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2023 HSR&D/QUERI National Conference Abstract

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1177 — Social connectivity and coping among vulnerable Veterans during the COVID-19 pandemic

Lead/Presenter: Sonya Gabrielian,  COIN - Los Angeles
All Authors: Gabrielian SE (VA LA HSR&D Center of Innovation), Moore EM (VA LA HSR&D Center of Innovation) Zito MF (Desert Pacific Mental Illness Research, Education, and Clinical Center) Kozikowski SD (VA RR&D THRIVe) Lopez JR (VA RR&D THRIVe) Lesgart M (Lewis Katz School of Medicine at Temple University) Green MF (VA RR&D THRIVe)

Public health precautions of the coronavirus disease 2019 (COVID-19) pandemic dramatically changed how people socialize. However, little is known about the extent to which the COVID-19 pandemic changed the social connections of Veterans with tenuous interpersonal relationships at baseline, including homeless-experienced Veterans (HEVs) and Veterans with psychotic disorders. During times of physical distancing, we sought to understand how these populations experienced changes in their social connectivity and identify coping strategies employed.

Participants were recruited from a parent study on mental health and functional consequences of the COVID-19 pandemic on vulnerable Veterans. From August-November 2020, we conducted semi-structured interviews on a purposive sample of 43 Veterans who received services at the VA Greater Los Angeles, including HEVs (n = 11), Veterans with psychotic disorders (n = 16), and a comparison group of Veterans without these vulnerabilities (n = 16); we intentionally sought participant diversity across age, gender, and current housing status. We queried Veterans about changes in their social connections; the role of technology in maintaining connections; and coping strategies used. We used rapid qualitative methods to analyze these interviews, with a lens towards informing VA service adaptations.

Many HEVs and Veterans with psychotic disorders saw few changes to their social relationships; they described strikingly few interpersonal connections at baseline. Some participants in both vulnerable groups characterized their social contacts as entirely determined by treatment settings. This finding contrasted from the comparison group, in which many Veterans described robust pre-pandemic social networks and feelings of isolation. Many HEVs described difficulties using technology to communicate; the reasons for this were multifold, including discomfort with technology, access barriers, and preferences. In contrast, many Veterans with psychosis and Veterans in the comparison group easily adopted social media and other technology (e.g., Whatsapp, Zoom) to communicate when physical distancing was enacted. Veterans across all groups highlighted the value of their military experiences to cope with stressors; some Veterans compared the pandemic to a war zone and valued keeping strict routines during the pandemic. Many HEVs and Veterans with psychosis described solitary activities as a longstanding coping strategy that could be continued regardless of physical distancing. Veterans across all three groups valued VA services to stay connected while physically distancing (e.g., mental health groups, support groups for special populations).

While pandemic policies surrounding physical distancing greatly increased psychological distress in the general population, HEVs and Veterans with psychotic disorders may not perceive as many pandemic-related changes to their social networks as a comparison sample of Veterans. Though many HEVs struggled with transitioning to technology to communicate, more Veterans with psychotic disorders were able to use technology to stay connected. Our data also suggest that resilience derived from military service was adaptive during the pandemic, complemented by VA services that provided support.

These data suggest the value of service and policy development that enhances social connectedness and community integration for HEVs and Veterans with psychotic disorders during and outside of emergencies. Some vulnerable Veterans are receptive to technology-driven communication, which may have important implications for fostering social connections.