbin A, Singh M, Gravenstein S, Hartronft S, Toms R, Gaudiano BA, Metrik J, Browne J. Depressive Symptoms Before and During the COVID-19 Pandemic in Veteran Nursing Home Residents. International journal of geriatric psychiatry. 2025 Jun 1; 40(6):e70108, DOI: 10.1002/gps.70108.

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Abstract:

OBJECTIVES: Infection control measures in the Department of Veterans Affairs Community Living Centers (CLCs), analogous to nursing homes, during the COVID-19 pandemic may have impacted residents' mental health. The purpose of this study was to examine changes in depressive symptoms before and during the COVID-19 pandemic in CLC residents. METHODS: This cross-sectional national cohort study evaluated depressive symptoms in Veteran CLC residents from geographically diverse CLCs across four 9-month periods of the COVID-19 pandemic: pre (before COVID-19), early (before vaccine), mid (before booster), and late (after booster). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9), a standardized depression assessment, which is a required measure in the Minimum Data Set (MDS). We computed change in PHQ-9 scores from the initial to the last PHQ-9 assessment for each pandemic period. We also performed a focused analysis of residents with a past year depression diagnosis. RESULTS: The overall sample comprised 47,755 Veteran CLC residents, 43% percent (n  =  20,554) of whom had a depression diagnosis. The overall cohort mean PHQ-9 scores were similar across pandemic periods (pre  =  2.64, early  =  2.48, mid  =  2.61, late  =  2.45). There was intra-resident decline in PHQ-9 during each period which was statistically, but not clinically significant (pre  =  -0.54, early  =  -0.47, mid  =  -0.55, late  =  -0.49). Residents with a depression diagnosis followed a similar pattern for scores and decline in the periods compared with the full sample. PHQ-9 average scores indicated minimal depression even among those with a depression diagnosis, limiting ability to detect changes over time. CONCLUSIONS: For CLC residents during the COVID-19 pandemic, PHQ-9 scores were not meaningfully different between time periods. Characteristics of the study (e.g., sample/setting) or of older adults generally (e.g., resilience) may explain the low rates of depression.