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

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.

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.

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.

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.